Picking the right health insurance plan is imperative, but it's also easier said than done.
It may seem as though there's an endless array of options, especially if you're buying a plan on an Obamacare exchange or through an insurer independently rather than choosing a plan provided by your employer. And navigating the differences between plans can be a major hassle involving reading a lot of fine print. So you've already picked a plan, it may be tempting to just stick with it -- even if it's not a perfect fit.
Unfortunately, this can sometimes be a big mistake if you've gotten stuck with the wrong insurance. To make sure you aren't keeping a plan out of convenience that's actually the wrong plan for you, watch out for these three red flags that suggest your insurance policy is a bad fit.
1. You routinely need out-of-network care
Insurance plans typically have networks of participating providers. Seeing one of those providers costs less than seeing an out-of-network doctor. These in-network providers have agreed to accept negotiated rates for covered services so you don't face surprise bills. And your insurer typically pays for a larger portion of in-network care and charges you a lower deductible for it.
Sometimes, however, you won't be able to find a provider in your network that offers the services you require. Or you'll have a doctor you love who doesn't accept your insurance. If that's the case, you may have to pay a lot of money to get the medical care you need or see the doctor of your choosing.
When this happens often, it may be worth looking for a different insurance policy that your preferred doctor accepts or that has a wider network in your area. It can even make sense to pay more for insurance that actually covers the care you need as an in-network service to save you from higher medical expenses throughout the year.
2. You're paying high premiums and never come close to meeting your deductible
Insurance polices with low deductibles typically have high premiums and vice versa. If you rarely use medical services -- and have no plans to do so in the future -- you probably don't need coverage that costs a fortune but that has a low deductible.
Say you're choosing between two insurance policies. One has $900 per month premiums and a $1,000 deductible and the other has $400 per month premiums and a $6,500 deductible. If you only see a doctor once all year and it costs you $100, you won't meet either a $900 deductible or a $6,500 deductible so the cheaper plan would make sense.
Yes, you would take on the risk of paying much more if something goes wrong and you end up needing a lot of medical services. But the cheaper policy would cost you $6,000 per year less than the more expensive alternative since your monthly premiums would be $500 cheaper. In one year and one month, you could save up the entire $6,500 you'd need to cover your higher deductible in full. You could keep this money in a health savings account or a bank account in case you need care and then pocket the difference in premiums.
3. You're incurring a fortune in out-of-pocket expenses care expenses every year
On the flip side, if you're paying a low premium, have a very high deductible, but need a lot of medical services, you may be better off switching to a plan that charges more up front but keeps costs during the year down.
If you routinely find yourself paying a lot for medical services or prescription drugs, obviously your plan isn't a great fit because it isn't covering what you need.
You should identify the reasons why the plan is leaving you with so many out-of-pocket expenses, whether that's a high deductible or too many restrictions on what services or drugs are covered. Then, see if you can find a policy that corrects the defect.
This could mean paying higher premiums to slash your deductible or looking for a policy that provides better coverage for infertility services or mental health counseling or cancer medications or whatever you're spending on.
Make sure you don't stick with your plan out of convenience
If you spot any of these red flags, it's a pretty good bet that your insurance policy isn't really an ideal one to meet your medical needs.
Next time open enrollment rolls around, check out our guide to picking the best insurance plan for you and reevaluate your options. You may just find coverage that's a much better fit and that helps to cut your healthcare costs significantly. It'll take a little effort, but the payoff could be big.