5 Things You Must Know About Health Care Open Enrollment

By Shannah Game on 18 November 2015 0 comments

It used to be easy. You got a benefits package at work, selected your health care plan, and your company footed most, if not all, of the monthly premium. But health care reform has brought some changes, and that includes the open enrollment period during which individuals select health plans.

Open enrollment for health insurance is November 1 through January 31, 2016, and vanishes just like Cinderella's glass slipper until this time next year. (Some exceptions to the open enrollment period exist, such as marriage, childbirth, or loss of employer-provided insurance.) That means that you've got no time to be lazy when reviewing your health care plan options for 2016 — and no excuse for not knowing the essentials of picking coverage.

Here are the five health insurance basics you must know before selecting a plan during open enrollment season.

1. Name That Plan

Plans change names, and it's common for the plan you had last year to completely disappear and suddenly be replaced by one that you don't recognize. Still, your insurance provider should notify you of any name changes to your existing plan, and provide annual renewal options that'll make the new name (and any other plan changes) clear. Also, keep in mind that a plan's name is less important than its premium, deductible, and benefits; if you can't find the plan you want by name, try searching by benefit levels and price, or contacting the insurer directly to inquire about new options.

2. Three Powerful Letters: HSA

Many employers are now offering what is called a high-deductible health plan. And if you have such a plan, you may be able to take advantage of a powerful addition called the Health Savings Account. HSAs allow you to sock away money to pay for your out-of-pocket health care costs — things like contact lens exams, prescriptions, doctor visits, etc. The beauty of the HSA account is that it's tax deductible — any money you place into this account can be deducted from your taxes the following year. In order to use this benefit, you've got to make sure that your health policy says it's an HSA compliant plan. Check with your HR department for guidance on HSAs.

3. Understand Deductibles

If your deductible is $5,000, then it means that any health care costs you incur during that year up to $5,000 will be your responsibility to pay. Once you hit that $5,000 mark, then your health plan will start covering some or all of your expenses (the percentage also varies by plan).

It doesn't matter if you have an HMO or a PPO — you will most likely have a deductible. Some plans will have a $0 deductible, and others a deductible of many thousands, but nevertheless, it's critical that you know what your deductible is. That is the amount that you'll be responsible for before your insurance kicks in.

If you don't have a large emergency fund saved and finances are tight, you might want to consider a lower deductible plan, even if it costs you a bit more per month. It may sound counterintuitive, but paying an extra $50–$100 a month for a lower deductible plan is probably a lot easier than suddenly coming up with $5,000 to pay the deductible on a hospital bill. In the end, there are no right or wrong choices when it comes to deductibles, but you must know what yours is — and be comfortable with that amount.

4. You Pay This, They Pay That (AKA Copay)

Your copay and deductible are like peanut butter and jelly — it's hard to have one without the other. Once you've hit your deductible amount, then your insurance enters the copay zone. This is when your health plan will start to pay a larger percentage of benefits towards your medical expenses.

For example, let's say your deductible is $2,000 and you've had a surgery this year, blowing past that deductible amount. You are now in the copay zone, and according to your plan, your copay amount is 20%. That means that you will owe 20% of all future medical costs for the rest of the year, and your health care plan will pick up the remaining 80%.

The higher the copay, usually the lower the monthly premium on your health plan, because you'll be picking up more of the bill. The key is picking a plan with a deductible and a copay amount that you and your budget can be happy with.

5. Out-of-Pocket Max

There's one last piece to talk about, and it may be the most important. Your out-of-pocket max is the maximum amount of money that you will have to pay toward your health care in a year. These numbers are usually larger than your deductible amounts. According to the Affordable Care Act, the max out of pocket for 2016 will be $6,850 for an individual and $13,700 for a family plan. These numbers are especially critical to know if you're planning on major surgery or have a serious medical condition requiring ongoing treatment. Purchase coverage and plan your finances accordingly.

Are you ready for open enrollment?

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