Health Care Article | Transamerica

Is Your Medical Coverage Plan Meeting Your Needs?

You likely receive an annual medical checkup to evaluate your personal health. Why not do the same with your medical plan to make sure it meets the needs of your current life stage?

First, identify exactly what’s covered by your plan

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Health care coverage can be quite complex and it’s important to evaluate if your current plan is meeting your needs.  Ask yourself the following questions to help determine if your current coverage is meeting your needs:

  • Are you currently only covered for basic needs? Would you benefit from more comprehensive coverage, including physicians services and prescription benefits?  
  • How frequently do you visit the doctor? You may be paying higher premiums which would result in lower co-payments, but if you don’t make frequent use of your coverage, this may not be the best approach for you. 
  • Do you need easy access to specialists? If so, does your plan require that you get a referral?
  • Do you have a specific doctor or hospital that you prefer? If so, are they in the network that your plan utilizes? 
  • Do you know what your out-of-pocket maximum is? Is this meeting your needs?

Second, explore your options 

If you think that you current coverage isn’t meeting your needs, find out what other options may be available. If you are working and covered through your employer talk to your human resources or benefits representative to find out if there are other options available.  If you are nearing retirement, find out if you qualify for retiree health care benefits through your employer.  Are you entitled to VA benefits? Here are some other ideas to consider:

  • Spouse’s coverage. If your spouse is working, you may be able to get health insurance through his or her employer. Perhaps their coverage will better suit your needs. Just remember that you’ll only be able to make changes during the annual open enrollment period or when you experience a qualifying change in status, i.e. loss of coverage, marriage, birth of a child, etc. 
  • Private insurance. While it can be expensive, the benefits of private insurance would likely outweigh the consequences of no coverage. A simple online search can help you determine your options for private insurance.
  • Health Insurance Marketplace.  The Affordable Care Act (ACA) was designed to expand medical insurance coverage to Americans who don't already have it by offering affordable and competitive rates through a newly created Health Insurance Marketplace and providing subsidies to eligible individuals who purchase coverage. The main aspect of the ACA is the mandate that insurance companies accept all applications, regardless of any pre-existing condition an individual may have. The law also forbids insurers from dropping individuals if they become sick and prevents companies from placing annual or lifetime limits on coverage. The Health Insurance Marketplace is an online resource for individuals and families to compare and purchase health care insurance. Individual states may have their own Marketplace and coverage and pricing will vary by state. For more information visit www.healthcare.gov

Third, compare options! 

Once you’ve explored your other options, compare them against what you think you’ll need and what your current coverage is to determine if it makes sense to make any changes. 

It’s never too late to start thinking about and planning for retirement. Investing in the appropriate health care coverage now will help keep you on the right track for a successful and more sustainable retirement.