It’s open-enrollment season. Are you signing up for health insurance right now? The information in this article can help you make sure you’re choosing a plan that meets your needs rather than one that may leave you high and dry.

Amber Turvey is revenue cycle director for Memorial Regional Health. This year, she and her staff have been seeing a rise in “junk” health insurance plans among MRH patients. Patients come to the hospital or clinics for care, and when they present their health insurance information, find that their plan actually covers little to nothing.

“I hate telling patients we can’t accept their insurance or that it has minimal or no coverage,” Turvey said.

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Health insurance red flags

Turvey said that it’s essential for health insurance buyers to read all the coverage details before choosing a policy. Here are some red flags to watch out for:

• “Repricing” plans — This is a type of healthcare plan that typically pays for no portion of care. Instead, the role of the repricing company is to negotiate with the health system on your behalf in an attempt to lower the amount you owe. But because these companies don’t have contracts with MRH, they are not actually in a position to receive a substantial discount.

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In recent weeks, a couple of patients with repricing policies received care at MRH. It turned out that neither policy paid any benefit. The patients — who had no idea that they didn’t actually have health insurance — ended up being on the hook for the entire bill.

• Cost-sharing plans — Medical cost-sharing programs (also called healthcare sharing plans) are not actually health insurance but instead an alternative to health insurance. Members pool their money to cover approved collective medical expenses. These unregulated plans are not legally obligated to pay healthcare costs and offer limited protections. Turvey said that in some cases, cost-sharing plans do function as expected, but make sure you research them to ensure they are a reputable company, and know that they do not cover everything and can expose patients to significant financial risk.

• No network plans — No network health insurance plans allow patients to choose their own healthcare providers and facilities rather than picking from a list of approved providers. Trouble is, typically these plans don’t have contracts with providers, which means providers are not obligated to accept the insurance. In addition, these plans are not regulated.

• Self-funded plans — These plans are usually received through an employer. Ask appropriate questions. Who regulates the plan?  Who are they contracted with?  If the administrator of the plan cannot answer those questions or states they do not have contracts, this can be another red flag.

Read the policy

Health insurance can be confusing, Turvey acknowledged, but it’s essential to read and understand the fine print before choosing a plan.

First, look for a plan that’s regulated by the Colorado Division of Insurance. These plans must meet certain minimum standards. Connect for Health Colorado is Colorado’s official health insurance marketplace, and all plans on this exchange are regulated by the Colorado Division of Insurance. The open enrollment window on the exchange goes through January 15, 2025.

Second, make sure you’re aware of the plan’s premiums, copays, deductibles and annual out-of-pocket maximums. If a plan doesn’t offer up this information, that should be another red flag. Also learn whether or not your local/favorite doctors, providers, and facilities accept the insurance. To find out if a healthcare plan has a contract with MRH, call the Billing Services office at 970-826-3133.

Third, before you choose a plan, get a second opinion. “My department can help you,” Turvey said. “Bring in your plan document, and we’ll sit down and go over it with you. Or just shoot me an email. We can’t tell you which insurance to buy, but we can help you understand the policy you’re considering and figure out if it meets your needs. We can give you an objective assessment. Not all plans are created equal.”