Choosing a good insurance policy during open enrollment involves assessing your needs, understanding your options, and considering costs. Here are steps to help guide you:
1. Evaluate Your Needs:
• Health Status: Consider your current health, any ongoing medical conditions, and how often you use medical services.
• Family Needs: If covering dependents, assess their medical needs as well.
• Upcoming Life Events: Pregnancy, surgeries, or planned treatments should factor into your choice.
2. Understand Plan Types:
• HMO (Health Maintenance Organization): Lower premiums, but require you to use a network of doctors and need referrals for specialists.
• PPO (Preferred Provider Organization): More flexibility in choosing healthcare providers but often comes with higher premiums and out-of-pocket costs.
• EPO (Exclusive Provider Organization): Similar to HMO but no referrals needed, though you must stay in-network.
• HDHP (High Deductible Health Plan) with HSA (Health Savings Account): Lower premiums, high deductibles, and eligibility for an HSA to save for medical expenses tax-free.
3. Compare Premiums, Deductibles, and Out-of-Pocket Maximums:
• Premiums: The amount you pay monthly for the plan. Look at this in combination with other costs.
• Deductibles: The amount you pay before insurance starts covering your costs. A lower deductible usually means higher premiums.
• Out-of-Pocket Maximum: The most you’ll have to pay for covered services in a year. After reaching this, the insurance covers 100% of your expenses.
4. Consider Co-payments and Co-insurance:
• Co-pays: A fixed fee for services like doctor’s visits or prescriptions.
• Co-insurance: The percentage of the cost you pay for services after meeting your deductible.
5. Check Provider Networks:
• Ensure your preferred doctors, specialists, and hospitals are within the network. Going out of network can be more expensive. You can access each policy and make sure your provider is in-networker.
6. Review Prescription Drug Coverage:
• Check the plan’s formulary (list of covered medications) to ensure your prescriptions are covered and at what tier (cost level). Get a list of your medications. And check to make sure each drug is on formulary. If not, is there an acceptable alternative your provider can prescribe? Keep a list of what is covered and what is not for each policy your company offers.
7. Use Employer Tools:
• Employers often provide online tools, calculators, or consultations to help you compare plans and estimate costs based on your anticipated healthcare use.
8. Factor in Additional Benefits:
• Some plans offer perks like wellness programs, telemedicine services, or discounts on gym memberships. Consider if these add value.
9. Review Flex Spending (FSA) and Health Savings (HSA) Accounts:
• These accounts allow you to set aside pre-tax money for medical expenses, which can lower your overall healthcare costs.
10. Seek Advice:
• Talk to your HR representative, financial planner, or insurance expert if you’re unsure about the best plan for your needs.
By carefully considering your health status, budget, and preferences, you can make a more informed decision during open enrollment.
In America, insurance is king. We all pay exorbitant fees for premiums and co-pays and insurance always comes out on top. We need a National Healthcare plan, but until that happens, we need to learn to navigate the complex healthcare system.
What challengers have you faced accessing healthcare? please comment below.
Blessings,
Heather
Calm Journey 