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How to take advantage of health insurance open enrollment

Right diagnosis can help keep costs under control

By Joyzelle Davis, Rocky Mountain News (Contact)

Published October 17, 2008 at 12:05 a.m.

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The leaves are crisping to amber hues, football season is in full throttle . . . which means that it's time once again for open enrollment at most employers that offer health care benefits.

U.S. workers with job-based health insurance can expect to spend 8.9 percent more for their health care in 2009, according to a study released last month by Hewitt Associates. Employees next year will contribute an estimated $1,946 in premiums and pay another $1,880 in out-of-pocket costs such as co-payments, coinsurance and deductibles for a total cost of $3,826.

Health care costs have surged above wage gains and the rate of inflation for more than a decade, but next year's projected increase comes as consumers are already grappling with record gas and food prices and dwindling retirement-savings accounts.

All of that makes picking a health care plan that fits with your budget and health care needs even more important next year. Open enrollment is the only time when employees can enroll in a health plan or make changes to their current coverage, but many times they don't thoroughly evaluate their choices first. More than 60 percent of employees default into the plans they selected the previous year, according to Hewitt.

Here are some points to consider while sorting through health plans:

Why does health insurance cost so much?

That's the most commonly asked question at open enrollment benefits meetings, said Paula Wilson, senior account manager of large group sales at Anthem Blue Cross Blue Shield, who spends much of every October and November meeting with employee groups.

Rising costs of technology, the expense for new drug development and additional new services added each year by health plans are the major factors for the annual increases, Wilson said.

How can I keep costs down?

As unappealing as it may be, do your homework. Hewitt recommends carefully looking over your benefits selections from last year and figure out what worked and what didn't.

Did you put enough money in your flexible spending account? How much did you spend in co-pays and other out-of- pocket costs? Do you have any life changes coming up that will affect your benefits, such as a dependent no longer eligible for coverage?

Use the savings available to you. The majority of employers provide incentives, often in the form of credits or lower deductibles, if you or your family participate in wellness programs such as weight management or smoking cessation.

Many health insurers offer a 24-hour nurse's line, so customers can call first to see if they really need to see a doctor or visit the emergency room. Others, such as Kaiser Permanente, offer online visits or telephone appointments without a co-payment charge.

King Soopers, Wal-Mart and most other major supermarkets now offer generic prescription drugs for $4, which can be cheaper than using your insurance plan.

My employer offers a PPO (preferred provider organization), HMO (health maintenance organization) and an HSA (health savings account). Which is the best choice?

There's no easy answer - it depends on your individual circumstance.

PPOs are typically the most expensive plans. First you must meet the deductible, and once you hit that, you pay coinsurance that's a set percentage of each service. Costs are paid 100 percent only after you've met the plan's out-of- pocket maximum. One major advantage: PPO plans are portable outside Colorado, allowing customers to visit doctors out of state for routine medical issues.

HMO costs are more predictable, with only flat co-payments for services and no coinsurance or deductibles. HMO networks are only available in state, however, although the HMO will cover emergency care if you're traveling.

HSAs are tax-advantaged, high-deductible health plans that hit the market just a few years ago. Once you've met that deductible, your costs are covered entirely.

"It's typically true that the people who buy HSAs are the very, very healthy or the very, very sick," Wilson said.

I know that I'm going to have a major medical procedure next year. How do I estimate how much it's going to cost, including my co-pays?

Insurers are increasingly posting costs for the most common medical procedures online along with prices for specific health care facilities and doctors.

As customers take on more decision- making and financial responsibility for their health care, they need greater transparency in pricing to help budget, said Jeff Miller, the head of Aetna's Colorado sales and service. Aetna launched a Web site this year that allows members to see the prices and outcomes for the top 30 procedures for any given physician in the Denver area.

"From an industry standpoint, benefit levels aren't improving," Miller said. "The shift clearly is to higher cost-sharing and deductibles, making these tools all the more relevant."

Comments

  • October 17, 2008

    8:03 a.m.

    Suggest removal

    Marshdale writes:

    "why does health care cost so much?"

    Sure the factors mentioned are part of the problem, but the biggest reason is that health care is a for profit industry in this country. Change that and you will see cost go down.

    RMN; I believe you do the public a grave disservice by printing this drivil.

  • November 17, 2008

    2:47 a.m.

    Suggest removal

    liquidone writes:

    Marshdale: Remove the profit and see the quality go down as well. It is basic economics.

    You want a solution? Try tort reform.