Open enrollment isn’t anyone’s idea of a good time, but health coverage is an important part of your financial health. Whether you’re getting insurance through an employer or the Affordable Care Act Marketplace, it’s important to ask the right questions before choosing a health plan for 2024.Thank you for reading this post, don't forget to subscribe!
“Open enrollment is a great time to do a personal health audit,” says certified public accountant Charlene Rhinehart, personal finance editor at drug savings site GoodRx. “Understanding your current and anticipated health care needs will help you decide which plan is the best fit.”
Here’s how to evaluate your options.
Is your doctor in network?
Plan networks change from year to year. If you love your doctor or specialist, make sure they are still in-network with the plan you’re considering for 2024.
You should also consider whether you want the option to go out of network — which you can usually do in a Preferred Provider Organization, or PPO, plan, although it will cost more. Health maintenance organizations, or HMOs, are cheaper but lack out-of-network flexibility.
Are your medicines covered?
If you’re on prescription drugs, check the plan formulary to be sure how your drugs will be covered in 2024. Drug coverage can change from year to year, even if you stick with the same plan.
“Even if you were previously in an Aetna plan, and you say, ‘Okay, I’ll stay with Aetna again,’ you still want to look and make sure the drug you’re taking is still covered by the formulary. But there is,” says Abby Leibowitz, chief medical officer and co-founder of Health Advocate, which provides integrated health advocacy and recovery programs.
What are the out-of-pocket costs?
Each plan has set costs, such as monthly premiums, as well as the cost of care, including deductibles and any copays and coinsurance. Comparing plans means estimating how much health care you’ll use over the next year.
On the one hand, you will have to pay that cost if you don’t use the plan for more than preventive care. On the other hand, if you are a heavy health care user there is a maximum amount you can pay into each plan. You can easily compare these situations.
However, there is a middle ground, where the best plan for you depends on the amount and care you will need over the next year.
“The tricky thing is that we never really know how much we’ll spend in a given year,” says Adam Rosenfeld, a health care benefits expert and president of employee benefits company Rubicon Benefits. He says the best thing to do is to look at your current claims information and imagine that next year will be the same. Which plan would you be better off with?
“This is the best predictive modeling you can do at this point,” Rosenfeld says.
Is a High-Deductible Plan Right for You?
A high-deductible health plan, or HDHP, in 2024 is defined as a plan with a deductible of at least $1,600 for individual coverage or $3,200 for family coverage, with maximum amounts not exceeding $8,050 or $16,100, respectively. Is. HDHPs typically have lower premiums, and sometimes companies make contributions to a health savings account or HSA to help cover the deductible.
An HDHP may be a suitable plan for people with a variety of health conditions, as long as they are willing to pay a deductible when they need health care.
“The question is, ‘Can you afford it?’” says Adria Gross, an insurance broker, consultant and founder of MedWise Insurance Advocacy, which helps clients and attorneys with medical claims issues. If you’re healthy, Gross says, choose an HDHP. But in the event of a bad accident, you’ll want to make sure you have the means to pay the full deductible amount.
Can you stack the benefits?
You may have access to voluntary benefits through your employer that can help cover costs that your insurance doesn’t cover. For example, Aflac policies can help pay expenses if you are in an accident or develop cancer.
You may find that you can get a high-deductible health plan and a supplemental plan that will help you cover your deductible for less than the cost of a traditional health plan. “It can be much lower than moving to the next level where the deductible is lower,” says Leibowitz.
Do you need special care?
Some insurance plans cover things like weight loss surgery or infertility treatments – but some don’t, and exclusions can make a big difference if this is a procedure you’re considering. You may find that one insurance company covers a certain surgery or test while another views it as investigational and not medically necessary.
“I call them fringes,” says Leibowitz. “They go beyond normal medical and surgery coverage.” He says the focus is narrow, but coverage can be significant.
He says the underlying message is that just because it looks like the same company plan you were at this year, don’t assume it hasn’t changed in ways that are important to you. “Networks, formulary, benefits,” says Leibowitz, “you have to do your homework.”
This article was written by NerdWallet and originally published by the Associated Press.