INDIANAPOLIS — It’s time for workers around the country to think — really think — about health insurance.
Open enrollment has started for many employer-sponsored benefits plans that renew their coverage Jan. 1. Next year’s plans may include free preventive care and other changes thanks to the health care law Congress passed earlier this year. They also are likely to come with a higher premium for employers and employees to pay.
Here are five questions to consider as notices from your human resources department about changing or adjusting benefits start trickling into your e-mail inbox.
Is my plan still right for me? Don’t blow off open enrollment without at least looking at your coverage to make sure it still fits. Unless you get divorced or have a child, this may be your lone chance for the year to adjust your benefits.
Significant savings could be at stake because prices and benefits can change from year to year, and your employer may offer more than one coverage option.
“A lot of people just default into whatever plan they’ve always been in, and you don’t want to be caught by surprise if there are changes in your plan you could have known about during open enrollment,” said Tracy Watts, a partner with the benefits consultant Mercer.
Consider switching to a high-deductible plan if you’re young and healthy and a sizable percentage of your paycheck goes to insurance. These plans come with premiums that are lower than traditional insurance, but patients pay more out of pocket on medical expenses before their coverage kicks in.
They can be especially attractive if an employer pairs them with a health savings account that lets the patient save money before taxes for expenses. But before committing to the high-deductible route, think carefully about whether you can handle the higher out-of-pocket costs.
People who have regular prescriptions should check for price changes. Employer-sponsored plans can have tiers or preferred status for drugs, and a move to a different tier affects pricing.
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Should I start or renew my flexible spending account? Flexible spending accounts, or FSAs, let employees set aside pre-tax wages for medical expenses not covered by insurance, but that money must be used in the year in which it is set aside or it is forfeited.
People with regular medical expenses such as prescriptions or contact lenses make good candidates for these accounts, said Nancy Metcalf, a senior program editor with Consumer Reports Health. FSAs also can help pay for big-ticket items such as braces or hearing aids that you know will hit in the coming year.
Starting next year, over-the-counter medicines will not be covered by FSA accounts unless a patient has a doctor’s prescription.
How will the health care overhaul affect my benefits? Several provisions of the new law take affect for plans beginning next year.
Insurers will be required to cover preventive care such as immunizations without charging co-payments or other forms of cost sharing. Lifetime limits on the dollar value of coverage will be prohibited. Adult children up to age 26 will be eligible to receive dependent coverage.
Your plan may not automatically include all these new elements. Coverage that existed before March 23 and hasn’t changed substantially may be grandfathered, in which case the plan will not have to offer the preventive coverage. Your employer will tell you whether a plan has been grandfathered.
Watts estimates that these changes from the new law could increase premiums by 2 percent or 3 percent, but that will vary depending on the plan, the people covered and the employer.
Aside from the overhaul provisions, how are benefits changing? Employers have been asking workers to share more of the cost for their coverage through higher premiums, deductibles or co-payments or by paying a greater percentage of coinsurance, which is what a patient pays for a medical service after a plan deductible is met. Watts said they’ve seen this trend develop for several years.
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