- Don't base your plan choice solely on premiums.
- Make sure the plan you choose covers any medications you take, and that the primary doctor you see will be in-network.
- We recommend choosing a plan that has access to an HSA, even if it isn’t funded by your employer. HSAs are a great savings and tax reduction vehicle.
Did you Know?
The out-of-pocket maximum is the most you should expect to pay for services next year. Even if you are healthy, you should always be prepared and have a plan for how to pay this amount—you never know when you might have an accident or unexpected medical event.
What is Open Enrollment?
November is the beginning of Open Enrollment (also known as Open Enrollment Period or OEP) for most Americans. During this period employees who are offered healthcare by their employer have the chance to make changes to their benefit options and employers sometimes change the plan options available to their employees. The three most common healthcare plans available during open enrollment are: HMO, PPO, and high deductible with HSA. Knowing how each plan works is the first step to making an informed decision about your coverage for the upcoming year. We recommend doing a bit of research on each type of plan before deciding because unless you qualify for a special enrollment circumstance, you will not be able to change your plan again until the following year.
How to Prepare for Open Enrollment
Once you understand the different plans available to choose from, consider the following questions to help you make the right decision:
- Do you take any medications? Make sure the plan covers any medications you take.
- Do you want to continue seeing a certain provider? Check to make sure your doctors, therapists, and hospitals are in-network.
- If you or a family member are facing any of the following treatments, take an extra close look at the details of your plan:
- Fertility – make sure you know what treatments are covered because it can vary greatly from plan to plan.
- Ongoing Physical/Occupational Speech therapy – check to see if there is a cap on the number of annual visits.
- Gender Transition – these benefits vary wildly from plan to plan, it’s important to understand what will be covered to avoid being stuck with high-cost treatments.
- Alternative Therapies – coverage varies for different massage, acupuncture, and chiropractic services so you should always double-check that your specific needs are covered under a new plan.
The answer to these questions can greatly impact what you pay out-of-pocket if the plan you choose doesn’t provide the necessary coverage levels.
- Investigate if any of the plans you have a choice between are eligible for an HSA. Due to the tax advantages of an HSA, these plans are often more affordable when you add in your tax savings.
- Here is a quick 3-step analysis you can do if you can’t decide between two plans:
- Take the monthly premium for each plan and multiply it by 12.
- Add the deductible for each plan to total from the prior step.
- If you think you are going to hit your deductible take the plan with a lower amount for step 2, and if you don’t think you are going to hit the deductible take plan with a lower amount for step 1
Frequently Asked Questions
I am expecting to spend X amount on health care this year, should I choose a PPO/HMO or a High Deductible Plan?
This is a common question and there are no simple answers, but we find that PPO/HMO plans offer excellent coverage, and if you expect to spend $10,000 or more on healthcare these can be a good choice. If you are young and/or healthy, High Deductible plans offer a lot of advantages including lower premiums and the option to establish an HSA.
How do I check if my doctor is in-network or if a prescription is in-network?
Look at the health plan materials provided as part of open enrollment—there will be a website you can visit to check if your doctor is in-network (and if your prescriptions are covered).
What do I do if my company offers only one plan?
If this is your only option for insurance, then your choice is easy, take the plan offered. However, if your significant other has access to insurance, you may want to compare your company’s plan versus theirs. You can use the same recommendations mentioned above to help you with your decision.
Want to Learn more
What is open enrollment? - Nerdwallet
10 Common Mistakes When Choosing Health Insurance - Quote Wizard