8 Tips for Choosing the Right Health Insurance Coverage for You

It’s official—open enrollment season is here! From now until December 14, you have the opportunity to choose new benefits plans (or keep your current plan) and sign up for an FSA.

According to a recent study, most people spend only 30 minutes considering whether to choose a new plan or re-enroll in their previous plan during open enrollment. It’s in your best interest to spend as much time as necessary to make this decision, as it can greatly impact how much you’ll spend in the coming year and what healthcare choices you’ll have. And even though you might like your current coverage, it’s still important to determine what changes have been made to your plan, whether your plan is still being offered, and how much your premiums will increase (according to OPM, average premiums will increase 7.4 percent in the next benefit year)

That said, here are eight tips to help you choose which plan is best for you.

1. Review your healthcare expenses from the 2015 benefit year and estimate what you might need in the coming year. What services are you expecting to use? Develop a best and worst case scenario when estimating your 2016 costs. Consider discussing your health with your current primary care physician. He or she might have thoughts on procedures or tests you should consider in the coming year that you’ll want to ensure are covered.
2. Make a budget for health insurance coverage. Look at your total expenses for 2015 and what changes you’re anticipating for 2016. Will you be taking on a larger rent or mortgage? Purchasing a new car? With all of your expenses calculated, how much do you have left for health insurance? You can always try to make trade-offs or save more to purchase the better coverage options, but this will be a good place to start.
3. Create a list of your preferred doctors or providers and compare this to any health insurance plan you’re considering. Will those doctors/providers accept a certain insurance plan? Will you have to pay more for services if the provider is considered out-of-network? And if so, how much more?
4. List out all of the prescription medications you take and your co-pay on those medications during the 2015 benefit year. As you look at various options, determine how your out-of-pocket expenses might increase or decrease.
5. Continuing the list theme, make a list of the benefits that are most important for you. Use your expected healthcare costs to determine in which areas you’ll want to have great coverage (for example, if you’re having a baby next year, you’ll want to ensure that you have great maternity coverage).
6. As I noted last week, during the 2016 plan year federal employees have the opportunity to choose the new Self Plus One option. Do not automatically sign up for this plan assuming that you’ll save money. As reported by The Washington Post, some enrollees are learning that the savings are minimal or non-existent. For example, in the 2016 plan year, the basic Blue Cross-Blue Shield plan will offer self-only coverage at $68.48 biweekly, family coverage for $164.20, and $160.75 for self plus one. Not the huge savings some people were expecting. Approximately 410,000 federal workers, retirees, and dependents covered under FEHB could see higher Self Plus One costs than if they chose Self and Family. Why? OPM explained it to the Post like this: “The government contributes the lesser of the maximum contribution or 75 percent of the total premium. The remaining amount is the enrollee share (how much the enrollee must pay). In some cases, such as plans with a premium cost that is above the program average, this calculation may result in a higher enrollee share for a Self Plus One enrollment than a Self and Family enrollment.”
7. Consider your overall health. Broadly and generally, younger people who are healthy will require less care and can often choose a high-deductible plan which will have a cheaper monthly premium, but which will require that you pay more out of pocket. Still, it is important to look at the total cost and the coverage you’ll be offered, and make a best case and worst case estimation of what you’ll end up paying.
8. With all of this information, create a spreadsheet to compare your plan options. Include columns for premium cost, deductible, coinsurance, drug copays, office visit copays (divide this by ER, specialty provider, and general doctors, if necessary), and out-of-pocket maximum. Also include separate columns for each coverage tier and type (especially if you’re considering self plus family or self plus one coverage). To get a simple breakdown of plan costs, visit this website and then complete further research on those plans that appear to best fit your needs.

This Open Season blog series is brought to you by: 

Aetna Federal Plans

Read the first post in the series here, and the second here.

Visit aetnafeds.com to find the plan that’s best for you. Or call us at 1-877-459-6604.

Choose your plan starting November 9.