Are you in the market for an individual insurance plan? Do you know what to look for?
The Maryland State Medical Society and the National Alliance on Mental Illness offer the following tips to evaluate insurance coverage:
1. Are your family’s doctors and physicians in-network?
Mistakenly seeing an out-of-network provider can leave you with unnecessarily expensive medical bills. Using in-network providers will save you additional costs.
2. Does this plan cover your family’s prescription medications?
If you take prescription medications, check to see if they care covered and on the list of pre-approved drugs. Choosing a plan that does not cover your most regular prescriptions will severely increase your family’s health care costs.
3. What are the out-of-pocket costs?
To estimate the full cost, determine each plan’s co-pays, deductibles and other out-of-pocket expenses.
4. Consider your continuity of care:
Read the fine print to make sure your insurance company can't increase your co-pay for prescription medicines in the middle of the year or change which medicines it will cover after your doctor has prescribed them.
5. What are the plan’s prior authorization and step therapy policies?
Prior authorization requires physicians to obtain the carrier’s approval before the carrier will pay for certain medications or treatment. Step therapy policies require physicians to prescribe cheaper alternatives before preferred treatment is covered.
Medicaid enrollment is year-round, and Medicaid-eligible Marylanders may start coverage immediately. Marylanders enrolled in Medicaid must renew their coverage once a year through the Maryland Health Connection.
Medicare open enrollment began Oct. 15 and continues through Dec. 7. For more Medicare information, call 1-800-MEDICARE or visit www.medicare.gov. You don't have to renew Medicare coverage if you are satisfied with your current plan, and it is still offered through Medicare.
Locally, the Valor Crisis and Training Center is hosting a health insurance open-enrollment event along with Western Maryland Health Connection from 10 a.m. to 2 p.m. on Tuesday.
“Trained experts will be on hand that day to work one-on-one with participants to help them enroll for coverage during their appointment or provide instructions and guidance for enrolling at a later date,” Valor’s Program Manager Sharon Hawkins said.