With the year coming to a close, this is the time for sharing heartfelt wishes for a happy, healthy new year, and for making resolutions for improving your life. Here’s one end-of-year pledge you may not have thought of: Check to be sure that you and your family have just the right health insurance.
You may be rolling your eyes. Getting health insurance doesn’t rank high on any classic list of New Year’s resolutions — but it’s a critical part of having a happy, healthy year, one you can anticipate with peace of mind. Since it can be daunting to try to find a plan that’s a good fit, I thought I’d offer a few simple rules — or CareConnect’s health insurance commandments, if you will. How many? Ten seemed like a good number.
The Four Commandments of Saving on Health Insurance for Your Small Business:
Find a network that fits. Depending on the needs of yourself and your team, a narrower, high-value network can be just as good as or better than one that’s more expansive. If much of your workforce is geographically concentrated, a selective network may well give you access to the doctors and facilities you need, while bringing you and your team substantial savings. Network size doesn’t matter as much as how well the network meets your needs.
Empower your employees. Instituting a disease management program — or choosing an insurance carrier with a robust disease management department — can pay off in improved health for your employees. As a bonus, that can mean big savings for your company. (In a disease management program, health professionals help your employees who have chronic illnesses — like asthma or diabetes, for instance — do the things that will keep them as healthy as possible.)
Ditch auto-renew. In the days before the Affordable Care Act took effect, there wasn’t a lot of variability in New York’s small group market – either between carriers or year over year. But all that’s changed. These days, plan options can change substantially from one year to the next, and so can premiums. To get the plan you want at the price you need, it’s best to shop around.
Check your HSA options. If you’re not familiar with health savings accounts (HSAs), you and your workers may be missing out. An HSA is a special kind of savings account that people can set up in conjunction with a high-deductible health insurance plan–money in the HSA is used to pay for health care costs. Contributions to the HSA are 100% tax deductible, and withdrawals made to pay for qualified medical expenses are untaxed. Health savings accounts (HSAs) and high-deductible plans combine to make a powerful tool for controlling health care costs. The tax advantages leave more money in your employees’ pockets for medical expenses, so having an HSA can make it easier for them to meet the plan’s high deductible. And as an employer, you benefit by the lower contributions required for the high-deductible health plan.
The Five Commandments of Saving on Health Insurance for Yourself:
Determine if the state exchange is for you. If you’re already insured through work, or if you receive Medicare, you are set. You don’t have to worry about signing up at all. If you are not insured through work, and your income may make you eligible for subsidies, you’ll probably want to check out New York State of Health, the state health insurance exchange. This is a marketplace where you can compare health insurance plans, find out how much they cost and purchase coverage.
Figure out if you are eligible for a subsidy or Medicaid. If you earn less than 138% of the poverty rate (about $16,000 dollars for an individual) you are eligible for Medicaid, which is also available through the exchange. If you earn less than $46,000 dollars a year for an individual ($52,920 as a married couple, or $95,400 as a family of four), you are likely eligible for a subsidy to offset some of the cost of an individual plan. In some states—like New York, for instance—there is also a new, especially affordable option for people who earn too much to qualify for Medicaid. It’s called the “Essential Plan,” and it can be had for no more than $20 dollars per person a month if you earn less than $23,540 as an individual, or less than $48,500 for a family of four.
Consider getting a helping hand. While signing up for a health plan is simple, there are a lot of options, and an expert can help you find the one that’s best for you. You can find a “navigator” who can explain your options at New York State of Health. A broker can help, too. Or you can call a health insurance carrier like CareConnect—we have a trained staff that’s ready to answer your questions.
Decide on the plan level that works for you. Plans are offered along a tiered system (bronze, silver, gold, platinum). Bronze plans have low premiums but high deductibles, so they’re less expensive upfront but will cover a smaller percentage of medical bills. At the other end of the spectrum, platinum plans have higher premiums but will cover much more of your medical bills. It’s important to realize that premiums can vary widely even for plans at the same metal “tier.” In New York State, you can find a gold plan for as little as $389 a month or as much as $956; silver plans range from $341 to $607; and bronze plans from $265 to $672. Clearly, it pays to shop around!
Don’t snooze and lose. Here’s another reason to shop around. If you signed up last year, you’ll be automatically re-enrolled unless you take action—and auto-renew can cost you money! Make sure to comparison shop your old plan against this year’s options. Some plans from last year’s open enrollment period have seen their premiums rise (by as much 30%), while others have actually gone down.
The 10th Commandment
Relax! That’s all there is to finding a plan that will work for you. All that’s left to do is to toast your friends and family and wish each other happiness and good health in 2016!
Alan Murray is President and CEO of North Shore-LIJ CareConnect Insurance Company, Inc)
Alan J. Murray