Get Ready for Open Enrollment

If your employer offers health insurance plans, you probably have several to choose from. When you can join one will vary. Consider your options well since you typically can make changes only once a year. Individual plans are ones youbuy with help from your employer. They have become more affordable thanks to laws that may let you lower your income taxes by deducting your premium from your taxable income, depending on whether you’re self-employed, how much you spent on health care, and what your income is.

You can change your insurance plan during a period called open enrollment. It usually takes place for a short time each fall or spring.

If you miss it, you may be stuck with coverage that doesn't match your needs or budget.

If you don’t have insurance through your employer, there is also an open enrollment period for health insurance Marketplaces, which are part of the Affordable Care Act, from Nov. 1 through Dec. 15.

If you choose to shop at a Marketplace, you may have more options than an employer might offer. You may also qualify for financial help to pay your premiums or cost-sharing, depending on your income, when you buy a plan through a Marketplace.

As you choose one for next year, consider these key issues:

Does your current plan still measure up?  You may be happy with the coverage you have now and want to keep it. But make sure you carefully review the updated terms of your plan. That way, you won't be surprised by any changes to benefits, deductibles, or other parts of coverage that you do not want or need.

If both you and your spouse or partner work, does it make sense to share a plan? Or should you each keep one through your own employer? Go over the choices from each employer to see which offers the better, more affordable plan.

Do others recommend the plan you are considering?  Look into organizations that rate insurance companies. For example, the National Committee for Quality Assurance, a health care nonprofit, ranks more than 500 private health plans.

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Which plans cover the doctors and services you want or need?  If you like the doctor that you see now, make sure she is in your plan's network. If not, going to a doctor “out of network” will probably cost you more.

If you use complementary or alternative treatments such as acupuncture, look for a plan that covers them.

Coverage for prescription drugs, mental health care, and other services that may be important to you will vary from plan to plan.

Which plans are best for your budget?  Add up your health care expenses from the last few years to help you predict your costs for the coming year. You should also consider any new health care needs for the upcoming year. Which of the health plans most closely match your estimate?

Consider things like:

  • Deductibles
  • Monthly premiums
  • Copays and other expenses that aren't covered by insurance

Does your employer or plan offer wellness incentives?  These programs reward you if you lose weight, quit smoking, and make other efforts to better your health and prevent disease. You may earn money to spend on health care costs, or you may pay less for your health plan.

Do you want an HSA or FSA?  HSA stands for health savings account. In 2019, if you have a high-deductible plan, you can set aside as much as $3,500 to spend on qualified health costs. The money you set aside can be paid with pretax income. You can roll over any unused money from year to year. Each household can set aside up to $7,000 per year.

You can add another $1,000 per year into your HSA if you are over 55. If you haven't spent all the money by the end of the year, it stays in the account and earns interest. You also can keep the account if you change jobs or quit.

FSA stands for flexible spending account. You can get them only through a plan offered by your employer. In 2019, an FSA allows you to set aside up to $2,700 of your pretax salary to pay for medical expenses not covered by your health plan.

Remember, you must spend the money in your FSA by the end of the year or you lose it, although some employers offer a 2-month extension. So think about your medical expenses during the coming year and put in only as much as you think you'll need.

WebMD Medical Reference Reviewed by Sarah Goodell on September 16, 2019

Sources

SOURCES:

National Association of Insurance Commissioners: "Health Insurance Open Enrollment: You Have Options."

American Institute of CPAs: "Should my spouse and I integrate our health insurance benefits?"

National Committee for Quality Assurance: "Top 20 Private Health Insurance Plans."

Agency for Healthcare Research and Quality: "Choosing a Health Plan."

National Association of Insurance Commissioners: "Health Insurance Open Enrollment: Choosing the Best Option for You and Your Family."

U.S. Department of Labor: "Fact Sheet: The Affordable Care Act and Wellness Programs."

IRS Publication 969: "Health Savings Accounts and Other Tax-Favored Health Plans."

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