Taking a closer look at your health insurance coverage each year, and doing an audit of your current policy, is a good practice to adopt to ensure that you are getting the best coverage at a great price.   Once armed with the facts, you can determine if you should stay with your current health insurance company or if you should search for other alternatives.

Doing your research and reviewing the pros and cons of each alternative is crucial. There are several factors that will come into play when making your final decision to keep your health insurance company or find a new one.

If you currently get your coverage through your employer’s plan then you may not have much say in the plan options or insurance company that is being offered to you.  If you decide you don’t like the health insurance option that your employer is providing to you then you do always have the option of leaving this plan in search of an individual plan on the market place.

Something to keep in mind, an individual plan may give you the freedom to choose your own insurance company and a variety of plans but that doesn’t mean that the premium you pay will necessarily be cheaper than the plan offered by your employer.  Employer sponsored plans must pay a portion of the employee’s premium when the employee is enrolled on their plan. But, the employer can no longer contribute to the employee’s premium when they opt out and enroll on an individual plan.   Although individual plans historically have been much cheaper due to carving out benefits, the trend is beginning to change now that the ACA (Affordable Care Act or “Obamacare”) requires mandated essential benefits and guarantee issue coverage on all individual and employer sponsored plans in the small market.

If you decide to take your search to the open market for an individual plan, here are some things to consider:

Plan options

Do you like the current medical plan that is being offered to you?  Look at all of the benefits that it provides and determine if these benefits are meeting your needs.  If you want a plan with different benefits, can your current insurance company provide this type of plan for you, or will you need to search somewhere else for alternate options?

Price

Benefits and price generally rank as the two most important factors when deciding to stay with an insurance company.  In the past, all benefits being equal, the company with the lower price would gain the customer.  Since the inception of The Affordable Care Act and the four tier pricing concept of platinum, gold, silver and bronze, you may find that the differential in pricing between companies may be much more comparable.  This means switching to a different health insurance company might not yield double digit savings any longer.  However, the possibility of saving 5 percent or more may be worth taking a second look.

Claim Payment

Think back to the claims that you have incurred over the last year and do a mental review of how your current insurance company performed at processing and paying your claims.  Were they paid quickly and without error?  There are general insurance industry standards when it comes to how quickly a claim is paid.  Most small claims are automated and payment can be made within a few days.  Larger, more complicated claims may take a little longer.  If your insurance company met or exceeded the company expectations set for claim payment then you should count this in the win category for staying with them.

Customer Service

Claim questions and disputes are by far the most frequent reason why a person generally contacts their health insurance company.   Sometimes there may be a need to ask a question or get some additional information about your coverage or plan in general.  If you have contacted your insurance company with any of these issues you probably have a pretty good feeling for the level of customer service they provide to their customers.

Your acceptable level of service may differ from others.  If you are someone that likes to speak to a real person and you find yourself instead navigating through a long list of prompts prior to being connected this may be a customer service nightmare for you.  On the flipside, if you are one who is more comfortable in using technology to get your answer and you can do this by going to their online website or through their automated phone system then you may consider this a positive customer service experience.

In the end, the decision to stay with your current health insurance company or to search for another alternative is an important decision.  Knowing what your current health insurance company has to offer in comparison to others in the market can go a long way to making a smart, educated decision.

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