10 Tips For Navigating Open Enrollment

By PokitDok Team,



For most Americans, the open enrollment period is just another day on the calendar — like tax day — when complex financial decisions must be made. As nice as it would be to glaze over the the details of insurance plans, the details of those might affect your benefits, how you use them, and their cost more than you might think.

It's in everyone's best financial interest to navigate the labyrinth of insurance policies during the open enrollment period. Here are 10 tips to help focus efforts and make better decisions for the year to come.


The Basics

1. Does Your Current Plan Still Make Sense For You?

Transamerica's Jackie Lam recommends everyone review their current plan during the annual open enrollment period. If there's something that doesn't quite fit, it's the perfect — and only, barring a life event — time to explore other options.

Here are a few things to look for:

  • Will you be able to see the same doctors this year as last?
  • What providers and hospitals are considered "in-network?"
  • Where will you be able to pick up your prescriptions?
  • Will coverage change for your family?
  • Are in-network facilities close to your home, your work, or your children's schools?
  • How well is the plan rated?

2. Don't Assume Your Policy Will Remain the Same

Many people are reasonably satisfied with their current plans, and don't feel obliged to spend the time looking into other options. The problem: Insurers often change their policies from year to year.

The Kaiser Family Foundation says that it is likely 2015 premiums will change in 2016 in their health reform FAQs. "There may be other changes as well, for example, changes in the deductible or copays for some services. In some cases an insurer may stop offering a particular policy and offer you new choices, instead."

Your insurance company will send you a notice of changes before Open Enrollment begins, so be on the lookout


3. Compare Your Plan to Your Spouse's or Partner's

According to personal finance author Suze Orman, the open enrollment period offers a good opportunity for married couples to cross-reference the benefits they receive for themselves and their families, particularly if both plans are employer-provided.

"If you've had kids since you last picked your plan, this check is doubly important," she writes. "Whose plan makes the most sense for your entire family? And if your employer is now charging an extra premium to insure a spouse who has access to a plan through their own job — this is a growing trend — I highly recommend you weigh the cost of paying that extra expense, or having your spouse switch to his or her own employer's plan."

Doctor holding piggy bank

4. Consider Switching to a High Deductible Plan

Lifehacker's Jennifer Fitzgerald recommends that some people might benefit by switching from a plan with a higher premium to a high deductible plan, and then pairing that with a health savings account.

"One caveat though on the [high deductible plan]," she wrote. "If you know you'll be making regular doctors visits, then you may want to compare a lower deductible plan with a [flexible spending account] (if available) from your employer."

Fitzgerald also recommended three resources for comparing plans:

  • PlanCompass, which she said has good information on doctors;
  • HealthSherpa, which she said has fast quotes and helpful side-by-side comparisons; and
  • Stride Health, which she said helps you understand and forecast healthcare expenses.

Most people don't use their benefits to the fullest potential because of their complexity and the way they are positioned. A little research can go a long way.

Employer-Provided Insurance Plan

5. Many Employees Will Face Higher Premiums in 2016

About one-third of large employers will raise employee premiums in 2016 and one-quarter of employers will raise deductibles, according to Tom Anderson at CNBC:

"You may also have to adjust your health-care coverage next year if you're married and your spouse can receive insurance elsewhere," Anderson says. "The National Business Group on Health found that 34% of employers will implement surcharges for spouses who can obtain coverage through their own employer, up from 29 percent this year."

A tax provision in the Affordable Care Act that goes into effect in 2018 will make it increasingly expensive for employers to offer healthcare-related benefits, so employees can expect to see shrinking benefits and higher costs over the next three years, at least. According to the report Anderson cites from the National Business Group on Health, employees can expect:

  • to have slightly higher premiums and deductibles next year,
  • more surcharges for spouses covered on employer-provided plans,
  • an increased focus on corporate wellness programs and nurse coaching to help employees make better lifestyle choices,
  • and telehealth options to offset the costs of healthcare provision. *


6. Look Into Your Employer's Voluntary Insurance Policies

Most employers offer some package of voluntary — or sometimes "supplementary" — insurance policies that you can opt into for additional coverage. These policies cover things such as dental work and optometry visits, and they can also help people pay for out-of-pocket expenses — such as rent or other bills — if you ever are unable to work for medical purposes.

