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Health Care Reform:

Health Insurance & Affordable Care Act

Tips for Making the Most of Obamacare

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Insurance plans do have to pay for non-network emergency visits under the health law. If you're in a car crash far from home you can’t be picky about which hospital saves your life.

But non-network hospitals often "balance-bill" the difference between what your plan pays and what they charge, which is often much more.

Avoid all emergency rooms unless it's really an emergency.

Traditionally, health plans came with a modest copayment for an emergency visit -- maybe $150.

But many policies sold under the health law, even those in the more expensive "gold" category, not only have ER copays of several hundred dollars but also subject ER charges to the overall deductible. (Copays are flat fees for specific services. Deductibles are what you pay out of pocket before the insurance kicks in.)

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.

Thu, Feb 13 2014

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