How to Review Your Health Insurance Plan img

How to Review Your Health Insurance for Open Enrollment

Now that open enrollment is officially closed, your health insurance plan is ready for the next year. That means that you can’t make any changes to your policy until the 2022-2023 open enrolment period. However, if you have private personal or small group health insurance, you have the flexibility to make adjustments to your policy as you go.

It is a good idea to review your health insurance policy at least once a year to make sure you have adequate protection for current or emerging health needs. You may want to check your policy’s coverage, shop around for a better plan, change healthcare providers, or add to your policy if you have prescription drug updates.

Below are some tips for reviewing and updating your health insurance plan. If you have any further questions about your current policy, feel free to contact Insurance Enterprise.

What to Consider When Reviewing Your Health Insurance Policy.

There are essentially five main areas you need to consider when reviewing and updating your policy.

1. Type of Plan and Provider Network

Do the health care providers, hospitals, and pharmacies you prefer fall within your plan’s network? In-network services and medicines are covered under a plan, while out-of-network services and medicines may require additional out-of-pocket costs or may not be covered at all.

Out-of-pocket costs for out-of-network services may not count toward your plan’s out-of-pocket maximum. Check to see if your preferred primary care or specialist provider and the pharmacy near your home are in the plan’s network.

2. Premiums

Premiums are the amount you pay an insurance company for coverage, whether or not you use medical and pharmacy services. You typically pay premiums monthly, and if you stop making payments, you risk losing your coverage.

These are not the only costs associated with coverage. You will also be responsible for paying deductibles and for cost-sharing. Co-pays and coinsurance for most health care services and treatments.

3. Deductibles

The deductible is the amount you pay out of pocket before your coverage kicks in. Out-of-pocket costs may include specialist visits, procedure fees, and in some cases, even prescriptions. Certain preventive services, such as approved cancer screenings and vaccines, are typically covered with no cost-sharing before reaching your deductible.

If you select a plan with a high deductible, you will most likely have a lower monthly premium. Lower deductibles often have higher monthly premiums. Many insurers require you to meet a deductible before covering medical or pharmacy services.

Most insurance plans have the following deductibles:

  • Single deductible
  • Combined deductibles for medical and pharmacy
  • Separate deductible for pharmacy

Be sure to check with your insurer to know if your plan has either a single, combined deductible or a separate deductible for prescriptions.

4. Co-pay or Coinsurance

You may be responsible for other out-of-pocket expenses even after you reach your deductible. Common medical expenses include:

  • Coinsurance – a percentage of costs you must pay for a medicine or service
  • Co-pay – flat fees you are required to pay for prescriptions or covered services

5. Prescription Coverage

Each insurer has a list of medicines covered by the health insurance plan. If a medicine is not on the list, it may not be covered. You will have to go through a potentially lengthy process to obtain coverage. The list of covered medicines is in tiers, which determine how much of a co-pay or coinsurance you may have to pay.

Make a list of your current medicines, and compare it to the plan’s formulary to make sure your medicines are covered and you understand the out-of-pocket costs associated with them.

Contact Insurance Enterprise for Premier Health Insurance

If you have questions about group or individual health insurance and need health insurance quotes, contact Insurance Enterprise at 888-350-6605. Speak to a licensed agent and find out more about how you can get an affordable health insurance plan.

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