3 Critical Tips For Open Enrollment

It’s everyone’s favorite time of year! That’s right: we’re talking about open enrollment for individual health insurance, which means it’s time to evaluate your current health insurance plan, look into available options, and make adjustments to fit your needs. 

Of course, there are a ton of moving parts that go into choosing the right health care plan. Open enrollment ends on January 31st to get covered in 2020 without a special enrollment event (like losing coverage through work or having a baby). What can help you to make the best choice for your situation? Here are 3 tips to help you navigate the complexities of open enrollment for 2020.

1. Anticipate Your Needs

First of all, think about your healthcare needs for the coming year. Even though you may know what your normal needs will be, it’s also wise to plan for the unpredictable (trips to urgent care, emergency room visits, and so forth). Moreover, if you’re a parent you should consider which plan would be the best option for your dependents.

Ask yourself questions such as these:

  • Do you anticipate many visits to the doctor, or do you expect to remain healthy throughout the next 12 months?
  • What would your plan cover in the event of an emergency?
  • What percentage of your paycheck are you willing to allocate to healthcare insurance each month? 
  • Do you have a preferred doctor, or are you agreeable to visiting different healthcare providers?

It’s important to ask yourself such questions because plans vary widely as to the amount of coverage offered, the monthly premium charged, and the number of participating medical providers. When you have a good grasp of what you’ll need for the coming year, you’ll be in a better position to choose the best plan for you. 

2. Become Familiar with the Terminology

The healthcare industry is full of technical jargon. That’s why it’s important to get a handle on at least the basic vocabulary associated with your typical plan. Three crucial terms that you’ll see in just about any plan on the market are:

  • Deductible. A deductible is the amount you pay out of pocket for covered services before your insurance plan kicks in. For instance, a $500 deductible means that you would have to pay $500 before insurance paid anything. Some plans have deductibles that apply to almost everything, other plans have deductibles that only apply to big stuff like being admitted to the hospital and some plans have $0 deductible.
  • Co-insurance. Co-insurance is what you have to pay after your deductible has been met. Taking the above example a bit further, if you have already met your $500 deductible, and have a new medical bill for $1,000 with a co-insurance plan of 30%, then you would pay $300 from that bill, and your insurance provider would cover the remaining $700.
  • Co-pay. A co-pay refers to a set amount that you would pay for a particular covered service, with the insurance company paying the rest. If a doctor’s visit costs $80, and you have a co-pay of $20, then you would pay the $20 and your insurance company would pay the remaining $60. 

Understanding what each one of these terms actually means (and others specific to the plan you’re looking at) will help you to make an informed decision, and avoid unpleasant surprises in the future. 

3. Compare Available Plans

Finally, look at which plans are available in your market, and decide accordingly. Healthcare plans are generally divided into one of four categories:

  • Health Maintenance Organization (HMO)
  • Preferred Provider Organization (PPO)
  • Exclusive Provider Organization (EPO)
  • Point of Service Plan (POS)

Look for the type of plan that fits your anticipated needs coming into the new year. For instance, HMO plans generally have the lowest premiums of these four options, but typically don’t cover out-of-network care (unless it’s an emergency). You are also required to have a primary care physician. On the other hand, PPO plans do offer out-of-network coverage (even though your out-of-pocket costs are higher) and don’t require you to retain a primary care physician.

Depending if you prefer Kaiser, Sutter, Dignity or another health care provider is another big factor to consider.

These 3 tips will help you save on stress and point you in the right direction towards finding the best healthcare plan for you! Of course, there are many, many more details associated with each policy, which means there are also a lot more opportunities for mistakes and misunderstandings. For extra guidance, contact your local Rue Crew experts! Learn more here, and get a customized quote today. 

Alex Rue