I Think I Signed Up for the Wrong Insurance Plan – What Should I Do?

If you’re unsure about the insurance plan you chose, or you’re having regrets because you found a better option, you may be wondering what your next steps are. Do you have to wait until the next health insurance enrollment period? Are you stuck with an insurance plan you no longer want? This guide explains what to consider.

1. Evaluate Your Current Health Insurance Plan

First, evaluate your current plan to determine that there really may be a better option available to you. Consider specific health insurance details, including:

• Health insurance monthly premium cost
• Health insurance deductible
• Health insurance plan doctors available
• Health insurance plan copay costs
• Health insurance plan out-of-pocket maximum

Think about the answers to these questions:

• Does your current plan fit your and your family’s healthcare needs?
• Can you see the doctors you want to see?
• Do your healthcare plan’s costs fit your or your family’s budget?

It’s also important to look at the type of health insurance plan you signed up for. The three main types of health insurance plans are health maintenance organization (HMO), preferred partner organization (PPO) and exclusive provider organization (EPO). You may want to switch from one type to another based on the details explained below.

HMO

An HMO health insurance plan requires that you select a primary care physician who is your main healthcare provider. 

If you need to see a specialist doctor, your primary care provider will need to refer you to that specialist in order for your healthcare expenses to be eligible for health insurance coverage. If you see a healthcare specialist without a referral, or one who’s outside of the HMO network, you’ll likely be responsible for all the costs associated with your visit or treatment.

PPO

A PPO plan has a preferred list of providers for all types of physicians. If you’re on a PPO plan, you’re not required to see a primary care provider, and you don’t need a referral to see a healthcare specialist. 

If you see a doctor on the preferred list of providers, you’ll likely have a larger portion of your bill covered, compared to if you choose to see a doctor who’s not on the preferred list of providers.

EPO

An EPO plan is like a hybrid of an HMO and a PPO. EPOs may be less expensive than other plans, but they may be more restrictive in the doctors you can see. You don’t need a referral to see a specialist on an EPO plan, but you will be responsible for covering out-of-network costs.

2. Compare Your Current Plan to Other Available Plans

Once you’ve clarified the details of your current plan, you can compare them against what else is available. To understand the other options that may be available, look at your current insurance provider’s options to see what other types of plans they offer. 

Answer the same questions above to compare your answers. In particular, pay attention to the following.

Are you paying a lot of out-of-pocket costs?

If your health insurance out-of-pocket costs are high, you may want to consider switching to a health insurance plan that has a higher monthly premium but that offers lower out-of-pocket costs.

You may find yourself in a situation where you’re paying a lot of out-of-pocket expenses because you require frequent medical visits, or you need a lot of prescriptions filled. If your family’s health situations require a lot of healthcare and/or prescriptions, you may want to look for a plan with lower out-of-pocket costs.

Are you paying high health insurance premiums, but you’re not close to reaching your deductible?

If you pay high monthly premiums, but you never come close to meeting your deductible, you may be able to get the healthcare coverage you need with a plan that has a lower monthly premium amount and a higher deductible.

Keep in mind that choosing a higher deductible health insurance plan could cause issues if there’s an unforeseen emergency or an expensive medical event you have to deal with. Make sure to weigh the cost versus the risk to make a decision you’re comfortable with.

Are your preferred doctors out-of-network?

If your preferred doctors are out-of-network with your plan, you’ve likely signed up for the wrong plan. You can try to find a plan in which your preferred providers are in-network. Otherwise, you may have to pay a lot of out-of-pocket, depending on how frequent your visits are.

3. Begin the Process to Change Plans

When you determine you want to switch health insurance plans, you can begin the process to change what you have. You may currently have a plan through your employer or through your spouse’s employer. Or, you might be on an Affordable Care Act (ACA) plan. Or, you might have a private health insurance plan, like through an individual health insurance plan or family health insurance plan. 

If you have a group insurance plan through work, or your spouse does, contact the human resources department to check about the possibility of modifying your choices.

When that’s not an option, you may qualify for a special enrollment period for healthcare insurance. Special enrollment periods are offered to those who have experienced a qualifying life event, such as a marriage, divorce, death or job change. You typically have up to 60 days after a qualifying life event to switch healthcare plans.

If you’re outside of the health insurance open enrollment period, and you don’t qualify for a special enrollment period, you may have access to private health insurance plan options that could better meet your needs. The insurance experts at AZ Health Insurance Brokers can help you determine:

1. Whether or not there’s a better health insurance plan available to you, in terms of healthcare coverage, costs or both
2. How you can get better healthcare coverage if you missed the open enrollment period

There’s no cost to talk with a health insurance expert at AZ Health Insurance Brokers. Call 602.617.4107, or contact us online or email quotes@azhealthinsurancebrokers.com.