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Health Insurance & Affordable Care Act

Tips for Making the Most of Obamacare


That means you could be billed for the full cost of an emergency visit -- up to the out-of-pocket limit.

"This is a huge difference and will really hurt the unsuspecting person," says John Jaggi, an Illinois insurance broker. "We're putting a lot more people into that exposure here."

Broken leg? Head to the hospital. Sprained ankle? Maybe wait until the urgent care center or doctor's office opens.

Pay monthly premiums on time and accurately.

"Do not mess around. Pay your premium," admonishes Karen Pollitz, a consumer specialist at the Kaiser Family Foundation. (KHN is an editorially independent project of the foundation.) "Otherwise that will be the end of you and you won’t get to sign up again until the next open season."

(Open enrollment for 2014 coverage ends March 31. Open enrollment for 2015 begins Nov. 15.)

Even underpaying the premium by a few cents could give the insurance company grounds to kick you off, she said. Insurers allow a brief grace period if you get behind -- somewhat longer if you're receiving premium subsidies -- but they will terminate coverage for nonpayment.

Register online with your new insurance company.

Insurance sites are good for tracking claims. Increasingly they also let you shop around for the best deals on non-emergency treatment.

"Your health plan might pay one imaging center half what it pays another imaging center," Metcalf said. "That's really important if you've got a big deductible."

Save paperwork. Make sure you really owe what doctors and hospitals bill you for.

"Now is a good time to become a pack rat," says Pollitz. "If you’ve got any concern, it really is worth it to make a call and get them to explain what they did."

If you don't get satisfaction from providers or insurers, try regulators.

Check the insurer's explanation of benefits detailing your claims. It may show a phone number for a consumer assistance program in your state to help deal with medical coverage.

Here is a list of consumer assistance programs. This list has contact information for state insurance departments and other regulators. 

Do read the plan's summary of benefits and coverage.

"Get it and print it out, because that has the details of your plan," says Metcalf. "How it works. What do you have to pay in order to go to a primary care doctor? Is it before or after the deductible?

"How big is your deductible? How much does it cost to go to the emergency room?"

It's not like reading John Grisham. But the subjects -- your health and your money -- are really important.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Thu, Feb 13 2014

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