It can be hard to anticipate your healthcare needs for the coming year, but your company’s annual open enrollment period is the time to consider what you think you’ll need. Here are nine questions to think through as you assess which health plan provides the care you need at a price you can afford.

1. What is the deadline?

Open enrollment periods happen at a consistent time every year, and are the only time can sign up for or switch health insurance plans (with a few exceptions). Most companies hold open enrollment during the fall, with a January 1 start date for any changes. Your open enrollment window could be a few days or a few weeks long. Make sure you know the open enrollment dates and mark them on a calendar so you have time to consider your options.

2. Is there another time to enroll?

Ask your HR rep about what qualifying events trigger Special Enrollment Periods. Outside of open enrollment, the only time you can sign up for a health plan is during a Special Enrollment Period, or SEP. Qualifying events may include:

  • Starting a new job
  • Getting married or divorced
  • Having a baby or adopt a child
  • Losing health insurance due to divorce, separation or death
  • Other qualifying events (check with HR)

Barring one of these events, your health plan is locked in for the entire year.

3. Has my current plan changed?

If you are happy with your current health plan and want to continue, double-check if there are any changes to the plan for the coming year. Pay close attention—even a small change could make a big impact if it’s for part of the plan you use often. For instance, if your specialist copay increases or mental health services are dropped. Look specifically at plan elements that you use regularly, whether that be prescriptions, urgent care visits with younger children, mental health services, and more.

4. What is the true cost of coverage?

Choosing the right health plan requires more than looking at premiums and choosing the least expensive option. Also consider:

  • Deductible. This is the amount you pay before your insurance begins paying for care.
  • Coinsurance. The percentage of healthcare costs you’re responsible for after meeting your deductible.
  • Copayments. The fixed amounts you pay for healthcare at the time of service after meeting your deductible.
  • Out-of-pocket maximum. The most you’ll pay for services covered by your health plan in one year, including your deductible, coinsurance, and copayments. This does not include your premiums.

5. What is the cost for dependents?

If you have dependents like a spouse or children under age 26, check how much it costs to add them to the health plan. Some organizations charge extra to add a spouse who can be covered by their own employer. Review your partner’s insurance plan to see if it makes sense to switch to their plan, stick with one provider, or go with separate coverage.

6. Is my doctor in-network for the plan I’m choosing?

It’s a hassle to change doctors, so confirm that the providers that you and your dependents use are in-network. With in-network providers, you benefit from things like cheaper copays and lower agreed-upon rates for services. There could even be a lower deductible for in-network providers.

7. Are my prescriptions part of the drug formulary?

Confirm that the prescriptions you rely on are still included in the plan’s formulary—even if they’ve been covered in the past. A drug formulary lists the generic and brand-name drugs covered by the plan and is listed in plan overview documents. Formularies typically group drugs into tiers; the higher the tier, the higher the cost. Sometimes, plans require you to try a less expensive drug before a more expensive one is covered. If you have multiple prescriptions, this can be a huge hassle.

8. Can I set aside money in another way to pay for health expenses?

Ask your employer if they offer tax-advantaged accounts, like a Flexible Spending Account (FSA) or Health Savings Account (HSA), that you can use to lower your overall out-of-pocket costs. You’ll contribute pre-tax dollars to these accounts and use that money to pay for qualified expenses like copays, coinsurance, and even things not covered by your plan, like vision services. HSAs are only available to people with a high-deductible plan, and unused funds are rolled over from year to year. FSAs, on the other hand, are use-it-or-lose-it. While most employers offer a grace period at the end of the year, if you don’t use FSA funds, you don’t get them back. Employers aren’t required to offer either of these options, but if they do, it could save you money.

9. Does the health plan include an Employee Assistance Program, or EAP?

EAPs are designed to help employees with personal and work-related issues that fall outside the purview of a typical health plan. For instance, they may include counseling, legal consultations, elder care assistance, career coaching, and more.

Taking time to ask questions now can save you from questioning your own decision-making skills down the line. You can feel confident you picked the right health plan for the upcoming year, despite the inevitable unknowns that are part of the process.


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