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Tuesday, September 15, 2020

5 Tips for Navigating the World of Health Insurance

 If you’re not already covered under your parents’ or employers’ plan, you’ll likely have to look for coverage in the Health Insurance Marketplace, or from an insurance broker. Under the Affordable Care Act (ACA), marketplace plans can’t deny you or charge more for coverage when you have a disease like MS.

Here are five tips on how to navigate the sometimes tricky world of health insurance.



See if you can get government assistance

If you don’t qualify for Medicaid, you might make the cutoff for a program that helps with health insurance costs. The government offers assistance in the form of subsidies, tax credits, and cost-sharing reductions when you buy a plan from your state’s marketplace. This financial assistance could significantly lower your premiums and out-of-pocket costs.

Check whether your doctor is on the plan

Look up all the doctors and specialists you currently see using the plan’s online search tool. Also, look up your preferred hospital. If your doctors and hospital aren’t in-network, you may want to keep looking for another plan.

See if your services are covered

How much you’ll pay for services can differ depending on the company you choose. And certain plans may limit the number of visits you get with specialists like physical therapists or psychologists.

Look on the plan’s website or ask an insurance rep to see its Summary of Benefits and Coverage (SBC). The SBC lists all the services the plan covers, and how much it pays for each one.

Find out if you qualify for free health insurance

Insurance can be expensive, especially on an entry-level salary. It’s worth checking into whether you qualify for Medicaid. This federal and state program offers health insurance coverage at little or no cost to you.

Review the plan’s formulary

Tier 1 usually includes generic medications. Tier 4 has specialty drugs, including the pricey monoclonal antibodies and interferons used to treat MS. The higher the tier of the drug you need, the more you may have to spend out of pocket.

Also, find out how much you might have to pay if your doctor prescribes a new drug that’s not on the plan’s formulary.


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