Preparing for Open Enrollment

Annual open enrollment is finally here!  It’s time to review your current benefits, and maybe even choose new benefits.  But make sure you’re making an educated decision--not understanding your benefits and/or taking the time to choose the appropriate benefits can be a problem. In fact, a recent study by Aflac showed that 56 percent of American workers estimate they waste up to $750 each year because of costly mistakes they have made with their health insurance benefits.

It’s important to fully understand your benefits, especially if you are making changes in your life, or are expecting big changes in the coming year –like getting married, or thinking about starting a family. These are questions you need to ask yourself when selecting benefits this open enrollment period. 

Health Advocate, Inc. offers the following tips to help you make the best choices to meet your needs.

·         Don’t over-insure or under-insure. Before choosing a plan, it’s important to assess your current health and financial circumstances.  For instance, patients with a chronic condition should consider a plan that covers numerous visits to doctors and specialists. For those planning on starting a family, it’s important to look for insurance that will cover prenatal care. If you are young and relatively healthy, you could consider a high-deductible health plan in order to save money on monthly premiums. 

 

·         Check to see if your doctors are in-network. Don’t automatically assume your doctor is covered in your plan’s network.  If you go out-of-network, you will be paying more out-of-pocket costs to see your preferred doctor.  Contact your insurance company to find an in-network doctor or call your Personal Health Advocate, who can help you locate a physician.

 

·         Your current health plan may not be right for you. Your coverage may have changed. Maybe your copay is higher or maybe your prescriptions are not covered anymore. Take the time to look into other policies that may better fit your health needs.  

 

·         Take into account any life changes.  Are you planning to have a baby and need maternity coverage, or are you adding an adult child (up to 26 years old) to your plan? Don’t assume that your current plan will automatically provide coverage. Review your benefits carefully.

 

·         Know the differences between a Health Savings Account (HSA) and a Flexible Spending Account (FSA). Depending on your company’s benefit offerings, both HSAs and FSAs may be available, and it’s important to understand the differences between the two so that you can choose the one that best meets your needs. For example, both options allow you to put money aside into a fund for medical expenses. But an HSA can be held on until retirement if you choose, while the funds in an FSA will be lost before the end of the plan coverage period if it is not used. 

 

·         If one is available, budget your Health Savings Account (HSA) properly. An HSA can be spent on qualified health expenses, such as most major medical, dental or vision. The money placed in an HSA is pre-tax and accrues interest year after year, so you never have to deal with “use it or lose it.”

 

If you are a Health Advocate member and you have questions about your benefits, call us today!  A Personal Health Advocate can address your questions or concerns and help you better understand the ins-and-outs of your health plan.

What to Look for When Choosing a Health Plan

Have you looked at your health insurance policy lately? Maybe it’s worth checking over the details of your plan to see if it suits your needs. A recent article in Insureme.com discussed tips on how to dust off your insurance policies this spring.

Health Advocate provides the following advice on what to look for when selecting a health insurance policy. Keep in mind that with an employer-sponsored plan, once you are enrolled, you will not be able to make changes until the next annual open enrollment period. However, you can make changes if you have a life-changing event such as a divorce, job change, marriage, birth of a baby or adoption of a child.

Choosing a plan.  To pick the best coverage, first calculate your healthcare costs from recent years and try to estimate what your costs might be for the coming year. Don’t forget to include the cost of doctor’s visits, daily medications and any medical procedures you might need.

Do you really need all the bells and whistles? Some people have a tendency to think, “It’s a health insurance policy--I want the best.” That often translates into the most expensive plan. You may be paying too much if you choose a policy with a low deductible. Low deductibles are good if you frequently need medical care. However, if you’re young and healthy, it may be wiser to choose a high deductible plan. That way you’re covered for catastrophic illnesses without paying high insurance premiums.

Picking a robust plan. If you have a serious medical condition, you may want a health insurance plan that gives you several options for care, even if it costs more. You may not want to keep a plan that restricts you to doctors within a single healthcare system or requires referrals to see specialists.

Double-check the plan. Does the plan have prior authorization requirements? A prior authorization is an extra step that some insurance companies require before they decide if they want to pay for a medical service or a prescription medication.

