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Spring 2024  Volume 16, Number 2        

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How to Pick the Best Health Plan at Work

When open enrollment comes around, you may feel overwhelmed evaluating the health insurance options your employer offers. However, arming yourself with key information can make navigating this decision much smoother. Follow this practical guide to choose the plan that best fits your needs and saves you money.

Understand the Different Plan Types

The first step is learning the distinct features of indemnity plans, HMOs, PPOs, and HDHPs. Indemnity plans allow you to visit nearly any doctor or hospital for covered services, although you’ll pay more out-of-pocket without network discounts. HMOs require you to select a primary care physician who coordinates your care within the plan’s network. PPOs offer more provider choice flexibility, while HDHPs feature lower premiums but saddle you with large deductibles.

When deciding, experts say to think ahead to your expected healthcare needs so you can pinpoint the right balance of flexibility and affordability. Those wanting more choice flexibility may lean toward PPOs or indemnity plans. However, the freedom to access out-of-network care comes with higher costs.

Check Your Doctor’s Network Status

Another major factor is verifying that your preferred medical providers participate in the plan’s network. Being forced to switch doctors can cause unnecessary hassles. Go online or call each provider’s office to confirm they are in-network for the specific plans you’re considering.

According to experts, staying in-network saves approximately 30 percent off your medical bills. So, if keeping your doctor is imperative, use it to guide your plan selection process.

Compare Cost-Sharing Elements

You also need to understand how you and your insurance split healthcare expenses. Deductibles, copays, coinsurance, and out-of-pocket maximums indicate your financial responsibility.

Average deductibles today run over $1,700 for individual coverage and $6,100 for families. You must foot the bill for this amount before coverage kicks in for most care. Then, you pay either a flat-rate copay or percentage coinsurance until reaching your plan’s out-of-pocket max.

Experts emphasize the need to calculate your total estimated costs — not just monthly premiums — to determine the best financial value. Those expecting significant medical needs may opt for a low-deductible PPO or HMO to activate coverage quicker.

Factor In Family Members’ Needs

When covering dependents, carefully evaluate how each person may use healthcare services in the coming year. If your child requires braces plus your spouse manages a chronic illness, those needs should guide your plan selection. Identify who requires frequent specialist visits, tests, medications, and procedures.

Compare prescription drug formularies to ensure each family member’s medications are covered at favorable copay tiers. If not, you may face exorbitant out-of-pocket costs. Experts also advise checking if your adult children can stay on your plan until age 26.

Double Check Additional Perks

Finally, explore each plan’s supplementary offerings like dental, vision, and life coverage plus health savings accounts, gym memberships, and employee assistance programs. These perks can enhance financial protection and your overall well-being.

For example, free preventive dental cleanings could help you avoid major restorative bills down the road. Or an HSA’s triple tax savings may help counteract a high-deductible plan’s financial risks. Determine which extras hold the most value for your personal situation.

Please call us for help and more information.

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In this issue:

This Just In... 3 Medigap Surprises to Watch Out For

8 Top Tips from Millionaires for Growing Your Retirement Nest Egg

What Is First-to-Die Life Insurance and Do You Need It?

How to Pick the Best Health Plan at Work

Important Retirement Trends to Keep an Eye On




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