Whether you are updating your current coverage or enrolling in a personal health insurance plan for the first time, open enrollment is right around the corner. Now is the time to get prepared so that you can get a plan that works for you without waiting. Below we provide some tips on how to prepare for open enrollment, as well as an essential checklist to get you started.
Know the Basics of Health Insurance
When enrolling in health insurance, remember the basics of insurance costs, as they can affect how much you pay for coverage and medical treatment.
Monthly Insurance Premium
The monthly cost you must pay to maintain your health insurance coverage. This is often referred to as a monthly premium.
Copayments and coinsurance
Payments you make each time you get a medical service.
Deductible
How much you spend on covered services before the insurance company pays a portion of the covered services (except for free preventive services).
Out-of-pocket maximum
The most you spend on covered services in a year. After you reach this amount, the insurance company pays 100% for covered services.
It is important to understand how your health insurance policy works so that you know exactly what you will be paying for every time you visit the doctor. Your health insurance broker can go over the different types of plans available (HMO, PPO, etc.) and help you understand what your plan will cover and what it will not cover. They can also help you save money while maximizing your coverage through the right provider.
Which Health Insurance Plan is Best for Me?
You may be wondering which health insurance company is the best? When choosing a plan, you first need to assess your personal healthcare needs, look at all your options, and choose a health insurance plan that fits in your budget. How do you determine which health insurance is best? Ask yourself these questions:
- How often do you visit your doctor?
- What type of treatment do you need in the next 12 months?
- What prescription drugs do you currently take?
- Which healthcare providers/physicians do you prefer?
Once you decide your healthcare needs, you can narrow your search to health insurance companies in your state.
Health Insurance Checklist
Below are some things you need to consider as you get ready to update or enroll in your health insurance plan.
Health Expense Audit
Review all expenses from the previous year.
- Premium
- Copays
- Deductibles
- Out-of-pocket payments
Calculate estimated expenses for the new plan year. Discuss potential changes in your treatment plan for the upcoming year with your doctor before calculating estimated expenses.
Benefit changes.
Review the summary of benefit for coverage changes from the previous year.
- Office visits
- Prescription drugs
- Hospital or lab services
- Preventative health
- Physical and occupational therapy
- Mental health services
- Medical equipment
Paying the same monthly premium as the previous year doesn’t mean that the same benefits are covered or at the same level. For example, your physical therapy coverage may change from 12 visits per year to three visits per year. Never assume that premiums, deductibles, copays and coinsurance are the only differences between plans, even when the plan is offered
Premium and Deductible
Check for changes in your monthly premium and/or annual deductible. You may have separate medical care, drug and durable medical equipment deductibles. Usually, a lower premium means a higher deductible.
Copay and Coinsurance
Check for changes in copayments or coinsurance (the percentage you must pay for services) for your most commonly used services and products and well as for emergency and hospitalization services
Prescriptions
Make sure the drugs you take are on your plan and check which tier they are on. Your primary drug may be moved to a higher tier and that means you may pay more money out of pocket.
Provider Network
Never assume that your providers are still in-network even if the plan is offered by the same insurer. Always ask your provider’s office to confirm, because sometimes the insurers’ online directory may not be up to date. A provider is not automatically in-network for all the plans that an insurer provides. For example, a provider may participate in the insurer’s PPO plan but not the HMO plan You will also need to confirm the in-network pharmacies and lab facilities.
Flexible Spending Account
Check if your employer offers an FSA. Find out the grace period and rollover policy so you don’t lose unspent balances.
Health Incentive Programs
Find out whether your employer offers a financial incentive for good health practices e.g. exercise, healthy eating and weight management. These monies can be applied to out of pocket expenses.
Spouses and dependents
If your spouse, dependents or adult children under age 26 are currently covered through your employer-sponsored plan, make sure that your employer is still extending coverage to these beneficiaries. Also, see if your employer has changed the amount they’ll contribute toward dependents’ monthly insurance premiums. If your spouse’s employer offers insurance, compare costs and benefits with your current plan.