Consumer Reports: Shop smart to get the right health insurance


Not all health insurance plans are created equal, says Consumer Reports. Choose the right health insurance by doing the following:

Insured at work, or buying it yourself

• Enroll on time. Open enrollment for plans bought through a state or federal marketplace started Nov. 1, and runs until Jan. 31, 2016. If you miss that deadline, you can't get insurance for the rest of the year unless you or your spouse experiences a major life event, such as changing jobs. Most employers offer health insurance sign-up in the fall.

• Don't auto-renew. Reconsidering your options every year may be a hassle, but it's something you should do. Premiums go up, or down, from year to year, so the most affordable choice last year may not be the same this year. You may also have developed new health care needs that don't play well with your current provider network.

• Be wary of low-cost plans. You may be tempted by a plan with a low monthly premium. But those "deals" can cost you big in the long run, mainly because they often come with high deductibles — the amount you have to pay before insurance kicks in. They are almost always the wrong choice if you have a chronic disease such as diabetes or you take expensive medications. But low-premium plans may make sense if you're generally healthy and don't tend to need much beyond an occasional visit to the doctor.

• Know your providers. If you're considering a health maintenance organization (HMO), you must stick with in-network providers except for emergencies. Go outside that network, and you'll have to pay the whole bill. Preferred provider organizations (PPOs) have larger networks and allow you to get care from out-of-network providers, though even they have "preferred" providers who charge less to members.

If you're on Medicare

• Sign up right. Enrolling in Medicare Part A, which covers hospital inpatient care, is straightforward: Do it right before or after you turn 65, even if you still work and get insurance through your employer. That's because you don't have to pay a premium for Part A, so it won't cost you a dime.

Things get more complicated with Medicare Part B, which covers doctor services and outpatient hospital care. Sign up too early, and you could pay for insurance you don't need. Sign up too late, and you face a permanent increase in your Part B premium of 10 percent for every year you should have been enrolled but weren't.

If you're retired or will retire at 65, sign up for Part B when you enroll in Part A. If you still work, delay Part B if you get insurance from your job or your spouse's job and it has more than 20 employees. If it's smaller, sign up for Part B right away: Your employer's plan covers you only after Medicare pays its share.

• Don't confuse Medicare Advantage and Medigap plans. Traditional Medicare allows you to go to almost any doctor or hospital in the U.S. — but you are still responsible for 20 percent of most outpatient care. That can add up, especially if you need costly treatments such as outpatient chemotherapy. To cover them, you can use Medigap or Medicare Advantage: private plans that supplement or replace your traditional coverage.

Under Medigap, Medicare pays its share of the bill, then forwards the rest to your Medigap plan. It can be a good choice if you want the freedom of going to any provider you like.

Medicare Advantage provides the same services as traditional Medicare, includes drug coverage, and allows you to deal with just one insurer. But you must receive care from providers within the plan's network, and you may have to pay an additional $100 or more per month.

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