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Tips for Choosing a Health Plan

November 24, 2015

Below are tips you can use for the 2016 open enrollment season along with a helpful checklist. 

1. Do your homework and take advantage of the tools offered to you
You wouldn’t purchase a car without researching your options first. The same should go for health insurance. Companies may offer benefit plan meetings where you can ask questions and compare plan options. A little time invested in this meeting can go a long way in helping you choose the best plan for your family’s needs. For Individuals, there are many online options to help you compare health plans and choose the right one for your needs. Brokers and ACA navigators are great resources to utilize to help talk through health insurance options.

2. Understand and learn what basic health insurance terms mean
Health plans offer numerous educational resources to help you understand how health insurance works and what frequently used terminology means. Some important items to understand include:
-What is the difference between copayment and coinsurance?
-What does deductible mean and how could it impact out-of-pocket costs?
-What is a subsidy?
-What are preventative benefits?
-What does it mean to seek “out of network” services?

3. Consider a consumer-directed health plan (CHDP)

Today’s health care consumer want the ability to get care when and where they need it. CDHPs put the consumer in more control of their health care spending. More and more employers are offering these types of products to incent employees to live a healthier lifestyle and to become more educated when it comes to utilizing health care services. In some cases, employers may pick up more of the cost of an employee’s health insurance if they choose one of these types of plans. Also, some of these plans offer the option to roll over to the next plan year any money not spent.

4. Examine your family’s past health care spending
The best way to determine a good plan fit for 2016 is to understand what health care services your family used this year and take into consideration what expenses may occur in the next year—like the expected birth of a child or if you will have to manage  a chronic condition like diabetes or COPD.

5. Before continuing on your current plan, read the details
Many employees default to the same plan choice from year to year without examining the details. But often times, the plans have changed -  employers typically will change the amount of employee contribution as a result of the increasing cost of health care services. For Marketplace plans, even though the plan name remains the same (gold, silver, bronze, etc.), the benefit and deductible levels may have changed slightly from the previous year. It pays to read and understand the details.

6. Verify in advance that your physician and hospitals are part of the network for the plan you are choosing
This is especially important if you are switching your insurance company or you are switching to a different health plan. Be sure that your physician and hospitals in your area are considered “in network” by the plan you are considering. This goes for specialists along with primary care physicians.

7. Verify prescription medications are covered under plan

Health plans contain different formularies, which is the list of prescription medications that are covered under the plan and at what level. Consumers should make sure any medications they are on are included on the formulary for the plan they are considering. In some instances, medications may only be available in the generic form.

8. Take advantage of your health care flexible spending account, if appropriate
Health care flexible spending accounts use pre-tax dollars to help pay health care expenses like co-pays and deductibles, but you must carefully estimate and use all the money in these accounts during the course of the year. Your flexible spending account vendor should have a list of approved expenses so you can plan how much you can put into your flexible spending account.

9. Learn about and take advantage of value-added benefits
Many insurance companies offer consumer tools and educational information to help consumers make better health care decisions. With competition for health insurance increasing, value-added benefits is one way health insurance companies differentiate themselves from competitors. Be sure to take advantage of these tools when you choose your health plan—and throughout the plan year.

-Does your health plan manage your health across the entire care continuum?
-Does your health plan cover telehealth services for 24/7 medical consultations?
-Does your health plan offer cost and quality comparison tools?
-Does your health plan work collaboratively with providers to help make health care more affordable?


What Should I Look For?

Today’s health plan customers are in a better position than ever before to become educated and to make informed choices about what health plan is best, based on individual needs and experience. Asking yourself some key questions will give you a leg up when choosing the health plan that is right for you.

  1. Am I satisfied with my current choice of networks and doctors?
  2. Are my current doctors covered by this health plan?
  3. What is my household’s current and anticipated health care service usage, what are the kinds of things we will need?
  4. What are my out-of-pocket expenses and monthly premium costs? How does a deductible impact my out-of-pocket costs? Does is it make sense for me to pay a higher premium for lower out-of-pockets or vice versa?
  5. What subsidies may be available as I consider an ACA Marketplace plan?
  6. Prescription medications are some of the most utilized benefits. What coverage is provided by the plans I’m evaluating? Are my current prescriptions covered and at what level? Is the plan I’m considering a generic-only plan?
  7. How much will it cost me if an emergency situation occurs?
  8. What types of health or wellness programs could I (or my family) benefit from?
  9. Are these types of programs offered by the health plan I’m evaluating?
  10. Have I looked into health plan report cards provided by independent organizations like the National Committee for Quality Assurance?
  11. What value-added benefits are available to help me make better health decisions?
  12. Do the health plans I’m evaluating provide quality and cost comparison tools for health care services?
  13. Are 24/7 telehealth medical consultations available as part of the benefit plan I’m considering?
  14. What types of experiences are friends and family having with their health plans when they have questions?
  15. Are my customer service needs met quickly and efficiently?