The thought of changing your health insurance plan may be daunting. But when you learn your employer is making changes, it provides you with the opportunity to review your health care needs and possibly select a better-suited plan.
The first thing that many people think about when picking an employer-sponsored health care plan is price. What are the plan’s premiums and out-of-pocket expenses (e.g., deductible, copayment and coinsurance)? While price is undeniably an important factor when choosing a new plan, there are several other criteria that should be examined before electing new coverage.
Reviewing Provider Networks
When weighing your new plan options, it is important to check out each insurer’s website to determine if your current physician is within the plan’s network. Knowing which physicians are in-network can help reduce costs, since receiving out-of-network care typically will result in higher out-of-pocket expenses.
Prescription Drug Coverage
Some insurance plans have certain drug formularies, or a preferred list of medications, and step therapy requirements, which require individuals to try more cost-effective treatments before “stepping up” to more costly drugs.
If step therapy requirements are not followed or if your medication is not on the carrier’s formulary, your prescription could cost more, or it may not be covered at all. If you regularly take a certain medication, you will want to visit your new carrier’s website to view the plan’s drug list. A drug requiring step therapy, for example, may be marked with an “ST.” If a medication you take is on this list, contact your physician to determine the best course of action. Reviewing prescription drug coverage before selecting a plan helps ensure you are financially prepared for any adjustments to prescription drug coverage and can reduce confusion at the time of pharmacy pick-up.
Mental Health and Substance Abuse Coverage
Although mental and behavioral health treatments are one of the 10 essential benefits required by the Affordable Care Act (ACA), individual insurance policies may vary on the extent to which these services are covered. For instance, some plans may cap reimbursement at 20 therapy visits while others may not have an annual limit. Being aware that limits for these services may change between your old and new plan is essential when planning for and managing your health care expenses.
Upcoming Scheduled Medical Procedures
If you have already scheduled a medical procedure for the new plan year, it is important to contact your physician’s office to ensure you are still covered under your new plan. For example, a pre-authorization for surgery may be required by your new insurer, so by communicating insurance changes with your physician’s office prior to receiving services, you can avoid any billing surprises after the procedure.
Lastly, some plans may feature tax-advantaged options like a health reimbursement account (HRA) or health savings account (HSA). While these programs vary in requirements and structure (for example, HSAs must be tied to a high deductible health plan), their end goal is to help minimize health care expenses. Reviewing new plans to see if an HRA or HSA is offered may be one way to potentially reduce your financial responsibilities.
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