Introduction
Hello everyone! My name is Adam and I work as a benefits coordinator at a mid-sized company. Every year during open enrollment season, I get lots of questions from employees about navigating the process of selecting or changing their health insurance plans. It can definitely be overwhelming trying to choose the right plan for you and your family from all the options.
That’s why I wanted to share some of the tips and tricks I’ve learned over the years to help make open enrollment a little less stressful. Whether this is your first time going through the process or you’re a seasoned pro, I hope you find some useful information here. Let’s get started!
Understanding Open Enrollment
First, let’s talk a bit about what open enrollment actually is. Open enrollment is the period each year, usually in the fall, when employees can enroll in or change their health insurance plans for the following year. The open enrollment window typically lasts 1-2 months.
Outside of open enrollment, you generally cannot change your plan unless you have a qualifying life event like getting married, having a baby, or losing other health coverage. This is to keep the insurance risk pools stable for insurance companies.
During open enrollment is your only guaranteed chance each year to review your options and select new coverage if desired, before the new plan year starts on January 1st. Even if you’re happy with your current plan, it’s still a good idea to check during open enrollment in case there are any changes to benefits or costs that you should be aware of.
Know When Open Enrollment is for Your Employer
The first thing you’ll want to do is find out the specific open enrollment dates for your employer’s health plans. These may vary slightly from the typical fall window. Your benefits department should communicate open enrollment details in advance through emails, posters around the office, or notices in your paycheck envelopes.
Be on the lookout for these notices and mark your calendar with the important deadlines. At my company, open enrollment runs from November 1st through November 30th each year. Don’t procrastinate – enroll before the deadline or you’ll be stuck with the same plan for the next year.
Review Your Plan Options
Next, take time to thoroughly review all the health insurance plan options available to you through your employer. Many employers offer a choice between HMO, PPO, and High Deductible Health Plans. Be sure you understand the coverage and costs associated with each type of plan.
Look closely at things like deductibles, out-of-pocket maximums, copays, coinsurance, which doctors and facilities are in-network, and any extra services covered like vision or dental. Pay special attention to how much you and your employer contribute to the monthly premiums for each plan.
Comparing plans side-by-side based on your actual healthcare needs is key. A spreadsheet can help you organize the details. Don’t just pick the cheapest premium – make sure it aligns well with how you and your family utilize care. Speaking of which…
Review Your Healthcare Utilization
Taking a look back at how much healthcare your family actually used over the past year is a great way to help determine the best plan. Think about things like:
- Doctor visits – How many times did you or a family member see a primary care doctor? Specialist?
- Prescriptions – Do you have ongoing prescription medications? How much did they cost out of pocket last year?
- Tests or procedures – Did anyone have lab work, x-rays, imaging scans, or outpatient surgery?
- Chronic conditions – Are there any family members with conditions like diabetes or asthma requiring consistent care?
- Hospital stays – Hopefully not, but good to know your options if needed.
Understanding your typical health needs will reveal whether a lower premium HSA-qualified plan or more traditional full-coverage option is best for minimizing total annual costs. Make sure the plan you pick supports your likely utilization.
Look at Your Providers
Another important step is checking that your preferred doctors, dentists, hospitals and other healthcare providers are included in the networks of plans you’re considering. Having to change providers mid-year can be a headache.
Log into the insurance carriers’ websites using sample member IDs if needed to search provider directories. Be aware some great doctors may only be in-network for certain plans. This could ultimately influence your selection if continuity of care is important.
Consider Adding/Changing Dependent Coverage
During open enrollment is also the time to add or remove dependents from your coverage, like a new spouse, newborn baby, or child aging off your plan. Be proactive in verifying everyone who should be covered is accurately listed. Missing a new dependent could result in problems getting them insured later on.
Similarly, remove any ex-spouses or children no longer eligible to avoid paying for unnecessary dependent coverage. Note that adding new family members may increase your premiums. Your employer’s benefits team can answer eligibility questions.
Update Your Beneficiary Info
While you’re reviewing your benefits, don’t forget to verify your beneficiary designations are up to date for any life insurance or retirement plans through work. Life happens and your circumstances may have changed, so it’s good to confirm these important details are accurate each year. This ensures your wishes are followed in the event of your death.
Ask Questions of the Benefits Team
Your company’s benefits coordinator is another great resource during open enrollment to answer any lingering questions. They can explain plans, costs, provider networks and other specifics in more detail to help you make an informed selection. Schedule some time to virtually meet with them if needed for personalized guidance.
Don’t hesitate to ask about anything you’re unsure of. It’s much better to clarify details up front rather than realizing mistakes down the road. They’re also there to address concerns about changes in premiums or benefits from the previous year.
Run the Numbers
Once you’ve got a good handle on plan options and healthcare needs, it’s time to crunch some numbers. Use the details you’ve gathered to estimate your total out-of-pocket costs under each plan scenario. Account for things like:
- Monthly premiums
- Deductibles
- Copays for regular doctor visits and prescriptions
- Costs for any procedures or services typically used
- Out-of-pocket maximum protection
Plug in real or projected numbers to compare your total expenditures. This quantitative analysis will make the best financial choice really stand out. Remember to factor in coverage for the entire family as well.
Consider an HSA in Some Cases
If you opt for a High Deductible Health Plan, think about pairing it with an HSA or Health Savings Account. Contributions to an HSA are tax-free, funds can be used for medical expenses tax-free, and any remaining balance rolls over year to year.
The HSA essentially acts as a personal health fund to pay medical costs – even retirement healthcare one day. For many individuals and families, the premium savings of an HDHP combined with tax advantages of an HSA make it a very appealing option. Just be sure you have adequate savings to cover the higher deductible if needed.
Compare Spousal Plans
In dual-income households, evaluate whether one spouse’s employer coverage makes more financial sense as the primary medical plan over your own company’s benefits. The lower premiums and richer benefits of a spouse’s plan could be a cost-saving choice for your family versus two partial plans. Single coverage under their employer also avoids paying for potentially unnecessary dependent coverage.
Just keep in mind some employers don’t allow being covered as both an employee and dependent under the same company’s health plans. Make sure to check policies before dropping your own coverage. Coordination between two plans also requires extra paperwork.
Get Quotes from the Marketplace
Another wise option during open enrollment season is to compare your workplace plans to individual policies available on your state’s health insurance marketplace. Premium tax credits that lower monthly costs may be available depending on your household income. This could make a bronze or silver marketplace plan a more cost-effective choice.
These public exchanges also offer catastrophic plans for those who want ultra-low premiums but very high deductibles. At minimum, generating potential premium estimates through the marketplace is worthwhile peace of mind in case your circumstances change and you need alternate coverage later on.
Pay Attention to Any Changes
Carefully review your current plan’s open enrollment materials for notification of any adjustments to benefits, formularies, provider networks, costs or other modifications compared to the previous year. This impacts whether staying with your existing plan still makes sense or if a change is warranted. Double check premiums especially – sometimes gradual increases occur each year.
Even if you’re keeping the same coverage, understanding what’s different is important so you know about these changes and can prepare for any new out-of-pocket implications when services are utilized. Plus, you’ll be informed for questions others may have about variations to coverage details.
Consider Paperless Billing
Saving a few trees by opting into paperless billing from your insurance carriers also means saving yourself time and hassles. Electronically received bills, EOBs, ID cards and other documentation is more convenient and reduces clutter. Not to mention prompt access to this important information via your online member portal instead of waiting for snail mail.
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