It’s that time of year again! Health Insurance Open Enrollment. Most people fall into two categories here:
Those who stress over all of the mail and notices about their upcoming Open Enrollment Season, and those who merely procrastinate, can’t believe it is that time of year again and never bother to check and just (if they can) let things remain status quo.
If You Are Still Working
For those who are still working and who are covered with their employer’s health plan, that can work for you, as yes they will usually offer decent plans. The reason for this is that most employers have your back. They have a professional managing all of the plan offerings and most of the time, if you take no action, last year’s plan rolls into this year’s plan and you still have coverage. Most Plan Administrators will make some noise if there have been any big changes in the plans from one year to the next so maybe you will be okay. But – remember! The employer is looking at their entire workforce, and hopefully offering a variety, but that variety is for the masses. NOT for your particular family situation. That is up to you to do that!
Procrastination- Beware!
Last season, I witnessed first-hand what happens if you procrastinate. A friend, working for a small firm did just that. She ignored the mail, skimmed the notices and did not sit up and focus on a potential health insurance change, feeling sure that the plan probably just went up a bit, but would basically be the same. WRONG! Even though in previous years the changes had been minimal, this year one of the six plans previously offered was going to be phased out. The notices said as much, but not focusing on Open Season, busy with other deadlines, she figured she would just let things roll and go with the “status quo”. Big mistake! Responsible for both her and her daughter’s health insurance, she was stunned when she overheard (after the deadline) someone in the office mention that their plan was no longer offered and had they picked another, and hoped that it would be as compliant, as they were now checking with their physicians to make sure that they were “in-network” with the new plan.
What happened to those who were in the phased out plan, and did not pick a new offering? They were all rolled into a default plan, which was adequate but by no means cherry-picked by them as being sufficient for their family healthcare choices.
Advocacy- Be Proactive
Although here at HealthLink Advocates, we would never recommend this course of action (total denial!), we will urge you to at least take the time to make sure that your coverage remains the same, and that the cost of that plan does not go up in price exponentially.
However, if things have changed in the last year for you and your family, it is time to get yourself organized and take a good look! Most employers offer more than one plan. Take a look at all of them to see where you fit. One strategy would be to ignore what your current plan is, and read the provided plan excerpts with a highlighter in hand. Highlight what is important for your particular situation. For instance, does someone in your family have a health condition that requires monitoring of blood work on a regular basis? (What are lab benefits?). Does someone need to have semi-annual imaging done (what is the coverage for imaging costs) to continually monitor, for instance, a benign cyst? Is your physician watching your cholesterol or other levels to monitor your health? Has your Ophthalmologist mentioned that you are developing cataracts (How much of the cost of outpatient surgery is covered)? The list goes on and on!
Potential Costs
Maybe your eight year old has started to play on a competitive sports travel team. What happens if you wind up in an Emergency Room? The average cost of a brain MRI at a local hospital is as much as $2,000 .00 (howmuchisit.org). Yes, of course if you have insurance much of this is covered, but NOT until you have met your deductible and let’s not forget the co-pay and additional bill from the Radiologist. Look at your plan. It is all laid out for you before you choose which insurance policy to sign on for. Did you choose that plan with a $5,000.00 deductible?
Without question, you should review your policy choices carefully every year. Even if the plan you choose last year remains the same (except of course, for the cost which will usually rise a bit annually), that plan may not be the best fit for your family for the next year.
The Emergency
Did you have a baby last year? Most plans will cover the cost (regardless of the deductible) of routine physical exams, immunizations, flu shots that come along with a new little one. But what happens when your baby wakes up during the night with a high fever and you are so unnerved that you run to the local ER? Hopefully, it is just an ear infection or strep throat. If it’s not, oh boy! Things may need to be ruled out. Are you going to say no to an expensive test because you have that $5,000.00 deductible in your high deductible plan? You could already be in for a $250.00 co-pay for just walking in the door. Some plans will waive the ER costs if a hospital admission is part of the ER visit. Is that how your plan works? It’s a long way from $250.00 to $5,000.00.
Be smart…..get that highlighter and start a quick review. Then it’s time to make your choices - not after you get that bill for $5,000.00 for a virus that caused a high fever and sent you to the hospital in the first place.
Download your Summary of Benefits and Coverage (SBC) which is available on almost every healthcare portal and mark it up. If your employer website offers a “Comparison Tool” be sure to use it to see what fits best for your family. Make sure that your choices are tailored to a plan that serves you and your loved ones best!
Here are a few resources to use to check and compare healthcare costs:
https://www.healthcarebluebook.com/
https://www.fairhealthconsumer.org/