Shopping for health insurance and selecting the plan that�s likely to best meet your needs is no simple task. But neither is using health insurance once you have it. Insurance terms and health plan rules often lead to confusion, and unfortunately, to costly mistakes.

Here are five common health insurance mistakes to avoid.

1) You assume you�re covered. It�s common for people to assume that once they have insurance, they can simply go for care. But all health plans have limits on the services they offer. Before you make an appointment with your doctor, be sure the care you need is covered by your plan. Also make sure you understand how much of its cost will be paid by insurance. To check your coverage, you can either read your policy or contact your insurer.

2) You don�t check your plan�s medication list. If you take medication, check your health plan�s list of drugs (also called a formulary) to determine if it is covered. If it�s not, ask your doctor if there is a reasonable alternative.

3) You assume your doctor is in-network. Many of the new health plans include far fewer doctors and hospitals than they did before the Affordable Care Act. It�s been difficult in some cases to clearly tell who is and who isn�t participating. Even doctors have been unclear about which plans they�re working with. Check with both your insurer and your health care providers to confirm their in-network status before going for care. Seeing a doctor who is outside your plan�s network can be very costly.

4) You don�t know your insurance terms. Studies have shown that a very small number of people are able to accurately define basic health insurance terms. Not understanding these terms will make it difficult to figure out how much your medical care is likely to cost. Here are four of the most common terms:

  • Co-pays are fixed fees paid at the time of service for a medical visit or prescription drugs, such as each time you see your doctor.
  • Deductible is the amount you�ll have to pay for services your health plan covers before you get any help covering your bills. If your deductible is ,000, you won�t get any financial help from your plan until you�ve met your ,000 deductible. Deductibles won�t necessarily apply to all services.
  • Co-insurance is a percentage of the cost of your care you�ll need to pay, generally after meeting your health plan�s deductible. For example, if you�re responsible for 30% co-insurance for a medication that costs 0, you will pay for that drug.

This glossary of health insurance terms provides a comprehensive list of common terms you�re like to come across when using your policy.

5) You pay your bill too soon. After a doctor�s visit, you�ll receive what�s called an explanation of benefits, or EOB. It shows the service you got, how much your doctor charged, and what portion of the bill your insurer paid. If you�ve received a bill from your doctor, hold off on paying that bill until you receive your EOB and can confirm that your insurer paid its portion.

What mistakes have you made when using your benefits? Share your experience in the comments section below OR like bellow


If you�re covered by Medicare, now is the time to make changes to your health plan and prescription drug coverage. Medicare�s annual open-enrollment period is open until December 7th.

With so many plans to choose from, shopping for a new Medicare Advantage and/or Part D prescription drug plan can seem like a daunting task.

Here are five things to consider when shopping for your Medicare coverage options:

1. NOT shopping can cost you.
Each year, cost and benefit details of Medicare Advantage and stand-alone Part D drug plans change � even if just a little.

Those changes can be costly.

According to a recent survey of 49,000 people using eHealthMedicare.com to compare Medicare plans, people who switched to a new Part D drug plan saved nearly $ 700 in 2015. In addition, they were 20% less likely to hit the prescription drug coverage gap.

The bottom line: Even if you�re happy with your current coverage, shop your options during this open enrollment period to make sure you still have the plan that best meets your needs.

2. Look beyond premiums.
A plan with a low monthly premium may be more expensive in the long run if doctor visits or prescriptions come with high out-of-pocket costs throughout the year.

To get a true sense of what you�re healthcare costs are likely to be, look beyond your monthly premium to understand each plan�s deductibles, co-pays and coinsurance.

3. Make sure your drugs are covered.
Expect to pay more when you fill your prescription drugs next year. Across the board, Part D plan deductibles and other out-of-pocket expenses are rising.

Confirm that the medications you need are covered by your plan. And, check on the details of cost-sharing tiers, which are very common in most plans. Generics on the lowest tiers cost the least, while brand-name and specialty drugs on the highest tiers come with the highest out-of-pocket costs.

Finally, don�t forget to check which pharmacies participate with your plan, and which tiers the plan has placed them on. Prescriptions cost less when you fill them at a pharmacy identified as one offering �preferred cost sharing.� And beware: Not everyone lives near a pharmacy with preferred prices.

4. Is your doctor in-network?
Making sure your doctors participate with your health plan is one of the most important parts of picking the right policy. Out-of-network care can be very expensive. In fact, a recent report by America�s Health Insurance Plans found that out-of-network providers charged patients on average 300% more than Medicare rates for certain procedures and treatments, such as MRIs and chemotherapy.

5. Check star ratings.
Medicare has a quality rating system in which plans are ranked from one to five stars, with five the highest. Try to choose one with no less than 3.5 or 4 stars. You can see a plan�s ratings on the Medicare plan finder

at www.medicare.gov or call (800) 633-4227.

You can also get free personalized counseling services through your State Health Insurance Assistance Program

at: www.shiptacenter.org or by calling (800) 677-1116.