Check into whether your doctor is in the plan’s network. You will pay more to visit healthcare providers outside the plan’s network, so it’s best to make sure your doctor is covered under your plan.

Understand who is covered. Check to see if your spouse or dependents are covered. If you recently got married or had a baby, you may want to add the new members of your family onto your plan. Some plans cover dependents, while other plans do not. Be sure to find out about whether stepchildren are covered. Some plans have a time limit for adding a spouse or newborn. For example, some plans require you to add your baby within the first 30 days following birth. Other plans will waive the additional premium for the first 31 days if you enroll within 31 days following birth. If you recently got married, some plans allow you to add your significant other within 30 days of the event.

 Find out if your medications are covered. If you take prescription medications, check them against the insurance plan’s formulary. Some prescription medications have higher co-payments than others and they might vary from plan to plan. Mail-order options might be available for maintenance drugs at a lower cost.

Budgeting your expenses.  If your employer offers you the option of a healthcare spending account, whether it is a flexible spending account (FSA) or a health savings account (HSA), take a good look at it. These tax-free accounts can help you save money on qualified medical expenses that aren’t covered by your healthcare plan, such as deductibles and co-insurance. Each account has a different set of rules about how and when you can spend the money, but each is worth considering because the savings you’ll see can add up quickly.  

Prepare for the unexpected.  Everyone needs to be prepared for the unexpected, including job loss, divorce, or other life-changing events. Be sure you know what the benefit plan costs might be if you need to pay for it under COBRA. COBRA requires that most employers with group health plans must offer employees the opportunity to temporarily continue their group health care coverage under their employer’s plan.

How Health Advocate can help

If you are a Health Advocate member and have questions about your health insurance policy, call us to speak to a Personal Health Advocate.  Your Personal Health Advocate can help you with many insurance-related concerns, including but not limited to:

·         Explaining the difference between a high-deductible and a traditional health insurance plan

·         Finding out whether your current doctor is in-network in your new insurance plan

·         If your current doctor is not in-network, finding you a new, in-network doctor—plus transferring your medical records and help schedule an appointment for you

·         Evaluating your health insurance plan to see if it has prior authorization guidelines

·         Looking into whether your spouse and/or dependents are covered under your health insurance plan

·         Researching which prescription medications are on your health insurance plan’s formulary

·         Explaining the benefits of a flexible spending account or a health savings account, and tell you what is a “qualified medical expense” that you can pay for from these accounts

·         Helping you understand any insurance-related terminology that you find confusing

·         Helping explain COBRA and go over your options with you

Health benefits can impact your overall financial well-being, so making well-informed decisions about the type of coverage you currently require will help you reduce costs. If you are a Health Advocate member, we can help you be better informed about your health insurance policy, which can help you—and your bank account—stay healthier!

Confused by your Explanation of Benefits (EOB)? Health Advocate can help!

When you or your family member goes to the doctor for a checkup, lab work, or other medical tests or procedures, you should receive an Explanation of Benefits (EOB) in the mail. An EOB is not a medical bill. It is an itemized statement that includes the healthcare service you received, how much was charged for the service, what was paid by your insurance carrier, and what you are expected to pay out-of-pocket.

When you first look at an Explanation of Benefits, you may feel a little intimidated by all the information listed there.  Even if the document confuses you, don’t ignore or discard it.  It’s important to take steps to understand your EOB.  Here is a list of the most common information you will find on your EOB statement and how to read it.

Member: This will include your contact information or the contact information for a member of your family who received care. The group number on your insurance card will also appear here. 

Summary of services. This lists the medical services that you or your family member received. This will also list any charges that you may owe and that were not paid for by your insurance company. If you do receive a medical bill, it’s important to compare the bill to the EOB. You’ll want to make sure that you are being billed for the correct services that you or your family member received.

Summary of deductibles and copayments. This column shows you how much of your copays and deductibles you’ve paid to date.

Details of services. This explains what type of care was received, the date of the appointment and the provider’s name. This is very important information to keep on hand. If you receive a medical bill, make sure the healthcare provider on the bill, as well as the date and the type of service received, match the same information on the EOB. Errors are not uncommon, and it’s possible that the bill and the EOB may not match. In order to notice and handle billing errors quickly and efficiently, you should always keep your EOB on file so that you can compare it to your bill.

