Health care is not one size fits all and your health plan shouldn’t be either. Every individual or family has unique needs – your health plan needs to reflect that.
You may have underlying health issues, future goals like fertility or increasing your wellness, and different risk factors. These are just a few factors to consider when determining which health plan is right for you.
Health plans can also be difficult to navigate. It can be hard to figure out what you need, especially with so many terms like “deductibles”, “coinsurance”, and “premiums.” There are many factors to consider when looking at health plans and having the right guidance helps make the process much easier.
Finding the right health plan doesn’t need to be overwhelming and VEBA is here to help! Use these five tips to help you find a health plan that fits your needs.
1. Figure out where and when you need to enroll
One of the most important things to be aware of when choosing a health plan is knowing when and where to enroll. Marking the dates on your calendar can help ensure you don’t miss any crucial deadlines.
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.
If enrolling through your employer, each company will have a different process for where and how to enroll. Many streamline this process by making it available online. Again, this depends on your employer, but you can typically find this information through your HR representative.
2. Evaluate your current health care needs
Each individual and family has different health care needs, your health care plan should reflect that. This goes back to the idea that there’s no one-size-fits-all plan, so before comparing plans and costs, take inventory of what type of health care you need to feel your best.
This includes basic things like emergency and primary care coverage, but other things health care plans can cover may also be important to you. When determining your current needs ask yourself these questions:
- Do you take certain medications regularly?
- Do you need access to mental health care?
- Do you need comprehensive reproductive health coverage?
- Do you see alternative practitioners covered by insurance like acupuncturists or chiropractors?
- Do you need dental or vision coverage?
It can be helpful to go back and look at what health care you’ve accessed most in the last couple of years to see your top priorities. While health care needs can fluctuate, it’s important to be mindful of which ones tend to stay the most consistent for you.
Be mindful that you enroll in a plan that covers the 10 essential health benefits outlined by the ACA. These benefits include:
- Ambulatory patient services (outpatient care you get without hospital admission).
- Emergency services.
- Hospitalization (may include surgery or overnight stays).
- Pregnancy, maternity, and newborn care.
- Mental health and substance use disorder services.
- Prescription drugs.
- Rehabilitative and habilitative services and devices (these help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills).
- Laboratory services.
- Preventive and wellness services and chronic disease management.
- Pediatric services, including oral and vision care (adult dental and vision coverage aren’t essential health benefits).
When looking at plans on the internet, certain short-term plans seem too good to be true. While they usually have lower monthly premiums, they may not cover these 10 essential health benefits or have shockingly high copays.
3. Consider your future health care needs
Your health care plan shouldn’t just account for your current health care needs, it also needs to be able to cover you for future ones. Future health care needs include ones you may or may not anticipate or be planning.
These are just a few potential changes to consider when looking at health care plans:
- Fertility planning
- Changes in medications
- Age-related health care milestones like a colonoscopy or mammogram
- Potential accidents or illnesses
It’s impossible to know exactly what you’ll need in the future. The right health care plan allows you to be prepared so you don’t get caught off guard when life inevitably happens.
4. Compare estimated yearly costs
When looking at health care plans, many just look at the cost of monthly premiums. While this approach can work for some people who are young and relatively healthy, it can also backfire. If you just look at your monthly premium, you may face unexpectedly high bills if you have an emergency, or your health care needs suddenly change.
There are many other factors when looking at the cost of your health care outside the monthly premium. For example, look at each plan’s deductibles and copays to give you an idea of your potential annual costs.
In addition to a plan’s monthly premium, the out-of-pocket costs you pay when you access services impact your total health care spending.
Your total costs for the year include your plan’s:
- Monthly premium x 12 months: The amount you pay to your insurance company each month to have health insurance.
- Deductible: How much you must spend for covered health services before your insurance company pays anything (except free preventive services).
- Copayments and coinsurance: Payments you make to your health care provider each time you get care, like $20 for a doctor’s visit or 30% of hospital charges.
- Out-of-pocket maximum: The most you have to spend for covered services in a year. After you reach this amount, the insurance company pays 100% for covered services.
- Estimate the health and drug services you’ll use: Determine the health services and prescription drugs your household usually gets. Then, estimate the services you’ll likely use in the year ahead.
Yearly costs can also work the other way around. It’s important to find out how much your employer covers and any other health care subsidies you may be eligible for that can help reduce your overall annual costs.
5. Always review plan options
Looking at health care plans, crunching numbers, and thinking about your health care needs can feel overwhelming, plus you may automatically get enrolled in the same plan. So, it can be tempting to avoid reviewing your options altogether. Please don’t do this. You must review your options yearly, even if you like your current health care plan.
You might think you don’t need to do this if everything else has stayed the same. Your income hasn’t changed, you’re at the same job, you have the same number of people in your household, and there have been new health care needs.
Each year many possible changes can affect your health care plan, many of which are factors that seemingly have nothing to do with you. This can include things like having new insurers enter the marketplace or the changing price of premiums in certain states. These and other factors can affect what plans are available as well as the cost of said plans.
Choosing a health care plan doesn’t need to be complicated. Following these steps and having the right guidance can help you find the best health care plan for you and your family.
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.