If you�re interested in getting coverage under the Affordable Care Act for 2016, now�s the time to start shopping. Enrollment opened on November 1 and will continue through January 31 (though, you�ll need to make your final selection by December 15 if you want a policy in place by New Year�s Day). Even if you�re happy with your current ACA policy, it�s a good idea to review your options in the Marketplace, since each new year brings changes to plan costs and benefit designs.

Here are 4 things to watch during this open enrollment period.

1. Rising premiums. This year, premium increases are steeper than last year. Benchmark plans (the second lowest cost silver plan sold in each market and to which tax credits are tied) will jump by an average of 7.5% for 2016. But that�s just the average across 37 states using Healthcare.gov.

Costs will rise much higher in some states. For example, if you live in Oklahoma, you�ll pay an average of nearly 36% more for benchmark plan premiums.

The good news is that most people will be able to offset rising costs by shopping and changing plans. A government analysis found that people who switched plans within the same tier level in 2015 (bronze, silver, gold) spent nearly $ 400 less for the year on premiums after tax credits than they would have if they stayed in their existing plans.

2. Changing costs. The price of a plan�s premium isn�t the only cost that will change. Each year health plans make adjustments to out-of-pocket costs as well. So, check plan deductibles � the amount you must spend before insurance helps cover the bills. You�ll also want to note co-pays and co-insurance associated with going to the doctor or filling prescriptions.

To help you get a sense of what your overall costs are likely to be with different plans,Healthcare.gov is now offering a cost calculator, as well as tools to help you search for plans by participating doctors and covered medications.

3. Provider networks and drug coverage. Generally, plans sold on Healthcare.gov will continue to offer limited provider networks with access to fewer doctors and hospitals. And, there are more plans being sold this year that offer no out-of-network coverage at all.

Narrower networks that include fewer doctors are generally cheaper. But there�s a trade-off. Going outside your health plan�s network can lead to high and unexpected costs.

Another detail to check: The list of participating pharmacies and the drugs each plan covers to make sure you�ll have coverage for the medications you take.

Also, make sure you understand the associated costs you�ll face when you go to fill your covered prescriptions. For example, most plans put medications on different tiers that come with varying out-of-pocket costs. And, some plans have a separate deductible for prescription drugs. The way in which these costs are applied can have a huge impact on how much you ultimately spend.

4. Tax credit calculations. Tax credits are available to help lower the cost of insurance for individuals earning between $ 11,770 and $ 47,080 per year. Those earning less than $ 29,000 per year may also qualify to have their out-of-pocket costs reduced.

If you�re already getting a tax credit and don�t renew your plan through Healthcare.gov, your income will be automatically updated by the government with the most current information available.

Still, it�s a good idea to update your information during open enrollment to ensure that you�re not receiving too much or too little help, and to report any changes to your income or household size during the year to keep your information current and to avoid surprises at tax time.


Most insurers are now required to cover the full cost of preventive care, such as wellness check-ups, vaccinations, and screenings. But, as you may know, it can sometimes be difficult to determine which medical services and tests are truly considered preventive.

How can you determine if your visit is considered preventive and likely free? Here are 6 things to consider.

1. Know the law. Under The Affordable Care Act, vaccinations, cancer and other health screenings, wellness exams, and FDA-approved contraceptives are free in most cases. Health plans were already in place when the law took effect March 23, 2010 � called �grandfathered� plans � don�t have to comply with this part of the law.

2. Pay attention to details. There are guidelines set by medical and scientific authorities that determine whether or not medical services are considered preventive. The specific recommendations will decide if your visit is covered in full by your insurer.

For example, colonoscopies are covered in full for people over the age of 50. If you�re 35 and go for a screening, you�ll likely be on the hook for some portion of the cost.

For a complete list of preventive health services available cost-free, see the Kaiser Family Foundation�s Prevention Services Tracker.

3. Know your insurer�s rules. Your insurer has some wiggle room when it comes to interpreting the medical guidelines. For example, insurers must cover all forms of FDA-approved birth control pills, but that doesn�t mean your particular brand is on the list of those your particular plan covers. Instead, your insurer may pay only for the generic form.

4. Stay in network. If you want cost-free preventive care, you must stay in your health plan�s network. Care provided by doctors outside your plan�s network will cost you.

5. Be clear about the purpose of your visit. When you call to make your appointment, be sure to tell the person you speak with that you�re coming in for a preventive visit, such as a woman�s wellness exam.

Keep in mind that if you discuss an existing health issue during the same visit, you may get a separate bill for that even though the preventive service must be without cost.

6. Question unexpected bills. Always question any charges you don�t understand or think should be free. Often the mistake is a simple billing error that can be easily cleared up by calling your doctor�s office to explain it was a preventive visit.

Still hitting a roadblock at the medical billing office? Contact your insurer. Your health plan may also be able to step in on your behalf to get a payment issue resolved. If coverage is denied, you can also file an appeal with your health plan.