Open enrollment for most employer-sponsored health insurance plans is under way, or about to be, and now more than ever we all need to make good choices because mistakes can cost thousands of dollars.
A couple of real-life reasons…
If you're married, be sure to thoroughly research your and your mate's coverage — and choose the most cost-effective plan or combination. A co-worker lost some $28,000 over the past four years because, along with our employer-sponsored health insurance, she had her husband carry his coverage at $7,020 a year. The mother of a special-needs child, my co-worker thought she was being prudent carrying both policies, but after many runarounds — where reps with her husband's insurer repeatedly told her “we‘re coordinating with your primary insurance” — she finally was told that her husband's “non-duplicating policy” paid only if ours didn't pay on the claim. In other words, his paid out nothing!
What's more, she — save for a life-changing event like divorce (which they actually considered) — couldn't cancel her husband's policy, and owed premiums until this open enrollment period, where she could change her elections.
Last week in my dental hygienist's chair, I was, well, open-mouthed to learn her family of four recently paid $1,800 a month in premiums for health insurance with her husband's former employer, and that insurers wouldn't cover her husband because he took ongoing meds for kidney stones, didn't scoff about her son's spina bifida but charged $100 more to cover her daughter who suffers from acne. Though insurers, upon passage of health reform, can't turn down children with pre-existing conditions, they can, and did, charge more for her daughter who needed pricey meds and cream that insurers deemed cosmetic.
Lastly, a book author and source I met on a phone interview this week told me he shopped around for an in-network gastroenterologist to perform a recent colonoscopy that — with the passage of the health reform law — should, as a preventive care event, have been covered at no cost to him. But after his procedure, he was billed $4,000 because the procedure, unbeknown to him, was performed at an out-of-network facility.
All this is to say: Do your homework; don't automatically enroll in last year's plan without first making side-by-side comparisons. Given your claims experience from last year, electing a plan with a higher deductible may be your best fiscal choice. Aetna and other providers have calculators on their websites.
With health care reform, this year we're all to receive a Summary of Benefits and Coverage form from insurers to compare, theoretically anyway, plans apples to apples. To offset increasing health care costs, six of 10 employers are expected to increase premiums, co-pays and deductibles, according to industry reports.
On Sunday, with health reform mandates a little more than a year away, I plan to write about employers' health plan choices. Meanwhile, workers lucky enough to have employer-sponsored health care should heed the following tips, industry experts say:
• Be sure current physicians and area hospitals are in your elected plan's network.
• Review pre-existing condition exclusions, prior authorization requirements and annual limits.
• Check prescriptions you take against the list of each plan's approved drugs for co-pay variations.
• List premiums, out-of-pocket expenses, co-pays, coinsurance, deductibles, specialists and benefits for each health, vision and dental plan.
• See if the cost for dependent coverage has increased. Some employers are raising costs now that coverage is available for dependents through age 26.
• Take advantage of tax-favored flexible spending accounts (FSAs), which employees can use to pay deductibles, co-pays, dental care and more. Health reform limits contributions, starting in January, to $2,500. You can save about 30 percent on the money you put aside. My daughter needs braces, so a $2,500 contribution to my FSA is a no-brainer for me.
Here's to simple health care choices for you and yours.