Whether you’re joining the workforce, starting a new job, or aging out of a parent’s coverage, choosing the right options from your employer-sponsored health insurance offering can be confusing. These tips from Kathryn Rider, senior benefits director, The Cigna Group, can help you find the health plan that’s right for you.
1. Decide whether a high- or low-deductible plan will best meet your needs
Your deductible is the amount of money you need to pay for medical care before your health plan starts sharing the costs. For example, if your deductible is $1,700 for the year, you will pay out of pocket until you’ve spent $1,700. You’ll likely not need to pay for preventive care, such as an annual checkup or physical, which is provided at no cost to you if you stay in the plan’s network.
High-deductible plans have lower premiums (the fee you pay for your insurance coverage per month, typically deducted from your paycheck). Many are paired with a Health Savings Account (HSA), which you can contribute to, tax-free, during each pay period. Some employers also contribute to employee HSAs. The money in these accounts can be used for eligible medical expenses. A high-deductible plan may be a good fit if you are generally healthy and won’t need much more than preventive care.
In a low-deductible plan, you’ll pay a higher premium but can meet your deductible sooner. Low-deductible plans do not offer an HSA. These plans are typically a good fit for people with chronic conditions, those who are pregnant or want to become pregnant soon, or people who require expensive prescription medication.
2. Get a better understanding of the mental health care offering
Taking care of your mental health is key to living life with health, strength, and energy, which is why it’s important to understand what your plan offers should you need behavioral health care now or in the future. Step one is to see if your employer offers an employee assistance program (EAP). These programs are offered by many employers and are separate from your health insurance plan. For example, employees of The Cigna Group can utilize up to 10 EAP behavioral care visits per issue at no charge each year before tapping into their medical benefits.
If you’re seeing a therapist on a weekly basis, do the math to understand what your out-of-pocket costs will be, taking into account your deductible, copays, and other related expenses.
3. Check if your employer offers a plan selection tool
Plan selection tools will ask you to answer questions about the care you expect to need in the next year and then provide a cost comparison breakdown or a recommendation. Questions may include:
- How many primary care office visits do you expect in the next year?
- How many specialist office visits do you expect in the next year?
- How many prescriptions will you fill in the next year?
- How many urgent care visits do you expect in the next year?
- Whether you’d rather pay less for plan coverage and more out-of-pocket for unexpected medical expenses – or vice versa.
- Do you expect to have any major medical expenses next year such as having a baby or a scheduled surgery?
- How important is it that you have specific (known) providers in the plan you choose.
4. Find out whether your medical plan offers incentives
Many medical plans offer an incentive program that is designed to support and reward you for healthy behaviors. By taking a simple health assessment, plan members earn incentive dollars that are deposited into their plan account (such as an HSA) and can be used for health care costs.
Some plans will allow members to earn incentive dollars for tracking their health numbers such as body mass index (BMI), blood pressure, or cholesterol. Other incentives often include rewards for using various health apps, participating in health coaching programs, or staying up to date on preventive care.
5. Remember, you can change plan elections each year during open enrollment
Let’s say you go with a high-deductible plan and then realize you may have underestimated how much care you’d need. That’s OK – you’re only locked into the plan for one year. You’ll need to enroll annually within your employers’ open enrollment period (often called “annual enrollment"), which typically is scheduled for a couple of weeks or longer in late fall or early winter. During enrollment, you have the option to make changes to your plan elections. This is typically the only time you can change your coverage during the year, unless you have a qualifying life event such as getting married or having a baby.
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