Open enrollment has arrived. For many people, now’s the time to select next year’s health insurance.
If you or a family member needs frequent medical care, due to a disability or chronic health condition, your policy decision can be especially important—and, in some cases, especially confusing. Carefully weigh your options before you pick a plan.
More Than Money
Your insurance choice comes down to more than dollars and cents. Compare plans’ other aspects, too.
Covered Services Matter
Your needs might require that you have coverage for certain types of care—for example, rehabilitation therapy, prescription drugs, or chronic disease management. Check the summary of benefits document to find out what a plan does—and doesn’t—cover.
Know Who’s in the Networks
A plan’s copays, coinsurance rates, and out-of-pocket maximums might vary depending on whether you use providers and facilities from its network. If you have preferred providers or facilities, check to see if they’re in-network for any plans available to you.
To calculate total costs for the plans you’re considering, try to compare “apples to apples.” That means taking into account all parts of the equation—including premiums, deductibles, copay and coinsurance amounts, and out-of-pocket maximums.
Keep in mind:
- If you don’t need a lot of health care, you might not reach your deductible over the course of the year. In that case, your annual cost would include your premium payments plus any health care expenses you incur during the year.
- If you need a lot of health care during the year, you might reach not only your deductible, but also your out-of-pocket maximum. In that case, your annual cost would include your premium payments plus the out-of-pocket maximum amount. Health care expenses beyond that would be 100-percent covered.
- With some plans, you might be able to open a flexible spending account (FSA) or health savings account (HSA), allowing you to save pretax money to pay health care expenses. Your employer might offer to contribute to these accounts. If so, as you compare the costs of your options, remember to factor in that money you’ll receive.
- In a low- or no-deductible plan, medical bills might be lower (just copays or coinsurance amounts) than they would be in a high-deductible plan, where you pay full amounts until you reach your deductible. However, when you calculate each plan’s total cost—including premiums, employer contributions, etc.—the high-deductible plan might cost less, overall.
Ask for Help
Health insurance decisions are complex. If you’re unsure about which plan to choose, contact the insurance companies to ask questions, or seek help from someone who can offer expertise—such as a human resources staff member, a social worker or a financial adviser.