Tips for smart shopping during open enrollment season

It’s that time of year when companies are holding open enrollment. Blue Cross and Blue Shield of Georgia offers these tips to help consumers make educated decisions regarding their health benefits for 2015.

Do your research

· Be a smart shopper. Picking a health insurance plan might be one of the biggest financial decisions you make each year, but most consumers typically spend far more time researching cars and major appliances.

· Thoroughly review your enrollment materials even if you’re not changing health plans, and write down any questions you don’t understand. Your company’s benefits advisors or plan representatives will be able to help you choose the health plan option that best fits your needs.

· Understand wellness programs. Your employer may offer incentives for programs like participating in biometric screenings or talking to a health coach. Knowing if your plan offers these programs can save you money.

Understand and learn what basic health insurance terms mean

• Confused by all of the insurance terminology? You’re not alone. A recent survey conducted by Blue Cross and Blue Shield of Georgia found that 60 percent of consumers don’t know what a deductible is, and 85 percent don’t know the difference between copayment and coinsurance.

• Some important terms to know:

• • Copayment - a fixed amount you pay whenever you use a particular type of health care service. For example, you might have a $35 copay to see a primary care doctor and a $20 copay to fill a prescription.
  • Coinsurance - Unlike the fixed cost of a copayment, with coinsurance you pay a percentage of the cost of a healthcare service and your insurer pays the rest. For example, if you have a 20 percent coinsurance for hospitalization, that means you pay 20 percent of the cost of hospitalization.
  • “Out of network” services – an out of network provider is one who has not contracted with your insurance company for reimbursement at a negotiated rate. Some health plans, like HMOs, do not reimburse out of network providers at all, which means that it would be your responsibility to pay the full amount charged by the doctor. Other health plans offer coverage of out of network providers but your patient responsibility would be higher than if you were to see an in-network provider.
  • Deductible – The amount you must pay out of pocket each year before health-related costs before your insurance policy begins to pay.
  • “Preventative” services – Under the Affordable Care Act, most health plans must cover a set of preventative services like shots or a set of screenings at no charge to you. See https://www.healthcare.gov/what-are-my-preventive-care-benefits/ for a list of preventative services.

Determine what’s best for you and/or your family

• Some employers have a spousal surcharge. If your spouse has access to health insurance through his or her employer and they choose not to take it and go on your insurance instead, your employer may charge you extra. Having separate plans could save you money.
• Take into consideration other events that may occur in the next year—like having a child or if you will have to deal with a chronic condition like diabetes.

Verify that your physician and hospital are part of the network for the plan you are choosing

• This is very important if your plan options are from a different health insurance company or if you switch to a different health plan offered by your employer.

Don’t miss the deadline!

If you don’t make your choices by the time the open enrollment period ends, you may miss out on the opportunity to secure health care benefits from your company.