What do I need to look for in a health insurance plan?
The Tradeoff: Lower premiums mean higher out of pocket costs
The major choice you need to consider is the tradeoff between the cost of your monthly premium and the cost of your out of pocket expenses. The premium is what you pay each month to have health insurance, with a setup similar to how many people pay their car insurance each month. Depending on the health insurance plans you are looking at, your monthly premium might be higher or lower. There is a tradeoff between this and your out of pocket costs. Out of pocket costs are what you pay on top of your premium when you access health services.
For example, each time you go to a doctor’s visit you usually need to pay a "co-pay" for the visit. This is a fee that is on top of what you already pay in your monthly premium. Usually if you pay a higher monthly premium, you have less out of pocket cost. This is a good option for individuals and families who have a lot of health care needs, or more complicated medical conditions that require more care. On the other hand, some people who don’t need medical services as often might choose for a lower monthly premium, which means that their out of pocket cost is higher when they do need medical attention.
Provider Networks – How do I know if my doctor is in my new network?
Each insurance company works with a different network of health care providers. If you have a close relationship with your doctor, you will want to make sure that he or she is still going to be in the network of your new health insurance plan. This also applies to different hospitals.
This issue is really important if you live in a rural area. For example, if you need to see a cardiologist every few months, you will want to make sure that there is one available nearby in your health insurance plan network. If the nearest cardiologist was 100 miles away from your home, you would have to drive there to stay in network.
When you are comparing plans, make sure that you ask the insurance company or Managed Care Organization (MCO) about their provider network.
Where do I find health insurance?
There are several options available if you do not currently have health insurance. Starting October 1, 2013, you will be able to enroll in new Health Insurance Marketplace. You may also qualify for tax subsidies on this marketplace if you are within a certain income bracket. HealthCare.gov is a great resource if you have any questions about how this process works.
If you have a high-risk condition, you may qualify for the state high-risk pool. They are a great resource to ask questions and get referrals. You can visit their website here.
- More resources for finding health insurance:
- NM Health Insurance Consumer Assistance Program: 1-855-857-0972
- HealthCare.gov en Español: cuidadodesalud.gov
- Families USA: National health policy information & consumer resources
- Email Comments on Health Insurance Marketplace in NM to NM Office of Health Care Reform:
- My Community NM - Community health & social services resources in New Mexico (English & Español). Website here
- New Mexico Public Regulation Commission Division of Insurance: Provides access for consumers to reliable insurance products which are underwritten by dependable and financially sound companies. Website or 1-888-427-5772.
- New Mexico Center on Law and Poverty - Works with low-income New Mexicans to improve living conditions, increase opportunities and protect the rights of people living in poverty. Website here
- Native American Professional Parent Resources, Inc. - Provides culturally sensitive and appropriate services to Native American families in Albuquerque and surrounding areas. Website or (505) 345-6289.
- Indian Health Service - The federal health program for American Indians and Alaska Natives. Provides access to interactive map that can be used to find IHS, Tribal or Urban Indian Health Program (UIHP) facilities located in New Mexico. Website here
- Albuquerque Health Care for the Homeless - Provides primary health care services for the homeless at its freestanding medical clinic, 505-242-4644. Website, (505) 766-5197, or
- The Inspection of Public Records Act, providing the public with access to information about governmental affairs. Website here