3 Essential Questions to Ask During Health Insurance Open Enrollment

Noreen Fieber
Oct 24, 2017

You’re likely to be stuck with this decision for a year, so do your homework. Photo credit: Robert Daly

If your company offers health insurance, you've probably already gotten notice: It's open enrollment season. This is typically the time of year when you're given the opportunity to add, drop or change your health insurance coverage for the coming year.

As you evaluate your options, here are three essential questions you should ask during health insurance open enrollment:

"Be certain of your decisions. With few exceptions, you'll have to live with your choices for a year until the next open enrollment period."

HAS YOUR WORKPLACE COVERAGE CHANGED?

It's not unusual for employers to change insurance companies, plans or provider networks to better manage costs. If there's been a change in your workplace coverage since last year, ask about:

Your new plan options: Do you now have a new choice of plans from which to choose? If so, take the time to weigh each one against your priorities. An HMO (Health Maintenance Organization) plan tends to be more affordable than a PPO (Preferred Provider Organizations) plan. But PPOs typically give you more flexibility.

If your plan qualifies as a high-deductible health plan, an HSA (Health Savings Account) might be a good option, too, if you want to save — in advance — for medical expenses. Some companies will contribute funds to the HSA, but you can also open one on your own.

Your preferred doctor: Like your current doctor? Don't assume you can continue to see him or her if your workplace insurance has changed. Ask to see each plan's provider list as you evaluate your options.

Your prescriptions: The list of medications covered by insurance varies from one insurance company to the next and can change from year to year. Learn what's covered, how much you'll be asked to pay for each prescription and whether a (typically) lower-cost generic is available.

Your costs: Premiums, deductibles and co-pays can also vary greatly — so take the time to do the math. And if you know you’ll be expecting a significant (and potentially expensive) medical event in the next year, like the birth of a baby, ask your benefits manager to help you estimate your total cost under each of the available plans.
HAVE YOUR NEEDS CHANGED?

If you've experienced significant changes to your health or your life, you may want more, less or different coverage. For example, say you plan to get married in a few months and add your new spouse to your coverage. Does your partner have a chronic condition that needs specialty care? If so, he or she will probably have more flexibility to see specialists that are ‘out of network’ under a PPO plan. Or, say that back pain you’ve started to experience happens to get worse during the next year. Will a trip to the chiropractor be covered? Is the chiropractor your brother recommended in your current plan? If your needs have changed (or you think they will change in the coming year), revisit your plan and make sure it’s still the right fit.
WHAT ARE THE AVAILABLE INCENTIVES?

Health care premiums are expensive. So in addition to choosing a plan that’s right for you, see if you can offset some of your out-of-pocket costs by participating in incentives your company may offer. More and more organizations now offer financial (or other) incentives to employees who take steps to improve their health.

Keep in mind you may only be given a couple of weeks to decide what coverage you want to have before the open enrollment “window” closes. With few exceptions, you'll have to live with your choices for a year until the next open enrollment period, so it pays to ask questions now.