Health Care Open Enrollment 2016-2017: How to choose insurance coverage through work

Health Care Open Enrollment 2016-2017: How to choose insurance coverage through work
Source: Shutterstock
Source: Shutterstock

Despite all the attention given to complex, problem-ridden Obamacare — aka insurance via health care marketplaces mandated by the Affordable Care Act — most Americans still receive their insurance through their employers.

If that's you, open enrollment season might still be confusing, with dizzying choices in your menu of job-based health plans and complicated options that might help you save cash — if you could only understand them.

The key is comparison shopping: Look for insurance that fits your budget and needs, so you never need to dip into your emergency fund to pay for care.

Generally, the earlier you enroll, the sooner you will get coverage at the beginning of the new year.

Still lost? Here's how to find your way.

What is open enrollment? How do I enroll?

Open enrollment is the window of time when health insurers take on new participants in their plans and allow current enrollees to make changes to their coverage; employees can add, drop or make changes to existing benefits.

While the time for open enrollment is set — from Nov. 1 to Jan. 31, 2017 — for those buying insurance direct from insurers or through the HealthCare.gov marketplaces, employers set their own open enrollment window times.

First thing, get those dates on your calendar. Then, set a reminder.

Source: Giphy

For most employees, if you don't log in to your benefits system, your choices from last year will roll over to the coming year. But some organizations are shifting to "active" enrollment periods, during which time employees must log in and select a new plan, or actively re-select existing benefits.

Employers may, in some cases, offer a smaller number of plans to choose from than the open marketplace — though that depends on which state you live in.

Remember: You can still shop outside your employer-offered plans, but then your company won't subsidize any costs, and you may have to pay for the whole thing.

How should I choose health insurance?

The question on many minds: How much are my premiums? Premiums are the monthly amounts you pay to have health insurance coverage.

This cost will depend on a variety of factors, including your age, location, and the extent of your coverage; the national average cost of a premium is $230 to $254 monthly for a 21-year-old.

But premiums are only a piece of the picture.

Source: Giphy

Health care is different from other kinds of insurance. Even after you pay your premiums, there can be complicated ongoing costs in health plans.

As premiums go down, other expenses — like what you pay out of pocket — typically go up. Shopping around means figuring out the right balance.

Here are five other factors to consider:

Your co-pays, or what you pay out of pocket with each visit to a doctor. If you have a chronic condition, these can add up quickly so you may want to look for lower co-pays specifically.

Your deductible, or how much you pay before your health insurance starts to kick in. For example if you have a $1,000 deductible, you will need to pay $1,000 out of pocket before the insurer begins to pay.

• Your co-insurance, or the amount you're responsible for after the deductible is covered. For example, if after you have paid the $1,000 deductible you have 20% coinsurance, you'll be expected to pay 20% of each medical bill. The insurer will cover only 80%.

• Your out-of-pocket maximum, or the most you may be expected to pay in one year, out of pocket, for your care. Your health care covers 100% of the rest after you reach that limit.

• Your drug benefits. If you regularly take medicine, you will need a plan that offers comprehensive coverage. Also watch out for any restrictions around name-brand versus generic drugs if you have a preference.

In general, the rule of thumb is to buy only as much insurance as you need: If you're not planning to have a baby in the next year, skip the plans with robust maternity offerings.

And if you don't care about generic versus name-brand medicine, look for cheaper plans that offer only generic drugs.

Source: Giphy

What else do I need to choose? What are FSAs and HSAs?

In addition to thinking through health and prescription drug insurance, you may also need to decide on other benefit options during open enrollment season.

These include:

Flexible savings account or health savings accounts. FSAs and HSAs are not the same but behave similarly — they both let you stash away a few thousand dollars in pre-tax cash for expenses like out-of-pocket health care costs.

One main difference is that HSAs let you contribute more — up to $3,400 for individuals in 2017 — than FSAs, which allow you to save up to $2,600. Another is that HSAs require you to be on a high-deductible health plan, while FSAs do not. And money put into FSAs must be spent within the year, while HSA funds can be rolled over. Read up on other differences.

Dentalvision and life insurance, and short-term or long-term disability coverage. During open enrollment, you can add, drop or otherwise alter your coverage or switch to a new plan.

You should get to know these options carefully: Disability insurance, for example, will pay you all or part of your pay should you become unable to work because you get sick or hurt.

Choosing whether you need coverage can be specific to an individual's needs and how risk-averse you are.

When it comes to dental insurance, for instance, the annual cost of routine maintenance and cleanings can be less than the average yearly premiums, which can be between $50 and $180 for individuals

Then again, dental coverage comes in handy if you need a major procedure.

What else should I know to enroll in a health insurance plan?

Remember: Just because you're not selecting a plan from the marketplace, doesn't mean the Affordable Care Act doesn't affect you. All larger employers — those with 50 or more full-time employees — are now required to provide health care to their workers under the law.

The law also put in place a host of new consumer protections. For example, insurance companies cannot deny you coverage for pre-existing conditions, and parents can keep adult children on their policies through age 26.

Plus, you have a legal right to free preventative care: services, like screenings and vaccines, are now required to be completely covered.

Talk to your human resources coordinator or manager to find out exactly what you need to do to enroll this season.

Source: Giphy

The paperwork is annoying, so get organized and start by looking at your current health insurance plan. Be sure you have any documentation for any new information, like additions to your household or changes in your address.