Six things to consider when picking health insurance from your employer


By Michael Whitney

So you’re at your job and you receive a package from Human Resources containing options to choose a health insurance plan and upon reviewing the options, you’re baffled.   You simply don’t know which one to choose.

Medical plans offered by employers are changing drastically, and every year, many people are reviewing their plans to choose one that is either more affordable or offers more benefits.

Selecting a plan can be very confusing.

Kaiser Health News gives six important points to consider when selecting your health insurance benefits provider through your employer.

1) Make sure your doctor is in the network!

As employers shift to plans that look like HMO’s, it’s important to know that this may not benefit you. An HMO plan has a limited network of physicians and hospitals. Your doctor may not be in the network so make sure that they are in your network.  You can check by going on the proposed insurer’s website where they may have a directory that list doctors and hospitals that are within their network.

2) Is my employer changing where I get labs and medications?

More companies are hiring preferred vendors to deal with diseases such as cancer or multiple sclerosis. If you have a compromising disease it is best to pick a plan that covers where you’re currently getting your labs and medications.  Getting infusions or prescriptions outside the network could cost thousands of dollars extra.

3) How will my out-of-pocket costs go up?

Kaiser Health News state: It’s probably not a question of if. Shifting medical expenses to workers benefits employers because it means they absorb less of a plan’s overall cost increases. By lowering the value of the insurance, it also shields companies from the so-called Cadillac tax on high-end coverage that begins in 2018.Having consumers pay more is also supposed to nudge them to buy thoughtfully — to consider whether procedures are necessary and to find good prices.

How well this will control total costs is very unclear. Your company is probably raising deductibles — the amount you pay for care before your insurance kicks in. The average deductible for a single worker rose to $1,217 this year, according to the Kaiser Family Foundation. Employers are also scrapping copayments — fixed charges collected during an office or pharmacy visit.

4) How do I compare medical prices and quality?

Companies concede that they can’t push workers to shop around without giving information on prices and quality. Tools to comparison shop are often primitive. But you should take advantage of whatever resources, usually an online app from the insurance company, are available.

5) Can I use tax-free money for out-of-pocket payments?

Workers are familiar with flexible spending accounts (which aren’t that flexible). You contribute pretax dollars and then have to spend them on medical costs before a certain time. Employers increasingly offer health savings accounts, which have more options. Contribution limits for HSAs are higher. Employers often chip in. There is no deadline to spend the money, and you keep it if you quit the company. So you can let it build up if you stay healthy.

 6) How is my prescription plan set up?

Drugs are one of the fastest-rising medical costs. To try to control them, employers are splitting pharmacy benefits into more layers than ever before. Cost-sharing is lowest for drugs listed in formulary’s bottom tiers — usually cheap generics — and highest for specialty drugs and biologics.

If you’re on a long-term prescription, check how it’s covered so you know how much to put in the savings account to pay for it. Also, see if a less-expensive drug will deliver the same benefit.


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