Health Advocate Blog

What to look for when choosing a health plan

With open enrollment around the corner, you may be starting to think about your health insurance for the upcoming year. It is important for your health, and the health of family members who may join you on the plan, that you choose wisely. In addition, health benefits can impact your overall financial well-being, so making well-informed decisions about the type of coverage you currently require will help you reduce costs. Keep these tips in mind as you explore your plan options.

Choosing a plan.  To pick the best coverage, first calculate your healthcare costs from recent years and try to estimate what your costs might be for the coming year. Don’t forget to include the cost of doctor visits, medications and any medical procedures you might need. Also, consider how the plan worked for you this past year. Did you over-insure and not utilize all of the benefits you had available while paying a higher premium? Or did you under-insure and ended up spending more out-of-pocket then you anticipated?

Do you really need all the bells and whistles? Some people have a tendency to think, “It’s a health insurance policy–I want the best.” That often translates into the most expensive plan. You may be paying too much if you choose a policy with a low deductible. Low deductibles are good if you frequently need medical care. However, if you’re young and healthy, it may be wiser to choose a high-deductible plan. That way you’re covered for catastrophic illnesses without paying high insurance premiums.

Picking a robust plan. If you have a serious medical condition, you may want a health insurance plan that gives you several options for care, even if it costs more. You may not want to keep a plan that restricts you to doctors within a single healthcare system or requires referrals to see specialists.

Double-check the plan. Does the plan have prior authorization requirements? A prior authorization is an extra step that some insurance companies require before they decide if they want to pay for a medical service or a prescription medication.

Check into whether your doctor is in the plan’s network. You will pay more to visit healthcare providers outside the plan’s network, so it’s best to make sure your doctor is covered under your plan.

Understand who is covered. Check to see if your spouse or dependents are covered. If you recently got married or had a baby, you may want to add the new members of your family onto your plan. Some plans cover dependents, while other plans do not. Be sure to find out about whether stepchildren are covered. Some plans have a time limit for adding a spouse or newborn. For example, some plans require you to add your baby within the first 30 days following birth. Other plans will waive the additional premium for the first 31 days if you enroll within 31 days following birth. If you recently got married, some plans allow you to add your significant other within 30 days of the event.

Find out if your medications are covered. If you take prescription medications, check them against the insurance plan’s formulary. Some prescription medications have higher co-payments than others and they might vary from plan to plan. Mail-order options might be available for maintenance drugs at a lower cost.

Budgeting your expenses.  If your employer offers you the option of a healthcare spending account, whether it is a flexible spending account (FSA) or a health savings account (HSA), take a good look at it. These tax-free accounts can help you save money on qualified medical expenses that aren’t covered by your healthcare plan, such as deductibles and co-insurance. Each account has a different set of rules about how and when you can spend the money, but each is worth considering because the savings you’ll see can add up quickly.

Prepare for the unexpected.  Everyone needs to be prepared for the unexpected, including job loss, divorce, or other life-changing events. Be sure you know what the benefit plan costs might be if you need to pay for it under COBRA. COBRA requires that most employers with group health plans must offer employees the opportunity to temporarily continue their group health care coverage under their employer’s plan.

How Health Advocate can help

If you are a Health Advocate member and have questions about your health insurance policy, call us to speak to a Personal Health Advocate.  Your Personal Health Advocate can help you with many insurance-related concerns, including but not limited to:

  • Explaining the difference between a high-deductible and a traditional health insurance plan
  • Finding out whether your current doctor is in-network in your new insurance plan
  • If your current doctor is not in-network, finding you a new, in-network doctor—plus transferring your medical records and helping to schedule an appointment for you
  • Evaluating your health insurance plan to see if it has prior authorization guidelines
  • Looking into whether your spouse and/or dependents are covered under your health insurance plan
  • Researching which prescription medications are on your health insurance plan’s formulary
  • Explaining the benefits of a flexible spending account or a health savings account, and tell you what is a “qualified medical expense” that you can pay for from these accounts
  • Helping you understand any insurance-related terminology that you find confusing
  • Helping explain COBRA and go over your options with you