As summer transitions into fall, many of us are starting to think about apple picking, delicious homemade soups and comfy sweater weather. But fall also means open enrollment for many health plans is soon approaching. Some people start to stress when they get their open enrollment kits—but Meritain Health® is here to help educate you in any areas you’re feeling unsure about!
Consider your options
It’s a good time to start thinking about whether you’ll be renewing your existing health plan or choosing a new one. When considering your options, it’s important to consider how your current health plan worked for you this past year. Did you have to pay much towards your deductible or out-of-pocket costs, or did you just have routine visits/vaccines that were fully covered by your health plan? Will you have any medical needs that could carry over to next year or possibly even escalate going forward? Reflecting on this past year can help you start a blueprint for your plan options for the upcoming year.
As you consider what your coverage needs might look like in 2022, you should also think about any milestones coming up next year for you and covered dependents, and how they could alter your current plan coverage. Milestones for a health plan can include:
- Ongoing medical issues, such as:
- Scheduled surgeries.
- Ongoing treatments for physical or mental health issues.
- Pregnancy or pre-natal treatments.
- Diabetic conditions.
- High blood pressure or cholesterol.
- Cancer diagnosis—even if currently in remission.
- Birth dates that trigger specific tests*, such as:
- Cholesterol screenings in your 30s.
- Breast or testicular cancer screenings in your 40s.
- Diabetic screenings in your 40s.
- Colonoscopy tests starting at age 50.
- Birthdays that can cause a dependent to lose eligibility:
- For dependent children, the standard age limit is 26.
- Adults turning age 65 can elect Medicare, which can affect dependent spouses.
- Ongoing medical issues, such as:
These factors can greatly impact your likelihood of reaching your deductible and out-of-pocket maximums. So, spending a little more per paycheck might be more beneficial for you or your family if you anticipate the possibility of expensive medical treatments. For young, healthy professionals, a cheaper option with higher out-of-pocket limits could make more sense. Knowing your health status and medical expenses can help you target the right plans options available.
*Check your benefits plan information to see how these services are covered, such as age-related preventive care—which could be covered at 100 percent.
Make an enrollment checklist
With just a bit of planning and organizing, you can easily assess the plans that will best fit your potential health care needs in the coming year. Here’s a quick checklist of things to keep in mind as you prepare to renew or change your health plan options for 2022:
- Add your enrollment dates to your calendar. As you get ready to start researching your plan options, mark down when open enrollment starts and ends. The open enrollment period is for a specific time frame, and often you can make changes up until the last day. Check with your Human Resources department or in your enrollment materials for potential enrollment deadlines.
- Consider your medical needs and plan expenses. Your plan options will have varying amounts for deductibles, copays or coinsurance (when applicable), premiums, formulary tiers and out-of-pocket maximums. Your routine and potential medical appointments can help you narrow down the best options for you.
- Review any plan changes/updates. If you like your current plan and are looking to keep it, you should still review your enrollment materials to ensure there are no changes to the plan details. A new plan year can mean new restrictions, new out-of-pocket amounts and new formulary tiers.
- Make sure your preferred providers are in-network. Most plans have a network of preferred providers. But don’t assume your providers are still in network or accept your health insurance as you approach a new plan year. Providers can change their participation with networks during a plan year. Double check that your current providers participate with the plans you’re considering. You can typically do this through the network’s website or by calling your provider.
- Review coverage processes and limitations. Many plans require member verification or updates to review non-routine medical treatments. These can include medical necessity, prior authorization and benefit verification. Plans typically also have visit limitations on therapy sessions or restrictions on using copay cards for drug deductibles. Knowing these guidelines and restrictions can help you avoid errors in coverage.
Understanding spending accounts
In recent years, a lot of health care plans have gravitated towards spending account offerings, to give members more control over their health care options. If you’re not familiar with spending accounts or are confused about what each one does, we recently posted a detailed guide on spending accounts to help address common questions.
Contact Meritain Health with questions
If you have questions, we’re happy to help! Meritain Health members can simply call Customer Service by using the number on the back of your ID card.
This article is for informational purposes only, and is not meant as medical advice.