How to Choose a Health Insurance Plan
Open Enrollment Period Decision Making:
How to do it and When
(Hint: It’s NOW)
Making any type of difficult choice for yourself is one of the worst things about being an adult, but choosing a health plan to keep you and others alive and well is definitely one of the hardest and most important.
But important decisions don’t have to be hard. Coddle and Cure is here to help lead the way to the best plan that fits your individual (or family) needs.
First things first: What is open enrollment and when is it? IT’S NOW!
Open enrollment is the time of year when you are able to sign up for and make selections about your health insurance and other benefits.
This can be job based benefits, government run programs and even medicare.
Benefits to review during open enrollment besides medical insurance are things like dental, vision, FSA, 401K contributions, commuter benefits and more.
Open enrollment is not required to be a certain length of time. Most employers have an open enrollment period of at least two to four weeks.
During this current open enrollment season you are choosing insurance and benefits that will cover you during January 1,2022- December 31,2022.
There are many different ways to get health insurance. Here are the top four:
ON YOUR OWN:
You can purchase directly from a private insurance company, with the help of a broker or agent, or through an online service during open enrollment.
GOVERNMENT-SPONSORED PLANS:
Those who qualify for government programs such as Medicare or Medicaid can enroll in these plans to get coverage.
EMPLOYER:
This would be enrollment in the insurance plans offered through you or your partner’s employer.
Children can remain on their parent’s plan until their 26th birthday.
MARKETPLACES:
You can buy health insurance yourself through your state’s marketplace (if there is one) during open enrollment. You can go to HealthCare.gov and enter your ZIP code during open enrollment to find out your options. If your state doesn’t have one, you can use the federal marketplace.
What kind of insurance do I need?
It really depends on how much you are willing and able to pay upfront, your current or expected medical status, and your personal accessibility preferences.
There are many different kinds of plans as well as many different ways to get them:
https://www.nerdwallet.com/blog/health/health-insurance-guide/
HMO: Health Maintenance Organization: A type of health insurance plan that limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage.
PPO: Preferred Provider Organization: A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. Examples: Blue Cross, Aetna, Cigna, United Healthcare
HDHP: High Deductible Health Plan: A plan with a higher deductible than a traditional insurance plan. The monthly premium is usually lower. A HDHP can be combined with a HSA, allowing you to pay for certain medical expenses with your HSA account.
HSA: Health Savings Account is a way to save for medical expenses and reduce your taxable income. If you are enrolled in a high-deductible health insurance plan (HDHP) as defined by the government, you can qualify for an HSA.
FSA: Flexible Spending account: An arrangement through your employer that lets you pay for many out-of-pocket medical expenses with tax-free dollars.
Though they are the most common types of plans; the HMO, PPO and HDHP are not the only types of plans available; there are also EPO, POS and choices between adding a HSA and FSA.
Have you thrown your hands in the air yet?
Don’t worry, we will have you decoding this alphabet soup in no time. Check out our decoding guide here.
Some important things to consider when choosing a health plan:
Try to estimate your expected health goals and needs for next year?
Do you have any pre-existing medical conditions?
Any planned medical procedures ? Like finally getting that old knee injury fix or welcoming a new baby?
Make a list of prescription medications you take.
Do you have a particular doctor you want to continue seeing? Check with their office to see what networks they belong to prior to making your decision.
This my affect you choosing a cost effective HMO type plan
Would you rather have the flexibility of choosing your doctors from a bigger pool, or are you happy to join set network of doctors in your area?
Check what your company is offering.
If they don’t provide health benefits are they willing to subsides some of the cost?
Does your company contribute to the HSA account associated with the HDHP plan?
Make a budget. Consider your monthly premiums and the annual deductible to see what the plan may cost you for the year.
The next steps:
Here’s our check list to help get you started.
Identify how you will be getting coverage: job based, state Marketplace, Medicare, Medicaid or CHIP.
Decide which type of plan — HMO, PPO, EPO or POS — is best for you and your family, and whether you want an HSA-eligible plan. (You can refer to our health insurance plan guide here for a more in-depth explanation of the types of plans available.)
View your plan options side by side. Many sites have an option to compare plans. Select your top 3.
Eliminate plans that exclude your doctor or any local doctors in the provider network.
Determine whether you want more health coverage options with higher monthly premiums, or lower premium with potentially higher-out-of-pocket costs when you go to the doctor.
Make sure any plan you choose will pay for your regular and necessary care, like prescriptions and specialists.
Choosing a health plan can be overwhelming. If you’ve made it this far, congrats! You have already gained tons of knowledge to help you make an education decision. Do you have some questions? Think you could use some personal guidance- I’m here to help! Send an email to hello@coddleandcure.com to set up a free 15 minute consultation with me.
Be well,-Dr. D