During this open-enrollment period, here’s how to make sure the plan you choose is the best fit for your life right now
If you feel like open enrollment is a giant puzzle with ever-moving pieces, you’re not alone. It’s not easy to navigate—but there is help out there. If you’re satisfied with your current coverage and the premiums you’re paying, you may decide to keep everything the same.
On the fence about your current plan? Review last year’s premiums and claims. If you think you’re overpaying for out of pocket, or that you could scale back or ramp up your coverage, it may be time to make some changes.
Use this cheat sheet on what to consider for your current life circumstances.
If You Have an Ongoing Health Problem
Look for a plan that covers a range of treatment options
“You want to make sure all your providers, treatments, who’s administering them, where they are administrating them, your prescriptions—basically, whatever you do to keep that chronic condition under control—are covered,” says health care consumer advocate and licensed practical nurse Michelle Katz, MSN, LPN.
Weigh your plan options with your specialist, a nurse practitioner, or another trusted member of your health care team. “Even if you need to make a special appointment to ask questions and compare plans,” she says, “it’s worth it to have an advocate who knows you, knows your chart, and knows your treatment plan.”
For example, if you have diabetes, does a plan you’re considering offer regular consultations with a registered nutritionist? Or, if you have rheumatoid arthritis, is there an option that covers acupuncture or massage therapy to help prevent flare-ups?
If You Are Generally Healthy, with School-Age Children
Look for a plan that ensures your best pediatric coverage
If you love one specific pediatrician, priority one is making sure their practice is on your plan as comprehensively as possible, says Katz, who is the author of Healthcare for Less: Getting the Care You Need Without Breaking the Bank. That means you’re covered for both well visits and sick appointments.
And if your child has special medical needs, figure out which providers are in-network, and what the cost is if they’re not—regular out-of-network costs can add up quickly. Another consideration: Does the plan include any telehealth options? A Skype or other video call diagnosing bronchitis or pink eye can save harried parents, in both money and the drive to your provider in a snowstorm, heat wave, or when your child (and you!) is too miserable to make the trek.
If You Are Generally Healthy
Look for a high-deductible health plan plus a health-savings account
Congrats if you’re sailing into midlife in relatively good health shape. An A+ health record is definitely worth celebrating. But now’s not the time to coast—now is the prime time to start shifting your thinking to the long term.
When it comes to your health, says Katz, you never know what ailments or issues might come up year after year. That’s why she encourages healthy adults to consider combining a high-deductible health plan with a health-savings account (HSA). You can’t open an HSA without a high-deductible plan.
High-deductible plans typically cover only preventive services until you’ve met the deductible. HSAs let you use untaxed dollars for copays, deductibles, and other qualified medical expenses. Some health plans offer HSAs for their high-deductible plans, but you can also open an HSA through some banks and other financial companies.
“HSAs have great tax benefits,” she says. “You don’t get taxed on what you put into your HSA, you can roll the funds over from year to year, and when you do need the funds for a medical expense, you can pull it out easily.”
This way, if you have any big-ticket health problems that arise, you’ve set aside some pretax income to cover them. And if you stay healthy, you can save the funds for the next unexpected occasion.
If You Are on Medicare
Look for a supplemental advantage plan
Whether you’re new to Medicare or are renewing, think about whether you need a supplemental advantage plan to cover bigger expenditures that aren’t included in Original Medicare (Parts A and B).
Remember that as you get older, “you may need a lot more care than you might think,” says Katz.
One upside for Medicare enrollees who are on a fixed income is that there are a lot of low-cost or supplemented benefit options for seniors, including fitness club memberships and meal services.
She says to explore all of your plan benefits and extras to make sure you’re getting the most from your coverage.
