Anyone with employer-based health insurance should be taking some time now to review what their options are so they are ready when the time comes to commit to a specific plan.
Justin Held from the International Foundation of Employee Benefit Plans knows what to look for and recently spoke with HiFi News anchor Erika Grotto, where he described a five-step process.
Step 1: Review each plan
“The first step obviously is read your enrollment materials,” Held said. “It’s very important.”
The enrollment documents will explain the differences between the types of plans available. They’re going to offer a comparison of coverage levels, out-of-pocket costs and any other costs that you might expect to incur.
Step 2: Do the math
The second step is the most difficult step – doing the math to project healthcare costs for the year.
“Take your out-of-pocket spending, what you’re projecting to pay for the year, and add that to your premium that’s going to be deducted from each of your paychecks to see what that total coverage cost is for your plan year,” Held said. Keep in mind that there’s going to be a separate co-pay for prescription drug spending as well.
Step 3: Look for special services
The third thing to consider is finding out what treatments are covered, what services are covered and whether the providers that you typically use are already in your network.
“Which of your plans cover chiropractic care? How much will your maintenance medication cost under all those different plan options,” Held said. “You might have a long-standing relationship with a specific doctor or a specific health system or provider. Will you pay more to be with that doctor specifically?” he said.
Step 4: Calculate risk
How much risk are you willing to bear as an individual or as the breadwinner for your family? If you want every expense to be covered, a traditional plan might be the right choice.
“You’re going to pay a higher premium, but the plan is going to cover a lot more of those costs upfront, which is fantastic,” Held said.
Conversely, if you don’t go to a doctor a lot, if you’re younger, a high-deductible health plan that charges smaller premiums might be a better fit. Make sure to budget for the unexpected when you’re dealing with high-deductible plans.
Step 5: Consider what you need
The last step is to consider your health and that of your family, asking the following questions:
- Do you have any chronic conditions?
- Are you planning on a large expense in the next couple of years?
- Are you planning on having a baby?
It’s very important to compare what those plans cover and what the cost is going to be from your perspective.