Consider Using the Check List Model Promulgated by Dr. Atul Gwande (in his book – The Check List Manifesto)
This month we’ll discuss factors to consider when deciding what insurance is best, most cost-effective for you and your family in 2020, focusing on those who obtain insurance from their employer and the self-employed. For December, we’ll discuss those who have government insurance (e.g. Medicare, Medicaid, CHIP). Open enrollment for Obamacare policies in most states is from November 1, to December 15.
We think that using a check list, like we discussed in previous forums, is simple and helps avoid overlooking important factors. If you’re like us (the doctor editors of these forums), you may tend to just continue the same insurance you’ve had year after year. But what if your life situation has changed in any of the following ways:
- You’ve been blessed with the birth of your first child.
- You and your family’s medications have changed, including expensive brand-name meds.
- You’ve reached another milestone (e.g. you’re middle aged and have several teenagers who need insurance).
- There could be other transitions in your life affecting your insurance decisions for 2020 such as changing jobs; moving to a different state, etc.
Let’s consider two typical examples:
1) Your Employer Provides Your Insurance – and pays the majority of the cost. According to the Kaiser Family Foundation, the cost of employer-provided insurance (for the average large company) for an employee with a family was over $20,000/year in 2019.
Consider the following checklist:
- Has my personal/family situation changed? If so, what changes in insurance should I consider?
- Does my employer offer more than just one plan to choose from? Do I need to change from an individual to a family plan?
- Does my spouse’s employer provide a better, less expensive plan, than my employer? Are all the doctors we see with my or my spouse’s insurance in-network?
- Does my employer offer a health savings or flexible savings plan?
- Has my employer switched to another insurance plan that my family member’s doctors are not contracted with? If so, will I have to hunt for a new in-network doctor?
- Does my employer offer the option of setting up a Health Savings (HSA) or a Flexible Savings Account?
- If I’ve lost my job for any reason (along with any insurance), can I get covered under my spouse’s insurance? If not, should I continue my insurance under COBRA (if my company offers it)? Insurance under COBRA is usually less expensive than purchasing your own insurance.
- If you need to make changes to your employer-provided insurance, we advise having a face-to-face meeting with an experienced advisor in your employer’s Human Resource Department.
- If I’m considering quitting my job and starting my own business, what will I have to pay for health insurance?
2) You’re Self-Employed and Have, or Don’t Have, a Spouse and Children
- The cost for a high-quality ACA plan for a family in 2019 who didn’t qualify for a government subsidy was $1,154/month (about $14,000/year), not including out-of-pocket deductible and copays.
- Be prepared to pay higher monthly premiums (yearly cost of insurance greatly surpasses the rate of inflation and salary increases).
- The best insurance policies are Affordable Care Act (ACA) – approved policies that cover pre-existing illnesses, mental health and substance abuse treatment and much more.
- Compare different policies on the Internet (e.g. healthcare.gov; bewellnm.com)
- Don’t confuse ACA policies with short-term, cheap policies promulgated in 2019 and 2020 by the Trump Administration. These policies don’t cover pre-existing illnesses, have high deductibles, and have many other limitations. You’re never certain if the insurance company will be in business next year. But having some insurance may be better than going without.
- If you need a short-term policy, meet with a reputable insurance agent, compare policies offered on the Internet (read carefully the FINE PRINT), talk with those familiar with the healthcare industry. Above all, be careful!
More information about selecting health insurance can be found in Chapter 3 (pages 43-61; 203-212) in our recent best-seller, Insider’s Guide to Quality, Affordable Healthcare, available via Amazon.com and bookstores nationwide.
We encourage you to ask us questions about frustrations you experience with our healthcare system via our website, www.qualityaffordablehealthcare.net.
We will be publishing future forums every other month: the next will be in December. Keep in touch with our website – www.qualityaffordablehealthcare.net for periodic health-related breaking news. If you are on our email list we will alert you when new materials are added.
Wishing everyone a long, healthy and productive life,
Dr. Larry Lazarus and Dr. Jeff Foster