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You are here Consumer News Remar's Report It's Time to Review Your Health Insurance Coverage

It's Time to Review Your Health Insurance Coverage

November 2014

Whether you have health insurance through your employer, through a health exchange, or through Medicare, you have an opportunity to review and make changes to your health care coverage during November and December. No matter how you receive your health insurance, you should take this opportunity to review your current coverage and determine if it still meets your needs for the coming year.

Start by determining what your out-of-pocket costs were for this year. Then project what your expect your expenses to be next year. Will they be similar or have there been changes in your family’s health that could increase or decrease expenses? Do you want to keep your doctors or are you willing to change? Do you have other criteria that a plan must meet? Use this information to determine if your current plan meets your needs or if another plan would be better.

Employer Provided

Many employers will be making changes to their health plan offerings this year to reduce costs and to comply with the Affordable Care Act. Changes may include increasing deductibles and/or raising premiums. Some employers may be offering health care plans for the first time. So, it’s important for you to carefully review the materials that your employer will provide.

Typical plan types offered by employers are either preferred provider organization (PPO) or "consumer-directed" which are also called "account-based." In PPO plans, participants pay less if they use health providers within the plan’s network and more for those outside the network. Participants usually have a copay. In consumer-directed plans, which typically have higher deductibles and lower premiums, participants also use networks of providers but pay most of the cost until the deductible is met. Consumer-directed plans are usually paired with tax-advantaged health savings accounts (HSAs). The Remar’s Report Saving on Health Care Costs has more information about HSAs.

Determine your costs for each of the plans that your employer offers and compare them to your projected expenses. Then determine which of the plans meet your other criteria and will best fit your needs.

If you have insurance through a public exchange, you will have to cancel the plan if you will now be covered by your employer’s plan.

Tips for reviewing your health insurance

  • Determine what your out-of-pocket costs were for this year.
  • Project your expenses for next year. Will they be similar or have there been changes in your family's health that could increase or decrease expenses?
  • Do you want to keep your current providers or are you willing to change.
  • Do you have other criteria that a plan must meet?
  • Then determine if your current plan meets your needs or if another plan would be better.

Health Insurance Marketplace

Renewal notices for health insurance obtained through a state or federal marketplace have started arriving in mailboxes. Open enrollment starts November 15th and runs through February 15th but you must enroll by December 15th in order to be covered on January 1st. Experts are recommending that even if you are notified that you will be auto-enrolled, you should still compare plans. There are numerous reasons to compare including the following.

  • There may be other plans available that are a better fit for your needs. In some markets, additional companies are entering the marketplace with new plans.
  • The premiums and copays for your current plan are increasing.
  • Your providers will no longer be part of your current plan’s network. Insurance companies may make changes in their provider network to control costs.
  • Your insurance company is replacing your current plan with a similar plan. The insurance company can move you to a new plan only if they are no longer offering it in your area.
  • Your income has changed which will affect your tax credit.
  • More plans offered in your market can lower your tax credit because the tax credit is based on your income and the cost of coverage in your market.

Healthcare.gov has detailed information about your enrollment choices.

Medicare

Reviewing your coverage options is also important if you are covered by Medicare. If your projected expenses are higher or your health has changed, there may be another plan that better fits your needs. The open enrollment period for Medicare began Oct 15th and ends on December 7th. During open enrollment, you can make changes to your Medicare Advantage or Medicare prescription drug coverage. The Remar’s Report Make Medicare Plan Changes Oct. 15 - Dec. 7: What Needs Review? provides more information.

The Bottom Line

Taking time to review your health insurance options could help you save hundreds of dollars and possibly thousands.