Questions to ask during open enrollment

No one thinks open enrollment is a good time, but health insurance is an important part of your financial health. Whether you buy insurance through your employer or through the Affordable Care Act Marketplace, it’s important to ask the right questions before choosing health insurance in 2024.

“Open enrollment is the perfect time to do a personal health audit,” says Charlene Reinhart, CPA, personal finance editor at drug-savings site GoodRx. “Understanding your current and anticipated medical needs will help you decide which plan is best for you.”

Here’s how to weigh your options:

Is your doctor in network?

The planning network changes from year to year. If you love your doctor or specialist, make sure they’re still included in the plans you’re considering in 2024.

You should also consider whether you need the option to go outside the network. This can usually be done through a preferred provider organization or PPO plan, but the cost is higher. Health maintenance organizations (HMOs) tend to be less expensive, but they lack out-of-network flexibility.

Are your medications covered?

If you take prescription drugs, check your plan formula to see how your drugs will be covered in 2024. Even if you have the same plan, drug coverage can change from year to year.

“Even if you’ve been on an Aetna plan before and you say, ‘Okay, I’m going to stay with Aetna again,’ you’ll want to make sure the medications you’re taking are still on your prescription,” Abby says. he says. Mr. Leibovitz is chief medical officer and co-founder of Health Advocate, an integrated health advocacy and health benefits program.

What are the out-of-pocket costs?

In addition to the monthly premium, all plans have costs such as deductibles, copays, and long-term care costs, including coinsurance. Comparing plans means estimating how much health care you’ll spend next year.

On the other hand, there are costs you pay if you don’t use your plan beyond preventive care. On the other hand, if you use medical services frequently, there is a maximum amount you can pay under each plan. You can easily compare these situations.

However, there’s a fine middle ground, and the best plan for you will depend on the amount and type of care you’ll need in the coming year.

“The hard part is, if you’re in the middle, you have no idea how much you’re going to spend that year,” said Adam Rosenfeld, a health benefits expert and president of employee benefits company Rubicon Benefits. ” he says. The best thing to do is look at your current billing information and imagine it will be the same next year, he said. Which plan should I use?

“This is the best predictive modeling we can do right now,” Rosenfeld said.

Are high deductible plans right for you?

High-deductible health plans (HDHPs) in 2024 are defined as plans with a deductible of at least $1,600 for individual coverage or $3,200 for family coverage, and out-of-pocket limits of $8,050 or $16,100, respectively. Defined. HDHP premiums are typically lower, and your company may contribute to a health savings account (HSA) to cover your deductible.

HDHPs can be good plans for people with a variety of health conditions, as long as you are prepared to pay a deductible if you need medical care.

“The question is, ‘Can you afford it?'” says Adria, founder of Medwise Insurance Advocacy, which assists insurance brokers, consultants, and clients and attorneys with medical billing issues. Gross says. If you’re healthy, try HDHP, Gross said. However, if a terrible accident occurs, you need to make sure you have the means to pay your deductible in full.

Can you accumulate benefits?

Voluntary benefits may be available through your employer to cover costs not covered by insurance. For example, Aflac insurance can help pay for your expenses if you have an accident or get cancer.

In addition to high-deductible health plans, you may also have access to supplemental plans that can cover your deductible at a lower cost than traditional health plans. “It can be much cheaper than moving to the next step with a lower deductible,” Leibovitz says.

Do you need special care?

Some insurance plans cover things like weight loss surgery and infertility treatments, but some don’t, and if that’s the surgery you’re considering, the exclusion can make a big difference. There is a possibility. One insurance company may cover a certain surgery or test, while another may consider it research-based and not medically necessary.

“I call them the periphery,” Leibovitz said. “They go beyond the scope of normal medicine and surgery.” He said that while the focus is narrow, the scope can be important.

The underlying message, he said, is don’t assume that just because it looks like the same plan from the same company you joined this year, that what’s important to you hasn’t changed. “You have to do your homework on networks, prescriptions and benefits,” Leibovitz said.

Kate Ashford is a writer for the personal finance website Nerd wallet. This article was distributed by The Associated Press.

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