Allowed amount: This is the contracted amount of payment a provider has agreed to accept for a service, treatment or product from an insurer.  In network providers can collect up to this amount, but out of network providers may balance bill up to their charges.

Balance.  This is the amount that you owe the provider for any deductible, co-insurance, co-pay and non-covered services. You may have paid some of this (for example, your co-pay) at the time the services were provided.

Still feeling a little confused about your EOB? If you are a Health Advocate member, call us—a Personal Health Advocate can help you better understand your EOB.  If necessary, your Personal Health Advocate can also help you resolve any errors you may find on your EOB or medical bill.

Knowledge is power! How to be an informed patient

Being a patient can often try one's patience. From dealing with doctors who don't always run on time to navigating the complex healthcare system--and, of course, dealing with whatever malady made you feel lousy enough to seek out medical care in the first place--nothing about being a patient ever seems to be easy.

One thing you can do to make the process easier to handle is to try and be an informed patient. Knowledge is power, and with the below tips, you may be able to decrease the feelings of powerlessness that often happen when you're a patient.

• Start reading.  Read your benefits booklet, and accompanied benefits materials, very carefully.  Make sure you know what services are covered and your financial responsibility.  Know your preauthorization procedure and who to call with questions.


• Take advantage of your benefits.  Once you understand what your insurance plan covers, take advantage of these things.  Does insurance cover a yearly physical?  Do it!  Can you do a mail-order plan for your prescriptions, which would save you money on prescription copayments?  Go for it!  Health reform now requires that new health plans cover preventative care at 100%, so why not take advantage of it?


• Make sure your doctor's part of the "in" crowd.  Generally, and depending on your coverage, in-network care will be much less expensive for you than out-of-network care would be.  Before scheduling an appointment, call both the provider's office and the insurance company to make sure that the specific doctor(s) you need to see are in-network with your insurance plan.  Also, ask the receptionist to make a notation on your file that if you have any tests done that require lab or radiology work, you'd like them to be in-network as well.


• Pre-certify care whenever possible.  Emergencies happen--you won't be able to pre-certify a broken leg, for instance.  But if your doctor wants you to undergo surgery or other procedures, getting this care pre-approved with your insurance company will save you a lot of money and hassle down the road.


• Always carry your insurance card with you.  You don't know when an accident might happen--that's why they're called accidents.  Make sure your insurance card is always in your wallet.  If you need to get rushed to the hospital unexpectedly, you or someone accompanying you will have your insurance information readily available, which can simplify and streamline the process of getting you the help you need.


• Take notes.  When you're at a doctor's appointment, you might feel scared and overwhelmed.  That's why it's important to write things down while you're there--later on, you may be able to clearly recall your feelings of being overwhelmed, but you might not remember how many milligrams of vitamin C your doctor recommended, or which over-the-counter decongestant she thought might work for you.


• Ask questions.  If you don't understand what the doctor's talking about, ask.  If you're unfamiliar with a medicine or treatment your doctor's recommending, ask about it.  If you are unclear about anything regarding your diagnosis, ask for clarification.  The common theme here is ask.  Your doctor is there to help you, and he wants you to understand what's going on with your health, so don't be shy about speaking up and asking questions.


• Look over your EOBs.  Once you've visited the doctor and/or had a procedure or treatment done, your insurance company will mail you an explanation of benefits that will tell you what the insurance company thinks you had done and how much of the cost the insurance will pick up.  Read these carefully and match them up with your doctor bills--there could be errors.  Maybe there was a coding mistake and the insurance company thinks you had a totally different procedure done than what was actually done, which could result in more money out-of-pocket for you.  If you think you've found an error, notify your insurance company right away.


• Understand your insurance benefits appeals process.  Did your insurance company not cover something that you thought was covered?  You can appeal--but you need to understand the process.  By reading over your benefits information, you should be able to find out how that process works and what you'll need to do to appeal.


• Know when to ask for help.  You don't have to do this alone.  Find out if your employer includes an advocacy service such as Health Advocate in your benefits package.  If so, reach out to them for assistance with a variety of issues, such as negotiating a large medical bill, helping you find in-network providers, and much more.  If you don't have access to an advocacy service through your employer, check out Health Proponent, an advocacy service individuals can use.