3 Signs You Have the Wrong Health Insurance Plan


The Affordable Care Act has been implemented, and open enrollment is over. The numbers indicate that 8 million people now have health insurance who didn’t before, but the marketplace was a mess for a while, especially when Obamacare deadlines kept changing.

But health insurance has always been confusing. The terms deductible, summary of benefit and explanation of benefits have vexed consumers for years. What if this confusion and procrastination led you to purchase the wrong plan? Well, if you purchased insurance through the federal marketplace, you may not be able to change it unless you have a qualifying life event, including changes in income, moving out of state or having a baby. If not a lot changed for you this year, you’ll have to wait until the 2015 marketplace opens on Nov. 15.

Since health insurance is so confusing, it may be the case that you just don’t know whether yourinsurance plan is right for you. There’s no shame in that, and it doesn’t just go for new health insurance enrollees, either. It’s easy to imagine people with employer-sponsored plans picking the least (or most) expensive plan their employer offers and never give it another thought.

Here’s how to tell if your health insurance plan, no matter how old, is the wrong one for you and your family.

1. You would go to a different doctor if you could afford it.

Do you wish you could go back to your old doctor, but he or she isn’t in your network? Many Americans distrust their doctors, but trust is an important component in the patient-doctor relationship, so it makes no sense to stay with a doctor you don’t like or distrust. If you avoid visiting your doctor or haven’t chosen one since your current health insurance kicked in because you wanted to stick with your old doctor, it’s a clear sign to change plans.

Maybe you’re not pining after an old doctor because you feel like you’ve never had a really great physician that you liked and trusted completely. A lot of people may choose a doctor close to home or work who will take their health insurance or just rely on a friend’s recommendation. Sometimes this works out, but you don’t have to keep your doctor out of convenience and habit if you think there might be one out there who understands you better. A good doctor is worth the time you take to find him or her, and if you find one outside your insurance network it’s reasonable to think about switching plans.

2. You travel a lot and worry when you do.

Whether it’s for business or pleasure, if you’re a frequent traveler who worries about getting hurt or sick when you’re away, it may be an insurance red flag. This is especially relevant for individuals or families with health maintenance organization or exclusive provider organization plans. HMO and EPO plans are so restrictive that except in the case of certain emergencies, policyholders must stay in-network or pay medical fees in full.

These plans work for some people, as they tend to cost less in copays and premiums than other more flexible plans. That said, they don’t work for everybody, and which type of health insurance you have matters. Take a moderate or frequent traveler who may occasionally need medical attention that isn’t an emergency, like a trip to a clinic for a migraine or minor infection. EPOs will deny coverage in the case of certain serious emergencies if you go out of network – all in the name of keeping costs low. If the low cost of an EPO or HMO doesn’t seem worth the risk for your lifestyle, you may want to consider a different type of plan.

3. You avoid seeing a doctor to avoid costs.

If your copays are so high that you don’t have enough room in your monthly budget to squeeze in a doctor’s appointment, you may want to examine your other options. Even if your employer is covering part or all of the premium, it may be worth it to make room in your budget and pay for an upgrade. The monthly cost increase might be worth it if more of your services are covered so you and your family are up to date on physicals. 

What good is health insurance if you don’t use it, anyway? It’s there so you can afford to have a qualified professional catch any illness or injury around the corner and the ones you may not know you already have. Preventive care is becoming the new norm in health care, and it’s for good reason: You don’t want to be stuck with the stress, the pain or the bill if a little problem becomes a big one down the road.


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