Makeba Giles, on behalf of Aflac, suggests that this kind of insurance could be a useful way to cover deductibles in your primary coverage.

"According to a recent Aflac survey, 66% of workers would not be able to adjust to the large financial costs associated with a serious injury or illness, and 49% have less than $1,000 on hand to pay out-of-pocket medical expenses," Giles said. She noted that voluntary coverage could even help pay for other expenses such as bills, rent and child care when the recipient is unable to work.


7. One-Quarter of Employers Will Offer Plans With Small Networks

As employers raise premiums and deductibles for the insurance plans they provide, many will also shrink their coverage networks. "In 2016, 22% of employers plan to offer so-called narrow network plans, which can cost less but include fewer in-network providers, according to Towers Watson," Money's Kara Brandeisky writes.

For healthcare consumers, this is wildly important to know. As a patient, you will have access to fewer facilities and medical providers — and the changes can be confusing. If your doctor was considered in-network last year, and not this year, you might incur out-of-network charges without knowing it — and that bill might arrive months later. It's very important to be a savvy patient and ask the right questions up front when these changes are made — and to double-check frequently, as providers and medical staff might not even be aware of the changes.

The Medicare Open Enrollment Period

8. Medicare Open Enrollment Begins Earlier

Medicare's open enrollment period begins two weeks earlier, October 15, and closes much earlier, December 7. The National Council on Aging's My Medicare Matters does a great job of explaining what Medicare recipients can change during time period. To name a few:

  • If you have or will have Medicare Parts A or B, you can join or drop a Part D prescription drug plan.
  • If you have both Parts A and B, you can switch to a Medicare Advantage plan. Likewise, if you have the Advantage plan, you can switch to an A-and-B plan.
  • If you have Medicare Advantage, you can switch to a new Advantage plans.
  • If you have a Part D plan, you can switch to a new Part D plan.

What are the incentives for anyone to make these changes? My Medicare Matters notes three:

  1. Adding or switching Part D drug coverage can significantly reduce your prescription drug expenses.
  2. You can switch to a plan that puts your doctor, your hospital and your pharmacy all in-network, thereby saving hundreds or thousands in out-of-pocket costs.
  3. You can find a better-rated plan.


9. Warning: Scammers Also Know When Medicare Open Enrollment Begins

Cory Warren at LifeLock, a personal data security company, warns Medicare users that open enrollment provides identity thieves with several opportunities to scam unsuspecting people. Often, these people will send out official-looking emails that alert you of potential changes to your Medicare coverage.

Here are three steps he suggests you take to verify whether an email is official and safe:

  • "Hover your mouse over the sender's address. You should be able to see immediately whether it's from a healthcare provider.
  • Pay attention to the writing style and grammar. If you spot errors, consider whether a professional company would let those mistakes slip through their proofreading process.
  • If you're instructed to click on a link to access information, don't. The sender may be trying to trick you into going to a website that allows them to install malicious software — or malware — on your computer."


10. Check Whether Your Medication is Included in Part D Coverage

CNBC's Sharon Epperson reports that Medicare Part D premiums are not expected to rise next year, according to Fidelity and AARP. Still, taking a moment to determine whether your medication is included in your own Part D coverage is vital.

Medicare.gov is a worthy source to compare Part D plans' premiums and copays. Epperson also notes, "You can also contact your state health insurance assistance program for free consultation. To further cut costs, you can use a prescription drug pricing service to compare prices for medications." Services such as this let patients know whether there are coupons or other discounts available for their prescribed medications. Also, to avoid what the industry refers to as the "donut hole," or gap coverage, ask your doctor or pharmacist about lower cost alternatives.

images by:
London Scout, Greg Rakozy, Omer Yousief

The opinions expressed in this blog are of the authors and not of PokitDok's. The posts on this blog are for information only, and are not intended to substitute for a doctor-patient or other healthcare professional-patient relationship nor do they constitute medical or healthcare advice.

  Tags: Consumer

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