Never has there been a more dreaded phrase than “out-of-network.”
Well, maybe. But anyone who’s ever had health insurance knows the headache that is copayments, referrals and reimbursements.
Given that, staying on top of the maze of paperwork can sound about as appealing as a lobotomy. But this is the season for open enrollment, the one time of year (often no more than two weeks long) when many employers let their employees make changes to their insurance policies.
For the most part, you can’t change your health care choices at any other time of year, unless you’ve had a major life change like getting married or having a baby. That’s why it’s time to act now.
From getting your paperwork under control to getting money back by negotiating your bills, we bring you the ultimate guide to turning health insurance into a (healthy, brisk) walk in the park:
Figure Out Your Window
Call your HR representative to find out exactly when your open enrollment period begins and ends. The specific dates vary from company to company; if you miss your window, you’ll still receive the same medical, dental, vision and life insurance coverage as the year before, but you won’t be able to make changes to your accounts or sign up for a flexible spending account, for which you need to re-enroll each year.
LearnVest tip: Make a calendar reminder for yourself so you won’t forget to talk to HR.
Weigh Your Needs
If you’re single and generally healthy, you’re going to have very different insurance needs than someone who has recurring medical issues or kids to take care of. If you’re more of a once-a-year checkup type, you might be fine with a plan offering low premiums but higher co-payments; if you have kids, you might want to choose higher premiums but lower co-pays. Not sure if your current plan is meeting your needs? Most health care providers have online tools and calculators to help you compare different plans and crunch last year’s numbers to see if you would have spent more or less with Plan A or B. Whatever your decision, your new choices will usually become effective on January 1.
(Does a high-deductible plan make sense for you? Read here.)
LearnVest tip: If you’re married, find a peaceful Sunday morning to sit down and figure out whether you’d be better off on your spouse’s insurance plan instead -- here’s what to ask yourself.
Sign Up for a Health Savings Account
HSAs or FSAs are yet another way to save money on your health care expenses. HSAs are health savings accounts for people enrolled in high-deductible health plans. If you have one, you’ll contribute pre-tax money from your paycheck to an account that you can use for eligible health care expenses, and what you don’t use in a given year will carry over to the next plan year. You can even take your HSA with you when you change jobs.
FSAs, meanwhile, are flexible spending accounts that you can fill with pre-tax money and use for medical expenses and even dependent care (like child care costs). While HSAs are unique to high-deductible plans, FSAs are common even on traditional plans. Note that, unlike money in an HSA, money in an FSA does expire at the end of the year if you don’t use it. Open enrollment is the time to decide how much to contribute to your HSA or FSA, so make sure to take note now.
LearnVest tip: If you already have an HSA, see if you have leftover money from last year (or not enough), and adjust your contributions accordingly.
Put It All in One Place
Save yourself the time, hassle and manila folders by storing your health insurance records online. Our favorite new find is Simplee, a website that lets you link your health plans so you can see your total spending, deductible status and FSA or HSA balances in one place. It’ll also alert you to any bills you need to pay or miscalculations in your paperwork, like if you were charged twice for the same service. And it’s free. Think of it like the LearnVest My Money Center...for your health care.
LearnVest tip: Once you’ve linked your accounts, make sure you can access all of your statements. Then, consider shredding old records to reduce clutter.
Have large, complicated or ongoing healthcare costs? MedClaims Liaison is one way to have someone else handle it all: You can mail in all of your health insurance paperwork in prepaid envelopes to have experts follow up with any insurance issues and misprocessed claims. The idea is that many people are leaving money on the table if they’re not negotiating their medical bills and following up on their insurance reimbursements, but that’s a lot to keep track of. According to a representative, the average MCL user with an annual subscription gets back $10,000 from claims negotiations and reimbursements.
This is basically a full-service way to outsource everything about your health insurance, but we only think it makes sense for those with large, complicated or ongoing health care costs (who therefore have a lot of money to reclaim). That’s because it’s costly, and there are two ways to pay: A free trial period in which the site will sort through your statements and charge 33% on whatever money you receive back, or an annual membership for $500 per year, plus 10-15% on the money they reclaim for you.
LearnVest tip: Even if you don’t sign up for this full-service option, you can still get money back from negotiating your medical bills -- here’s how.
Make a Little Cash While You’re at It
Many companies will ask you to fill out a survey about the general state of your health, called a “health risk assessment.” It’s in their interest for you to fill out things like your weight, height, blood pressure and exercise habits, so they’ll sometimes pay you a cash stipend (like $50) for filling it out. If so, cash in!
LearnVest tip: Health insurance companies have an incentive to keep you healthy, so many of them will offer reimbursements for your fitness expenses (as in, they’ll actually pay for your gym), so ask your benefits person about this program.
Check Off All the Boxes -- and You’re Done
Once you’ve made your choices for the year, review your confirmation statement from your company and make sure to save any new ID cards you get in the mail. Then, we give you permission to forget about benefits for a while. A long while.
Maximize Your Benefits for the Future
How to make the most of your free employee benefits perks: check this out.
Some companies offer “employee assistance programs” that help you do everything from balancing work and family to finding daycare for your kids: what you need to know.
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And don’t forget: How Will Healthcare Reform Affect YOU?