What you need to know about the right insurance option

By Josh Harvison - bio | email

JONESBORO, AR (KAIT) – Americans across the country will be required to have some sort of health insurance, even if they are unemployed under the Affordable Care Act, which became law in September. According to healthcare.gov, insurance companies can publish their policies online for consumers to compare with other policies with different companies to find the right choice for them.

According to Beverly Nix with St. Bernards Healthcare Associated Regional Providers, the variety of differing insurance rates will change next year. Currently, many rates differ for the same plan. Despite the change in law, Nix said customers should still do their homework.

"It's going to make it more black and white for the consumer. You'll still want to check your network. You'll want to know what hospitals are participating in the plan, what physicians are and you need to go beyond your local market," said Nix.

For more information on the Affordable Care Act, click here.

Nix said customers must make sure their doctor or family of doctors is included in their plan. In some cases, patients seek medical attention outside their coverage area, which their insurance company will not cover.

"I think there's an assumption that insurance coverage is for everything. Under health care reform, we're going to be changing. Under today, that isn't the case. You need to ask the questions. If you want alternative care, you need to ask," said Nix. "When you're looking at insurance plans, if they're good insurance, the facilities want to participate with them. So if you're looking at the listing of facilities that they have in their provider network and you don't see some of the high quality ones, that should be a red flag."

Among the changes in federal law, the age limits on dependants have gone up to 26-years old if that individual is under their parent's plan. Also, the ability to change insurance policies will be easier.

Nix said when comparing insurance, make sure the locations of the hospitals are convenient for your family. She also said the bigger the list of specialists you will need, the better the insurance will be.

"In a worst case scenario if you or your spouse or child gets really ill, you'll have those options in your plan. You don't want to find that out after the fact," said Nix.

Aside from medical needs, Nix said it's just as important to ensure the insurance is affordable.

"You need to know what kind of deductible you can afford. You need to know what kind of co-pay you want, 80% co-pay or 100%. You need to know what premium you can afford," said Nix. "I think if you've got a good reputable insurance agent, he is going to get all of your questions answered and if there is a bleep, he'll take care of it to the best of his ability."

Nix said there is one easy way to save money.

"Smoking causes cancer and cancer raises health care costs, so we always push that they need to stop," said Nix.

According to Nix, ask the health insurer if they allow policies to be examined by external experts. If they do, that may mean their service is better suited to meet your needs.

"I think probably 80% of the population doesn't read it. If you're employed, then your employer can make that decision. Then you're blessed to have insurance coverage, and usually they have an HR expert that does that. They've gotten to where they really relax because the expert has looked over the policy," said Nix.

Finally, don't leave yourself open to the unpredictable. Don't terminate your current plan before you have another plan effective. You never know what could happen.

"It'd be my luck if I discontinued one before the other was effective. I'd get something. I'd break a leg. I'd do something, so you don't need to take that risk," said Nix. "Sometimes that (temporary insurance) could be costly, so just be careful. If I knew I was going to change, I would start looking at it about three months out. Get with a good agent. Get all my questions answered. Make sure my providers are in. Make sure the good hospitals are participating."

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