Every year your Health Insurance Group with your company will have an open-enrollment period. This is the time when you can add dependents to your current plan, change your coverage and add on to the group if not currently a member. Most people try avoid this like a dental check-up, but you really should take advantage. You should not just go with whatever plan you have had for the past year, two years or since you started with your company because its easy you should see what other plan would work for your life style. There are a number of insurance plans and with employers raising health-insurance premiums while at the same time scaling back benefits, so you need to be proactive in getting all the information necessary and making sure you and your loved ones are properly covered, after all, you can’t change your mind until next year around this time.
Don’t find yourself paying $200 for your allergy prescription you were paying $25 for last year, check ahead of time, because after you check that little box next to your plan of choice it is too late to go back. Don’t let the pharmacist be the barer of bad news.
Here are some of the best tips out there when making a decision concerning medical insurance during the open-enrollment process:
There are changes that you can make to your health-insurance plan during open enrollment.
If you do not currently have a health-insurance plan, now is the time to get enrolled. If you do have a plan, now is the time to switch if you have the option to do so. At this time you also want to correct inaccurate information and make sure that your spouse and all of your dependents are also covered.
Cheaper Premiums vs. Less Expensive Co-Pays
Like with most things in life, this depends on your situation. If you are healthy and younger, you can go for the lower premiums for your chances of having to visit the doctor often are lower, However, if you are older, have certain health conditions or have young children who visit the doctor frequently, you are much better off with higher premiums and lower co-pays–this will save you a bundle in the end. Make sure to also weight the value of the price vs. your health plan. If you choose a cheap medical plan that does not pay for certain benefits that you need, you are getting a poor value for you will find yourself paying in the end.
Lifetime Maximum Benefit
A lifetime maximum is the cap on the amount of benefits available to each policyholder. This cap is put into place in order to keep the cost of benefits affordable and to stabilize potential future costs. There are a lot of health plans that cap lifetime benefits at $1 million and are most often applicable to mental illness, drug and alcohol treatment and organ transplants.
If your plan has a low lifetime maximum cap, make sure to think carefully about how much risk you are taking on. It is possible for you to be healthy now, but have large expenses from one severe accident that can exceed a $100,000 in no time.
Can I switch health plans without undergoing medical screening for pre-existing conditions?
Yes, but only once time during the year. All other time sin the year you will have to sit out a pre-existing condition exclusion period. Also, if you were to enroll late in a group health plan you May have to wait as long as 18 months for coverage or your pre-existing conditions.
HMO vs. PPO vs. POS
There are several different types of health-plans out there. There are traditional fee-for-service plans (FFS), health-maintenance organizations (HMOs), point-of-serve plans (POS) and preferred-provider organizations (PPO). There are benefits and disadvantages to each plan that are necessary to consider when making your decision.
The least expensive are HMOs, however they are also the least flexible. HMOs require that you select a primary-care physician. In order to see a specialist you must obtain pre-authorizations from your primary-care physician for certain medical procedures. POS plans are more flexible than this, but they still require you to select a primary-care physician.
PPOs give policyholders great financial incentive — in the form or reasonable cop-payments — as long as you stay within the group of practitioners. While you can visit doctors that are “out-of network” specialists with out pre-approval, it can be more expensive.
Drug formularies and Pharmacy Benefit Tiers
Formulary: a list of medications for which a health plan pays.
Most health insurance plans that pay for prescription drugs have pharmacy benefit tiers in place that group certain drugs together for pricing purposes. Brand-name drugs, are usually in the top tier, and are the most expensive; generic drugs dare in the lower tiers and are less expensive. Depending on your prescription drug co-pay for a medication, you may be $5 to $10 for a lower tier drug and anywhere from $25 and up for a higher tier drug. Most plans have have 4 to 5 tiers, but some have as many as seven.
FSA’s vs. HSA’s
An FSA is a flexible spending account. This is a benefit plan that allows workers to certain companies the opportunity to pay out-of-pocket health and dependent care costs on a pre-tax basis. Over time, this lowers payroll-related taxes for both the employee and the employer. Although, if you decide not the use the money you’ve set aside by the end of the year, you will lose it.
An HSA is a health savings account that is technically a trust. It is designed to let you set aside money specifically for health costs, while receiving a tax break. HSA funds not used within the year can roll over to help pay for future expenses in the next year.
What’s the best way to compare different plans?
When you are given a choice between plans the most important things to consider are price and whether your family’s doctor is covered in that plan’s network. However there are other important criteria to investigate.
There are accreditation groups, such as the National Committee for Quality Assurance, who measures plans using a variety of standards. There are also ratings companies such as Standard and Poor’s, A.M. Best and Moody’s, that help to give you a overall picture of a health plan’s financial strength. Consumer groups publish “report cards”of insurance plans as well.
What if I have questions about my health insurance plan?
Visit your human-resources department at work or your benefits administrator. If you go to your state department of insurance there are analysts you can speak with.
