If you have recently left the corporate world, you may be wondering what to do about health benefits. Whether you have retired, started your own business or are pursuing a creative endeavor, health insurance is still a necessity. It can seem overwhelming to take on the responsibility of shopping plans and figuring out what will suit your needs best, especially if you are used to just renewing every year on your employer’s plan.
But with a little information, you can effectively compare health insurance plans and may even be able to find a better or more inexpensive plan than the one you had with your employer.
When you’re leaving your corporate job, you may have a few different options:
- Your Spouse's Plan
- The Individual Market
Your Spouse’s Plan
If you’re married, you likely can be covered under your spouse’s plan. You may have compared their plan with your own employer’s years ago and decided your plan provided the best value, but that may have changed over time. Additionally, your spouse’s plan may provide the best value compared to individual options.
Be sure to obtain any information available to your spouse about the health benefits provided by his or her job, and include it in any plan comparisons you make. When comparing health plans, there are three key elements you want to address.
- Network Size
This refers to the providers that are in your plan’s network, meaning you will typically pay less to visit them than out-of-network providers. Most plans with large networks are more expensive. If cost is one of your concerns, consider a “narrow network” plan, where only a small group of providers are included. But be aware — your longtime doctor might not be included in this new narrow network. If your relationship with a certain doctor or hospital is key, a narrow network plan might not be for you.
2. Premium Price
This is the monthly amount you pay to the insurer for coverage in their plan. In an employer plan, this is the amount reserved from your paycheck as your contribution to health coverage. Premium prices vary based on network size and breadth of coverage.
Cost-sharing refers to the part of your healthcare expenses that you will be expected to pay out-of-pocket. For example, you will pay 100 percent of expenses before you meet your deductible, so if you expect to use many healthcare services, you might prefer a plan with higher premiums but a lower deductible.
Turning 65 this year? You’re eligible for Medicare, the federal health program available to those 65-years-old and up, as well as younger people with certain disabilities. You can sign up for Medicare during the seven-month period between three months before and three months after the month of your 65th birthday.
Medicare has multiple parts, and researching the program can seem daunting at first. Here’s a basic breakdown of how Medicare works:
Part A: This is hospital insurance provided at no additional cost if you or your spouse have worked for at least 10 years and paid into the program. Part A covers hospital stays, skilled nursing facilities, hospice care and some home care.
Part B: Part B is medical insurance covering doctors’ services, outpatient and preventive care. You have to pay a premium to have Medicare Part B.
Part C: Also known as Medicare Advantage, these are privately controlled plans that include Part A, Part B and drug coverage.
Part D: This is prescription drug coverage. If you don’t have a Medicare Advantage plan, you’ll be required to pay additionally for prescription drug coverage
Depending which route you go, you may also consider a Medicare supplement.
The Individual Market
If you aren’t eligible for Medicare or coverage under another person’s plan, you will need to shop for a plan on the individual market. This refers to either the Affordable Care Act exchanges — or “Obamacare” — or directly from insurers, many of whom will sell individual plans straight to consumers.
Either way, when looking at individual plans, you will also want to consider the aforementioned comparisons — network size, premium price and cost-sharing arrangements — to find the plan that fits your needs best.
On the exchanges, you may also be eligible for financial assistance in the form of subsidies. Subsidies are based on income and used to offset premium costs. Even if your income is too high to be eligible for the subsidies, you can still buy exchange plans — you’ll just pay full price for them.
As you can see, individuals often have more plan choices than they realize when they leave their employer’s group plan. Seeking the help of an insurance broker or advisor may be the best way to evaluate the multiple options available to you.
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About Emily Kubis: Emily hails from Nashville, Tennessee, where she writes for Bernard Health. Before joining Bernard, Emily was the healthcare writer for the Nashville Post.