The Season of Open Enrollment is Upon Us
Like millions of Hoosiers this time of year, you are probably raking leaves and making decisions about your health insurance options for 2016. For employees who receive health insurance through their company, open enrollment season is in full swing.
Companies typically give employees a selection of plans. The options will usually have different costs to the employee–in the amount deducted from their paycheck and the total cost of the coverage for deductibles, co-pays and co-insurance.
For individuals purchasing on the health care exchange, there are a couple of changes this year. First, enrollment began Nov. 1 and continues until Jan. 31, 2016. To be covered on Jan. 1, you must enroll by Dec. 15. Secondly, under the Affordable Care Act, there is a penalty for not having insurance. In 2016 that penalty jumps to $695 per adult (up from $325) and $347.50 per child, or 2.5 percent of family income—whichever is greater. Rather than pay that steep penalty to the IRS, that money is better spent covering your family’s health needs.
There are a number of health insurance plan options on the exchange. Benefit plans are broken down by metal tier (platinum, gold, silver and bronze) and vary in premium, out-of-pocket costs and benefit levels.
Whether you receive your health coverage from your employer or from the exchange, here are some important tips to consider when choosing a health benefit plan:
1. Examine your family’s past health care spending. The best way to determine the health benefits you need in 2016 is to understand what health care services your family used in 2015. Take into consideration what expenses may occur in the next year—like the birth of a child. Plans with higher monthly premiums and lower co-pays and deductibles might be best if you anticipate using a lot of health care services. On the other hand, young and healthy consumers without kids might save with a plan that features low premiums and a high deductible.
2. For individuals purchasing health insurance on the exchange, pay attention to benefit and deductible levels and subsidies that may be available. Eighty-seven percent of Hoosiers who purchased insurance on the exchange last year received a subsidy to help offset the cost of the coverage.
3. Do your homework. You wouldn’t purchase a car without researching your options. The same with health insurance. Companies may offer benefit plan meetings where you can ask questions and compare plan options. For individuals, there are many online options to help you compare health plans and choose the right one for your needs. A knowledgeable insurance broker can help you sort out your options.
4. Consider a consumer-directed health plan (CDHP). Health care consumers want the ability to get care when and where they need it. CDHP’s give you more control of your health care spending. In some cases, employers may pick up more of the cost of an employee’s health insurance if they choose one of these types of plans.
5. Before continuing on your current plan, read the details. Don’t just default to the same plan as last year without first examining the details, because frequently the plans change.
6. Verify in advance that your physician and hospitals are part of the network for the plan you are choosing. And verify that the prescriptions you take are covered under the plan.
7. Take advantage of value-added benefits. For example, many insurance companies offer consumer tools and educational information, like online cost and quality resources, to help you make informed health care decisions.
The health care market will continue to evolve. Before you choose your health plan for 2016, study your options and be a confident consumer.
Rob Hillman is president of Anthem Blue Cross and Blue Shield in Indiana.