The risks of picking a health insurance plan with a low monthly premium
You’ve narrowed down your health plan options, and now you need to choose. Your instinct is to go with the lowest premium. But what are the risks?
When it comes to health coverage, picking a bargain may actually be more expensive in the end. Make sure to find out why the plan is cheaper so you don’t end up saying, “If I had known this, I would have made a different decision…”
Here are some things to think about before you pick a plan based on the monthly cost alone:
1. How healthy are you?
A bargain plan might be right for you if you’re healthy, have had only minor illnesses and don’t typically make more than an annual visit to the doctor.
A cheaper plan may surprise you with unexpected costs if you or a family member has:
- Unique medical concerns, like asthma
- Many recent doctor visits, for example, for a stubborn ear infection
- A chronic condition, such as diabetes
- A need for regular prescription medication, like cholesterol-lowering drugs
I recently talked to a mom whose son needed ear tubes and sinus surgery to help with chronic ear and sinus infections. (This is extremely common and actually happened to my daughter!) What started as a few simple office visits and antibiotics grew into outpatient surgery costing more than $10,000.
2. Are you okay switching doctors?
If you don’t mind changing doctors or clinics, a cheaper plan that covers a fewer number of doctors could be for you.
It could be an issue if the doctor you love isn’t covered by the health plan you’re interested in. It could also be a problem if he or she is covered by your insurance, but at a higher rate.
Think about whether you have:
- A favorite doctor or clinic
- A primary care doctor for chronic care or care coordination
I spoke to a member after she enrolled her family in a new plan for 2015. She took her two children for their regular check-ups at their usual clinic. She expected preventive care to be 100 percent covered. Unfortunately, their pediatrician is not covered by the new plan (not in-network) and the member had to pay for those services until she met her deductible (the amount she has to pay before her plan starts covering care).
3. Are you willing to take a gamble?
If your budget can cover the deductible (the amount you have to pay yourself before your plan will start kicking in for your care) in the case of an unexpected illness or an emergency, a low monthly premium plan could be an option for you.
Avoid a bargain plan if you’d rather have more predictable monthly costs to avoid paying more at the doctor or pharmacy.
Instead, pick a plan that gives you:
- The right amount of coverage for your health needs
- A lower deductible
- Clear out-of-pocket costs (copay or co-insurance)
You may need more unexpected medical care if you have kids, even if they’re healthy. Make sure to think twice before picking a bargain plan. It could easily cost you more money – and be a bigger headache – in the end.
Choosing a health plan for your family is an important decision. I encourage you to consult an adviser, plan representative or other trusted partner to help make the decision.
About Barb Breher
Barb Breher is a leader in the Member Services department at HealthPartners. She specializes in individual and family health plans. Barb loves helping members understand and use their coverage (it’s confusing!). When she’s not working, she loves relaxing and camping with her husband and two young daughters. Minnesota locals: she highly recommends Voyageurs National Park.