Choosing a health care plan is one of the most important decisions for yourself or your family each year. Open Enrollment is when people in the U.S. can renew, change, or cancel their health care plan and other adjustments like adding or removing dependents.
Although health care is essential for your well-being, navigating it can be complicated. Preparing for Open Enrollment is essential so you can choose the right health care plan for you. Let this checklist guide you as you prepare for the next Open Enrollment.
1. Review your current plan coverage
Understanding your current plan coverage allows you to evaluate how well it aligns with your health care needs. By reviewing the services, treatments, prescription medications, and costs covered under your existing plan, you can identify gaps or areas where your current coverage may be insufficient. This knowledge will help you make informed decisions when comparing plans during Open Enrollment.
Familiarizing yourself with your current plan’s provider network is crucial if you have preferred doctors, hospitals, or specialists you want to continue seeing. Check if your current health care providers are in-network or out-of-network under your current plan. This information will help you determine if you need to switch to a plan that includes your preferred providers or if you’re willing to change providers to access potential cost savings.
2. Identify any gaps in coverage
A good practice is to identify any limitations or restrictions within the plan. These rules determine how and when you can access certain health care services. By knowing the specifics of your current plan, you can see if there are any restrictions on seeing certain doctors, visiting preferred hospitals or health care facilities, or receiving specialized treatments.
This awareness will help you evaluate if your current plan matches your preferences and if switching to a different plan with fewer restrictions may be beneficial.
3. Evaluate the health care needs of you and your family
Your health care plan needs to address you and your family’s care needs. These are a few questions to ask yourself when determining your health care needs.
- What sort of services do you use regularly?
- Does someone in your family regularly take medications?
- Are you expecting any potential health care changes in the next year?
- Does anyone have a preexisting condition or congenital disease?
- Do you expect your health care needs to change from last year to this year?
Each individual and family will have unique needs, so you need to assess what those are to choose a health care plan that fits them.
4. Consider any potential life changes
It’s difficult to know what your exact health care needs will be in the coming year, so you need to pick a plan that can help cover you in the case of unexpected events. Potential life changes can include unexpected diseases or accidents, but they also include things you plan such as pregnancy or surgery. Insurance is not just for your current medical needs; it also helps protect you so you can get the care you need when life changes occur.
Plenty of life events can also affect what plan you choose. This includes things like having a baby or adopting a child, getting married or divorced, retirement, moving to a new area, changes in income, or the loss of a spouse or dependent.
5. Assess your financial needs
Another good practice is to understand your current plan’s cost structure. Take note of your current premium, deductible, copayments, coinsurance, and out-of-pocket maximums. This will allow you to evaluate the way costs may change between plans.
Looking at your FSA, HSA, and HRA options can also impact your budget. FSA, HSA, and HRA are different types of tax-advantaged savings accounts that can be used to pay for qualified medical expenses,
You also should assess how much you anticipate spending on health care over the next year and your budget. Considering your anticipated health care expenses and budget can help you select a plan that offers better cost management and potentially reduces your out-of-pocket health care spending.
6. Evaluate your Medicare benefits
If you have coverage under Medicare, you should be aware of anything that may change in the coming year. There are several key factors to consider that might prompt a change in your Medicare coverage.
Whether it’s adjusting your prescription drug coverage, finding a plan with a more suitable provider network, seeking better cost-sharing options, or taking the time to evaluate your needs. Looking at these options will help you make an informed decision and select a Medicare plan that best matches your individual health care needs.
7. Look at any network changes
It’s important to review your health care plan even if you are satisfied with your current one. That’s because there can be changes to the plan or to your network of providers that may affect your care.
Changes in health care provider networks can impact your access to preferred doctors, specialists, hospitals, or health care facilities. If your current plan no longer includes your preferred providers in-network or if it restricts access to certain health care providers, it may be necessary to explore other plans that offer a broader network and greater flexibility in choosing your health care providers.
8. Consider dental and vision insurance
As your health care needs evolve, your priorities may shift. We see this as alternative therapies become more popular and have more research to support their effectiveness.
Consider any changes in your preferences for health care services, such as alternative therapies, preventive care, or specialized treatments. If your current plan doesn’t align with your changing priorities, exploring different plans that offer the services and benefits you value can help ensure you receive the care you desire.
9. Consider any potential life changes
Most medical health care plans do not cover adult dental and vision benefits. Children, however, typically have dental coverage under normal health care plans.
Some people choose to pay out of pocket for dental and vision services, however, even dental emergencies can arise so it’s helpful to have an insurance policy in place. Those with current vision impairment or a history of dental issues will especially benefit from purchasing these plans.
10. Update your information
To make sure everything goes smoothly during Open Enrollment, make sure that all of your contact and personal information is up to date. Look at these items when updating your personal information:
- Your name, address, and birthday
- Income level
- Changes to dependents
- Spousal changes
- Beneficiary information
This is also a good time to organize any documents you need like tax returns or name change documents.
11. Research and compare plan options
Now that you have an idea of what your current plan offers compared to your changing health care needs, you can start to research and compare other options.
These are some of the main things to look at when researching and comparing plans:
- The cost of different plans. See the next item on the list for more details on this.
- The network of providers and hospitals.
- Covered services.
- Alternative services provided.
- Plan Type (HMO, PPO, HDHP, etc.)
- Plan ratings and customer service.
You’re faced with a lot of information when comparing plans, so it can help you take notes and write down any questions you may have.
12. Calculate the costs of your options
After you’ve calculated the costs of your current plan you can use it to compare against your other options. Look for plans that offer better cost-sharing or lower out-of-pocket expenses, especially if you anticipate frequent health care visits, treatments, or procedures in the coming year.
Taking into account your budget and expected health care expenses, you can determine if switching plans will provide you with greater financial benefits.
13. Consult with an expert
Choosing a health care plan can be confusing, you don’t have to do it alone! There are plenty of experts out there who are well-versed in the world of health care plans and the different terminology who can help guide you.
Your Benefits Administrator is a great resource who can help you discuss your options, that may be a human resources person or an employee benefits specialist. You can also contact the California Schools VEBA Advocacy team – your dedicated health care concierge – to help answer any benefits questions you may have.
14. Be mindful of the Open Enrollment period
There are specific Open Enrollment dates each year. If you miss the Open Enrollment window you may not be able to sign up for a plan or you’ll be automatically renewed for your current plan. The Open Enrollment window may vary slightly depending on your employer.
Your employer’s Open Enrollment dates are unique. Please contact your Benefits Administrator for more information on your enrollment period to ensure you sign up for coverage within your window.
15. Review & Save Your Plan Documents
Congratulations! You’ve decided on a plan, signed up for it, and made your first payment. The date your plan goes into effect depends on your insurer and when you signed up.
Now that you’ve done the most difficult part of choosing a health care plan, be sure to review and save your important new plan documents so you can easily access your explanation of benefits, and have your documents ready come tax season, or if any complications arise.
If you find this blog helpful in understanding health insurance and the open enrollment period, be sure to check out the other blogs in this series for more in-depth information here.
VEBA Resources
MyVEBA Portal: Easily view your current health plan information through the MyVEBA app or online portal. Download the app for Apple or Android, or visit the MyVEBA Portal for desktop access.
Benefit Contacts: For assistance with specific carrier benefits or issues, such as claims or coverage details, visit vebaonline.com/benefit-contacts to contact them directly.
Get Support: The VEBA Advocacy Team can help you review your health plan and discuss it with you in depth. Call 888-276-0250 or visit vebaonline.com/contact for assistance. For urgent requests, use the “Urgent” box on the contact form.
