Health

22 HEALTH • Winter 2016 Shopping around for health insurance F aced with a monthly health insurance premium increase of $312 a month next year, a Massachusetts family knew they needed to consider all of their options for 2017 insurance coverage. As soon as open enrollment start- ed on Nov. 1, they went to see a local Navigator, an organization funded to help Massachusetts residents review their health insurance options. They found they qualified for premium assistance through the state's subsi- dized ConnectorCare program, and therefore are able to receive state and federal help paying for their cover- age. After reviewing their options, they walked out with a new plan with a no-cost premium for 2017, after paying a premium in 2016. This story isn't unusual this open enrollment season. Across Massachusetts, many people are see- ing significant increases in their pre- miums for next year. That includes people buying insurance on their own through the Health Connector and even those who qualify for sub- sidies. Some carriers are dramatically increasing their rates and the state is no longer able to subsidize some high-cost plans. Not everyone qualifies for a $0 premium plan, but by shopping around, many people will be able to lower their scheduled 2017 increase, or even save money. Examing costs beyond premiums Managing health care – and its costs – is an important family deci- sion that should be reviewed every year. The monthly premium gets the attention, there are other factors. There is no one-size-fits-all solu- tion for an individual or family buy- ing health insurance, but knowing all the details can help determine what the best fit is for the next year. Premiums are the easiest factor to compare between plans, but not the only cost consideration to look at. The cost of a doctor's visit, for exam- ple, can vary, and the amount paid out-of-pocket can be different. How often a member visits the doctor, and how costly the services are, are important variables. Someone who goes to the doctor regularly or is receiving expensive care will be more likely to consider a plan with lower co-pays and deduct- ibles, but higher premiums. The Health Connector uses metallic tiers – Bronze, Silver, Gold and Platinum – to group plans with similar bene- fits together. Bronze plans offer lower premiums but higher co-pays and deductibles, with Platinum plans offer higher premiums, but smaller co-pays and deductibles. These details matter. For a 40-year-old in Worcester, the lowest- cost Bronze plan is $255 per month compared to $390 for the lowest-cost Platinum plan – a different of $1,620 annually. But, the Bronze plan includes co-pays of $500 for an emergency room visit and $1,000 for an MRI – after paying the $3,300 deductible. The Platinum plan co- pays for those services are $150, with no deductible. Other considerations When members talk about health- care preferences, having access to a certain provider is a priority. Checking to see if a doctor or hospi- tal accepts a particular plan is an important step. Once open enroll- ment closes, a member can't change plans to get back into a network that includes a specific doctor. Balancing cost with access to ser- vices and doctors can be challeng- ing. For those who want a helping hand, there are trained experts ready to walk through the shopping process. In Worcester, the Health Connector walk-in center is at 146 Main St., and the Family Health Center of Worcester is a Navigator with staff able to handle shopping questions. A full list of assistance around the state can be found at MAhealthconnector.org. Louis Gutierrez is executive director of Massachusetts Health Connector. BENEFITS ADMINISTRATION By Louis Gutierrez We offer: • Long-term and short-term care • Ancillary Services: dental, eye, podiatry provided at the nursing home • Respite and Hospice Care • PT/OT/ST Rehab services; 7 days a week • Full time Physician Assistant • Continuing Care Community: Assisted Living services and Independent Living cottages & apartments on the Briarwood Community campus "Healthcare Environment State of the Art" • Restaurant-style dining room • Bright and airy rooms • Activities; 7 days a week • Cable TV and telephones available in each room • Resident computer and free access to internet • Pet therapy through Tufts Veterinary Program Schedule a Tour Today! www.knollwoodnursingcenter.com 87 Briarwood Circle, Worcester, MA 01606 508-853-6910 At CONOVER + GOULD, we have worked in and around healthcare issues for over two decades and possess deep knowledge of this highly regulated, high-profile industry. From pharma to health IT to healthcare reform to quality improvement issues, we've helped our clients evolve, adapt and innovate in constantly changing and competitive environments. We've helped shape public policy and regulations at both the state and federal level, translated complex scientific and medical information into messages that matter and achieve results, and driven front-page coverage of key issues. You receive the expertise of our senior staff who work closely with your team to produce outstanding strategy, creativity, tactics and results Sound good? Want to learn more about what we can do for you? Contact us at info@conovergould.com or 1-866-411-7321. Knowing our business isn't enough. We work hard to make sure we know yours too. H

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