In choosing health insurance, Cariann Moore used an online
spreadsheet tool provided by her employer to compare insurance plans.
She found that a high-deductible plan with a lower pricetag would save
her money.
"For me, it makes it so much easier and demystifies
what can be a little overwhelming when you have all these options," said
Moore, who works for C3 customer-service firm in Plantation.
With
health insurance premiums up an average 7 percent for 2013, employees
are finding they need to be savvier consumers. To deal with rising
costs, employers are putting the onus on workers "to take control over
what their health expenses are," said Terri Byers, national benefits
enrollment manager for West Palm Beach-based Oasis Outsourcing, which
handles payroll and benefits for companies.
Here are seven tips on choosing health insurance and reducing costs:
• Make sure you enroll.
If you don't re-enroll in your benefits or are given new plan options,
you could end up without coverage for 2013. Check your enrollment dates,
often in early November or in the spring, and make sure you sign up.
Most
people who are offered employer-sponsored health insurance should take
it, said Keith Mendonsa, consumer insurance specialist for
eHealthInsurance.com, which provides insurance quotes online. And people
with pre-existing conditions should definitely take it, since they
could be declined on their own, he said.
• Pay attention to your insurance costs. Look at three things: your premium cost
contributions this year compared to last; your maximum "out-of-pocket,"
which is your financial obligation for a catastrophic health issue; and
your deductible.
"If my deductible is $2,500 and my out-of-pocket
max is $5,000, I know I'm going to have to pay $2,500 if I go into the
hospital. Can I afford that?" Byers said, as an example. But if the
deductible and out of pocket are both $2,500, then all your healthcare
expenses will be covered by your insurance after the deductible is met.
Consumers
make the mistake of picking what they think is the "richer" plan, Byers
said. But check whether your doctors are on the less expensive HMO
plan, as well as the pricier PPO insurance.
"It's really understanding your plan," she said.
• Compare traditional with high-deductible plan options. More employers are offering a high-deductible plan, which generally offers a lower premium.
But be prepared to pay the amount of the deductible in the coming year if you have serious health care issues, said Mendonsa.
Moore, 34, chose a high deductible plan because she's relatively healthy and doesn't have to buy many
prescription drugs. "It made more sense for me," she said. "Knock on wood; I haven't been in an emergency room for a very long time."
But
a family that has frequent visits for the children to the pediatrician
or even an emergency room may prefer the co-pays and lower deductible of
an HMO, Byers said.
Ask your employer if there's a "gap" plan
available, which is combined with high-deductible insurance to offset
the cost if an employee lands in the hospital. Under a high-deductible
plan, the employee has to pay the deductible, which can be $5,000 or
more, before surgery or other major health care expenses are covered.
• Use incentives to reduce costs.
"Employees should think about how they can be better consumers with the
services a carrier offers," said Heather Leck, president of Corporate
Benefit Advisors in
Delray Beach.
Some plans offer a hotline to a nurse or doctor, price checks on tests
ordered by a doctor, such as an MRI, or where to find the best deal on a
prescription.
At NCCI in
Boca Raton,
employees will find incentives including an extra $75 in their paycheck
if they participate in a program that encourages them to know their
blood pressure, cholesterol levels and other health measures, said Gail Nichols, compensation director for the data firm.
• Set pre-tax dollars aside.
Use a flexible spending account either from your employer or a third
party, such as a bank, to deposit money to cover health costs not
covered by insurance. Find the list of IRS-approved expenses on your
health insurer's website.
Note that contributions in 2013 for
flexible spending accounts have been lowered to $2,500 in 2013, but
Byers said she doesn't think it will affect most people. "I don't see
many people using the full $5,000," she said.
Employers that offer
high-deductible plans also may have the option of a health savings
account, where pre-tax dollars also can be socked away. The difference
between a flexible spending account is money must be used by year-end,
while a health savings account rolls over to the next year. If you have a
number of healthy years where you don't use what you deposit, you could
rack up extra retirement savings.
"Take advantage of the services that can help you save money," she said.
• Mix and match coverage. Your
spouse or domestic partner may have less expensive coverage. Or, it may
be less expensive for certain family members to be insured on an
individually-purchased health plan. Note that employer-based plans are
more likely to cover pregnancy, according to eHealthInsurance.
Mendosa
said some employees may find their employer's health plan no longer
meets their needs – perhaps they need a brand-name prescription and the
plan only covers generics. Or, the monthly cost for premiums is more
than the employee can afford. If you have no pre-existing conditions,
look at options to purchase insurance on your own.
But don't cancel or disenroll from existing coverage until approved for a new one, he said.
•Review coverage options for adult children.
Since 2010, the health care law has allowed adult children to retain
coverage under a parent's health insurance policy until age 26. But make
sure adult children who live in another state have access to your
in-network health care providers.
