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I get questions every day about individual health insurance plans, whether naturopathic care will be covered under the new plans, and whether someone should stick with their current healthcare company or switch. Note that all individual subscribers must choose a new plan before December 2013, and coverage begins January 1st 2014. If you get health insurance through your job, or through a spouse’s job, there will likely be no change needed. Here are some key issues you should consider when choosing a new individual plan.
Ask whether the plans you are considering will cover naturopathic care. Plans from Oregon’s Health Co-Op, Pacific Source, and Moda look like they have reasonable coverage for naturopathic medicine, and some have coverage for acupuncture and/or chiropractic. Oregon’s Health Co-Op will cover email and phone visits with your ND, too, and will allow your ND to serve as your primary care provider.
Ask about the max coverage for naturopathic medicine. Oregon’s Health Co-Op will cover me, or another in-network ND, as a primary care physician with unlimited coverage. Moda has a $1000 max on many of their plans for alternative care coverage. Pacific Source covers office visits with an ND as they would for an MD, but they will not cover other treatments under many of their new plans (craniosacral and Maya Abdominal therapy, for example, may not be covered).
Due to limited coverage and stringent pre-authorization standards, I cannot recommend Health Republic plans or Providence ASH plans, both of which go through the ASH network. Should you choose Health Republic or Providence ASH, your alternative care options will be very limited.
Is your preferred doctor in-network? Pacific Source and Moda have established networks, whereas Oregon’s Health Co-Op is a new plan. I have applied to be in-network with Oregon’s Health Co-Op, but have not yet been added to their network. I am in-network for Pacific Source and Moda.
Do you qualify for a subsidy? If your income is under a certain threshold for family size, you can reduce your out of pocket cost for an individual plan by applying for coverage through Cover Oregon.
Apply for coverage through an insurance broker to make sure you have the coverage you need. There are many options out there! This is at no cost to you, and you have an expert on your side.
Ask me if you have questions about a specific plan or company. We can talk about options at your next scheduled visit.
Resources for your health insurance questions or applications:
Brokers: two that I trust and have used myself
- Sue Ober and Associates specialize in individual plans
- Jennifer Wakayama specializes in sole proprietor, LLC and small business plans
Helpful sites:
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