Open Enrollment Time

Open Enrollment Time

It’s the time of year when employees learn about new health care benefits or changes to existing ones. Don’t miss the opportunity to get as much information as possible about the particulars of each available plan, including cost.

Here are some questions you should ask yourself as you consider which health care plan is best for you and your family:

  • How much is the monthly premium? This is the price you pay per month for your coverage. Keep in mind that lower premiums don’t always mean lower overall medical costs
  • What are your anticipated medical needs for the coming year? Estimate how often you need to see your medical team and what scans and tests will be required. Factor in your pharmacy and medical equipment costs, if any.
  • How much will you pay for services? Become familiar with the following terms:
    • Cost sharing—the arrangement that defines how you and your insurer pay for health care or medical equipment. Co-insurance, co-payment, and deductibles are all forms of cost sharing.
    • Co-Insurance—the percentage of the bill you must pay for medical care. For example, if your co-insurance is 20 percent, the plan will pay 80 percent of a medical bill and you will pay the rest.
    • Co-pay—the fixed amount you pay for medical care, often at the time of that care. The co-pay may be different for a doctor’s visit, an emergency room visit, and the cost of a prescription.
    • Deductible—the amount you have to pay in a calendar year before your health plan begins to pay. For example, if your deductible is $1,500, you must pay that amount for covered health services before your insurer will begin to pay your health care costs.
    • Out-of-pocket maximum—the most money you will have to pay for covered services in a calendar year. This amount varies based on your plan, so read the fine print. Some plans omit the deductible, co-insurance and co-payments from the total, which can drive up the actual amount you will have to pay.
  • Is your doctor included in the plan’s network? All insurance companies work with a network of physicians. If you visit someone out of that network, the insurance company may not cover the entire cost of your medical bill, or they could deny your claim completely. It is also important that your insurance plan network includes health care facilities and medical specialists in your area. Traveling long distances for care may be a hardship, or it may not even be possible, which may result in cancelled appointments or delayed care.

If you receive a cancer diagnosis, ask if the health plan covers a second opinion. Find out if you can choose your own specialists or switch doctors if you are not happy with the care that is provided.

To help pay for some of your expenses, ask your employer if a Health Savings Account (HSA) is offered. These accounts allow you to contribute pre-tax dollars to pay for your care, and the funds roll over from year to year. Another option your employer may offer is a Flexible Spending Account (FSA), which is based solely on employee contributions up to a specific amount. FSA funds need to be used within a calendar year and cannot be rolled over.

Have questions? Ask your human resources or employee benefit representative; they are wonderful resources to help you determine which plan is best for you.