Health Insurance Open Enrollment

This is “open enrollment” time for health insurance.  I have heard from a few clients who have Blue Cross Blue Shield individual plans that BCBS cancelled their plans.  I have had a couple of other clients that came to me for advice on which health insurance plan they should use.  In addition, Kyle has to go off my policy since he is turning 26.  Therefore, I have done a fair amount of work on health insurance, and I thought I would use this month’s post to share what I have learned (email me if you want a comment on the markets during November). Keep in mind that while I hold a life and health insurance license it has been 20 years or more since I have sold any policies, although through the years I have analyzed many life insurance policies and proposals for clients).  Your agent should be able to determine what is best for you.

The city you live in affects the plans available to you.  It appears that in the larger cities the plans are mostly HMO plans because there are plenty of doctors in those cities that are “in-network” for those plans.  In Abilene, while we have a lot of doctors, there are situations that require residents to go to larger cities for a certain specialist that we do not have here.  A HMO requires you to start all your care with your primary physician, then that physician will refer you to a specialist.  In addition, you must use a doctor that has a contract with that insurance company and that plan.  You may not use a doctor that is not in their network.  This can be a real problem if your doctor is not part of their network and you are switching insurance companies, so be sure to verify your doctor accepts the plan you are switching to BEFORE switching.

The other type of plan is a PPO.  Under this plan, you do not have to go to your primary physician first.  You can go to any doctor you want.  However, those plans reimburse more if the doctor or facility is in-network versus out-of-network.  PPO plans are generally more expensive, but I like them because I don’t want my insurance company telling me which doctor I can go to.  BCBS in Abilene no longer offer PPO plans.  They are only offering HMO plans here.  My plan is with BCBS but my plan is grandfathered for some reason.  I have had it a very long time, and maybe that’s it.  I keep being told that it might get cancelled.  And relatively speaking my premium is much lower than if I had to switch to one of the current plans.  BCBS has never caused a problem for me regarding claims, but as I said, I prefer not to have a HMO plan.

In Abilene we can choose to have a plan with First Care.  I will admit that I have no experience with their plans, but I have talked to several people who have the plans and a person at a local hospital with a high knowledge of the plans First Care offers. First Care is a regional insurance company, but I have been told that they do pay for doctors and hospital bills in other states.  However, a friend of mine who has First Care, and needed a hip replacement in Abilene, had his surgery delayed a few weeks because he was waiting to get it approved by First Care.  Also, according to what I read in some of their materials it appeared that if I had cancer and wanted to go to MD Anderson because I felt there was a certain doctor who was “the doctor” for that type of cancer, First Care could say that I had to use the cancer doctor in Abilene.  Also, First Care does not appear to have any benefits for mental health issues which may be important for some people.  First Care is generally the least expensive, but I am not recommending those plans to anyone.

That leaves two insurance companies that offer plans to Abilene residents: Humana and United Healthcare.  Humana is the only company offering a PPO plan, but they are offering only one plan.  It has a $6450 deductible, but you have 100% reimbursement after you satisfy the deductible.  It covers prescriptions like any other medical charge, so you have to satisfy the deductible before the plan pays for any prescription.  United Healthcare offers several plans, but they have NO out-of-network benefits and the premium for a comparable plan to the Humana plan was the same.  Therefore, I would prefer to have the Humana plan.

I have no idea if Humana approves their claims quickly or not.  I searched for reviews online but there were only a few, not enough to formulate a decision.

I hope this information helps you.  Let me know if you have any comments or questions.