Health insurance can be complicated and because different options are available to different groups, knowing what coverage is best for you is highly individual. Knowing what coverage you should choose depends on your available options, your health needs and your financial situation. The State Health Insurance Assistance Program (SHIP) is a free service available to Medicare eligible individuals to help beneficiaries make informed decisions about their healthcare coverage. SHIP counselors are trained to provide information on a variety of health insurance options including Medicare, Medicaid, VA Healthcare and employer-based plans.
If you find yourself eligible for more than one type of insurance, you may wonder how you should decide which coverage you should take. Deciding on your coverage depends on several factors, including cost, coverage, provider choice, enrollment availability and compatibility with other insurance.
COST:
Different insurance plans have different costs. Programs like VA Healthcare and Medicaid typically do not have monthly premiums and often do not have copays. Costs for employer-based plans vary wildly from plan to plan with some employers offering multiple plans with different costs. Medicare has a monthly premium as well as co-insurance for most services and the costs can increase for people with high income. Many insurance plans, like Medicare Part D plans or Medigap policies have higher cost when they include more coverage. When deciding on coverage, cost is one of the most highly considered factors but there are other factors to consider than cost alone.
COVERAGE:
Some types of insurance include benefits such as vision, dental and hearing aids. Some cover holistic medicine while others do not. Medicare does not cover certain services, like long-term care. Medicare supplement policies are available to supplement costs that Medicare doesn’t cover. When deciding on an insurance option, it is important to consider what benefits are most important to you so that you can find a plan that will cover those services.
PROVIDER CHOICE:
Not all providers accept all types of insurance. For some people, provider choice is another factor to consider when choosing health insurance. For beneficiaries enrolled in VA Healthcare, most services have to be provided by a VA provider in order to be covered. Medicare also requires that services be provided by those enrolled as Medicare providers. Adding a Medicare Advantage plan can increase restrictions on provider choice. Most employer-based plans also have a specific network of doctors and hospitals. If you have specific providers you want to see, be sure to check with those providers before choosing your health insurance.
ENROLLMENT AVAILABILITY:
Not all insurance is available to everyone all the time. In fact, most insurance has specific enrollment periods. Many employer-based plans do not allow beneficiaries to re-enroll in their plan once they have dropped the coverage. Medicare only has open enrollment into plans one time per year and enforces penalties for people who did not have credible coverage. VA Healthcare has priority groups and eligibility for benefits is based on those groups. If funding changes occur, some groups may lose benefits. Before deciding on coverage, it is important to consider if you would be eligible for coverage later if you decide not to take that coverage now.
COMPATIBILITY WITH OTHER INSURANCE:
Not every type of insurance works with other insurance. Medicaid is considered the payer of last resort, meaning any other insurance must be billed before Medicaid will pay. VA Healthcare will only cover services provided within the VA Healthcare system and cannot be used to supplement other types of insurance. Depending on the size of employer, your employer insurance may be primary to Medicare. Before deciding on one or more types of insurance, it is important to consider whether taking multiple types of insurance makes sense for you.
Choosing your insurance coverage is a complicated, highly individual decision, especially for people who are eligible for more than one type of insurance. If you need assistance in comparing your insurance options or deciding which coverage is best for you, the SHIP program is here to help. Trained, unbiased counselors can help you examine all insurance for which you might be eligible and help you look at which ones might be best for you. To make an appointment with a SHIP counselor with the Area Agency on Aging- Five County, call (435) 673-3548. If you are not in the Five County area, you can find a SHIP counselor near you at www.shiphelp.org.
Amy Brinkerhoff has worked for the Five County Association of Governments for almost ten years. She graduated from Brigham Young University in 2008 with a degree in Sociology. Amy has been a SHIP counselor since her first week at Five County and now serves as Coordinator for the SHIP and SMP programs, where she offers one-on-one Medicare Counseling and teaches classes on Medicare topics and Fraud prevention.
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