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Eyes Wide Open For Open Enrollment

It happens every year. The ‘big’ open enrollment insurance benefit envelope arrives and you can’t help but feel you should be thinking a little harder about which plan to choose, but aren’t exactly sure what to ‘think’ about.  You aren’t alone.  Every year the family premium has gone up (usually around 9%), and this year, on average, deductibles are rumored to go up 7%. So, yes, you should be thinking before choosing.

Choosing Your Open Enrollment Benefits

Let’s break this down. Some of the things to consider about the open enrollment options are obvious, others not so much.  The Obvious:

  • Make sure your doctor is still on the plan, since an in-network physician is certainly cheaper than an out-of-network provider.
  •  If you take a regular prescription drug, ensure it’s still covered.
  • Check out any new prior authorization stipulations.

Now, let’s cover the not-so-obvious things, you might forget to consider. The Not-So-Obvious:

  • Step children-plans vary on coverage for step children, so remember to find out your plan’s coverage.
  • Traveling abroad soon?  Check for coverage outside the U.S.
  • Right now, under the health reform act, plans can’t exclude children under 19 from pre-existing conditions.  However, that luxury does not go into effect for adults until 2014. Plans that do accept you with a pre-existing condition today, won’t necessarily pay for services related to that condition, for example, a pregnancy, which is considered a one-time condition.  But what about asthma? My best advice, call the insurer and ask if the treatments and medications will be covered. Keep asking until it is clear and in writing. The only stupid question is an unasked question.

Then there’s the money.  You can’t make a fully informed decision without evaluating the financials.  To do that, calculate the total annual premium payment, and add in the deductible and the maximum out-of-pocket (including maximum coinsurance).  This is your maximum expenditure, aside from co-payments. Once you know this final number for each plan offered, you will have a clearer picture to compare plans financially.  Things to consider when comparing plans are: higher premiums usually have lower deductibles and out of pocket expenses – not a bad idea if you plan on having a baby or someone in your family has been diagnosed with a chronic illness. If you are healthy, the lower premium with the higher out-of-pocket and deductible expenses might be a better choice.  It’s always a good idea to review your previous year’s healthcare costs to help realistically assess your choice.

Other ways to save dollars is to take advantage of any health savings accounts offered and incentives for improving health, such as cholesterol or blood pressure screening, smoking cessation programs, and other lifestyle change programs offered.  Often there are monetary incentives for participating in these programs.

Understanding your insurance benefits before you need them is so important to receiving good, quality care.  Knowing what you are covered for and the stipulations can make your provider visits much more effective.  Finally, read the fine print. It’s amazing how relevant the information can be, in fine print.

Employers are trying to save money. That’s the bottom line, and that is why YOU should really examine your options closely, with your eyes wide open.





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