A Preview of Healthcare and Acupuncture in 2015

Well, open enrollment is in full swing for healthcare plans starting 2015 - in fact if you’re choosing an individual or family plan off the exchange, you have until December 15th to pick a plan and enroll!  So get to it.  Even if you are insured through your employer, you are likely being offered new plans to choose from and are bound to the same timeline.

Having trouble making heads or tails of the coverage options and what is best for you?  Guess what - you’re not alone.  The theme of the week in my office has been patients asking me what insurance plan is best, so I’m putting to paper my general recommendations based on healthcare updates in 2015.

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A Quick Guide to Healthcare Plans in 2015

Simply put - what type of insurance plan is best for you depends completely on how you use healthcare.  Do you go to the doctor often in addition to your annual exam? Do you have children? A chronic illness? Or do you primarily use complementary and alternative care such as Acupuncture, Chiropractic and Naturopathic care?  Here are some simple recommendations for Oregon healthcare plans in 2015:

Best Insurance Plan for a Family - low deductible or copay plan ideal
check out Lifewise Essential Silver 2000, Lifewise Essential Silver 3000, MODA Standard Silver

If you have a family, especially with 2 or more young children, you can bet your bottom dollar that you’re going to go to the doctor a few times. You’ll likely end up in urgent care and maybe even in the ER for the highly active child.  With a family you want to choose the lowest premium plan you can that still reasonably controls out of pocket costs for doctors visits.  This means you either want a low deductible (preferrably $500 per person or less, but $1k is still reasonable) OR you want a plan with a reasonable deductible ($3,000 or less per person) that allows you a copay for doctor visits, urgent care and ideally ER visits.  A copay is not subject to deductible while a coinsurance percentage is - so even with a “reasonable” deductible instead of a low one, your out of pocket costs will be low for unexpected doctor visits if you have a copay instead of a coinsurance option.

Best Insurance Plan for a Healthy Individual - HSA or catastrophic
check out Bronze level plans such as Lifewise 5250 HSA, PacificSource Smarthealth Value Bronze HSA or MODA Be Smart

All insurance plans cover annual exams now, so if you are healthy and young you don’t need much more than that.  You’re better off with a low premium and little coverage.  You’ll save so much on premiums over time that you can afford to pay for care when you need it instead of paying (through high premiums) all the time.

Best Insurance Plan for Complementary and Alternative Medicine(CAM) - included CAM benefits or HSA
check out MODA Be Smart, All Lifewise Plans - can add dental/vision/CAM service, most Oregon Health Co-Op Plans also cover on a copay

Ideally, you will find a plan with a reasonable premium that includes coverage for CAM services on a copay not subject to deductible. If you can’t find a plan with a reasonable premium that covers this, however, an HSA is your best way to go.  With an HSA you get a low premium and high deductible, but all the funds you run through your self funded Health Savings Account are fully tax deductible and completely at your discretion - meaning CAM friendly!

Best Insurance Plan for Chronic Illness - HSA or low max out of pocket with good pharmacy benefits
check out Oregon’s Health Co-Op Simple Silver HSA Select, Lifewise Essential Silver $3,000 and MODA Be Prepared

If you have a chronic illness, you are probably taking or can expect to take medication and go to the doctor often.  It might seem like you want the most expensive cadillac of plans, but what you really need to balance is your premium compared to your maximum out of pocket and pharmacy expenses.   If your illness makes you likely to max out your benefits for the year, getting the lowest out of pocket max possible is your priority.  This is likely an HSA. If you go to the doctor often but don’t end up the hospital much, a copay plan or a plan with a low deductible and coinsurance is a good bet.

Stay Tuned for a Step by Step Guide and Glossary of Terms

There was way too much information to put in one blog post, so stay tuned to next week! If the guide above doesn’t give you enough information, next week (still before the deadline!) I’m going to give you a step by step “how to” guide that will walk you through assessing how you use healthcare and how to use that information to figure out what plan is best. AND I’m going to include a glossary of terms if things like “copay” and “coinsurance” and “deductible” make your head spin!

Health insurance is extremely important and extremely confusing, as well as a big investment of your hard earned cash. Spend the time to understand your options, speak to professionals and work with an agent to be sure you make the best choice for your individual healthcare needs!

Until next week, good luck!

~Rebecca