How to Navigate health Insurance

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By Caralee Adams

Life after being diagnosed with a heart condition is challenging enough. Having to figure out health insurance can add another layer of stress. Here are some tips for getting the most out of your insurance coverage.

Do your homework and plan. Insurance plans vary widely, so it’s important to study the details of your plan so you understand your coverage and responsibilities. “It is confusing at every stage of the game, from choosing a provider to chasing down all the paperwork,” says Gail Shearer, director of health policy analysis for Consumers Union.

Zero in on any mention of “pre-existing condition” in your plan. Look closely at coverage for hospital bills, rehab, medication, and other issues related to your heart condition. There may be a certain hospital, doctor, or prescription drug that you prefer. If your plan doesn’t cover particular providers, consider how much you must pay to go out of network, and put money aside for extra medical expenses.

If you have coverage through your employer, consult with the benefits office to navigate the system. If it’s too overwhelming, consider a private consultant. If you are a senior citizen, contact AARP, Area Agencies on Aging, or your state’s State Health Insurance Assistance Program (SHIP) for help. If individual coverage is too costly, a state-sponsored “high-risk pool” may be the answer.