Navigating for Health Insurance

Patient Expert

I recently had the “joy” of navigating for an individual insurance policy. I put joy in quotes because shopping for health care is not particularly fun, regardless of the company you pick or the site you use. It is often complicated and stressful and with the added pressure of picking the right plan for your unknown future needs; picking out health insurance is enough to make me want to up and move to Europe where I don’t even get a choice.

As a patient with two chronic illnesses, I don’t have the option of choosing not to purchase insurance and to risk the fine. Speaking of the fine - if you were considering going without health care the fees have changed for 2016 and have practically doubled. In 2016 should you choose not to have health care, you're looking at $695 per adult and up to $2,085 for a family in penalties.

Instead of passing up on health care this year, take a look at a few of the tips I've put together to help you pick the best and most affordable plan.

Educate yourself on healthcare terminology before you start

If this is your first time buying insurance you may not know what a premium is or what in-network and out-of-network means. Take a few minutes and read this great guide that has all the important health insurance terms that you will need to know.

Have important documents handy

If you haven't already started your application for 2016, make sure that you compile all of your information before you start just to make your life easier. They will ask questions about your household size, social security numbers, and some information about your salary and tax exemptions. You want to make sure you put all of this information in correctly because you may qualify for a tax credit towards your monthly premiums.

Input your doctors and medications

There is an option once you've setup your account to input your current doctor's names and medications. I'd recommend doing this prior to shopping insurance plans because each plan will tell you before you pick it if your specific doctors/medications are covered. This saves you time and frustration. I didn't realize this was an option until after I had already started shopping and once I went back in and added this information, it made it a lot easier to sort through my first choice in plans based on my current medical team.

Know your budget

My first instinct is to go straight to the platinum plan options and pick the Rolls-Royce of health insurance. My bank account, however, did not support this method. Before you actually start shopping, take some time to create a realistic budget for you and your family’s health insurance. Unfortunately, some of these plans are still very expensive and as patients who needs health care we might have to make some exceptions on our coverage in order to stay within budget.  You can start at the top by narrowing down the options by “Platinum” plans. These are the plans that give the most coverage, have the lowest deductibles but the highest monthly premiums. When considering your monthly premium, make sure to look at your prescription coverage and do the math on how many medications you currently take and add that to your monthly costs.

Use the compare feature

Once you've narrowed your options down to a few choices, use the compare feature to see the differences between the two or three plans that you are considering. Make sure you look at what doctors they accept (this is where entering in your doctors/meds into the system becomes helpful) and to click on each company's detailed list of prescriptions they cover. For example, you may find a great company at the perfect price but they only cover three out of four of your doctors. This is where you may have to make some tough choices.  Is the doctor that is not covered your PCP? Are they your colorectal surgeon? What is the level of importance of this doctor in your life and are you willing to replace them for the right insurance plan? This same ideology goes for covered medications. Does this plan cover your very expensive medications? What about your very cheap medications? Would you be willing to pay out of pocket for some medications but not others?

Call the insurance company and ask real questions

The website does a very good job of giving a brief overview of each plan, however I had some more detailed questions that I felt more comfortable calling to get answers for. Make sure you write down the detailed name of the plan before you call because many of the providers offer similar plans of similar names in different states (confusing, right?). For example the Blue Cross Compass 250 plan might not be the same as the Blue Cross Platinum 250 plan. You can call and ask for a detailed breakdown of your expected costs and to double check about coverage for your specific doctors if you’d like. There is no harm in gathering as much information as you can before make this very important purchase.

Call your doctor

I have found in the past that my insurance company’s website said that one of my doctors was covered under their plan, however the doctor’s office itself said they did not take my insurance. This is the result of the insurance company not updating their website regularly which can be frustrating and lead to some unexpected costs. Before you choose a plan, I would recommend taking the time to call your specific doctors, telling them about the switch in your insurance and just double checking that they will take your new plan. If they do not take your new plan, this is a good time to discuss possible out-of-pocket costs if this is a doctor you do not want to change.

Follow deadlinesThere are some very specific deadlines when it comes to picking insurance and making sure you’ve made your first payment. ** December 15th is the last day in 2015 that you can enroll in a plan for coverage that will start on January 1st, 2016.** It is worth noting that even if you’re on top of your responsibilities like hitting deadlines and paying your premium right away the process to confirm your insurance can be slow, which is why it’s helpful to get all your information in well before the deadline. Your application submitted through takes time to get sent over to the provider that you choose, they then take a few days to process your application and make sure you’ve paid. When you’re waiting for confirmation that your insurance will actually be available on the 1st of the next month this process can be grueling. Do yourself a favor and just make sure you’ve got everything in on time.

Overall I will say that the process of purchasing health insurance through the Marketplace was not as cumbersome as I had expected, though it wasn’t flawless either. Planning ahead will make this process a lot easier for you and hopefully much less stressful than it could be! Here’s to a happy and healthy 2016.

Jackie has been living with UC since 2009 and her J-pouch since 2011. She is the founder and executive Director of Girls With Guts, a non-profit that supports women with IBD and ostomies. She also blogs about her life with IBD and MS at

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