With health care premiums on the rise and employer group benefit plans offering less in terms of actual coverage, many consumers have found themselves struggling to choose the right benefits to meet their families' needs. Should you accept the group benefits offered by an employer, or would you be better off selecting a plan that’s offered by a state-approved marketplace to take advantage of tax savings and government subsidies?
Barriers to Selecting the Right Benefits for Families
The Affordable Care Act (ACA) was supposed to help families to obtain low-cost health insurance and wellness coverage while supporting long-term, responsible use of health care. Unfortunately, many families have found they're faced with premiums that are far from affordable, and a wide range of costs that aren't covered when they're trying to find health care services.
Surprise medical bills have become commonplace because consumers may find it difficult to understand the plans. A Kaiser Family Foundation survey revealed that “nearly seven in 10 of individuals with unaffordable out-of-network medical bills did not know the health care provider was not in their plan’s network at the time they received care.”
Granted, these issues are being worked out as health care reform changes the landscape of benefits. Meanwhile, talk with your HR administrator to sort out problems like these. Working closely with the benefits liaison can help, as can following some guidelines.
Identify Pressing Needs
Identify what pressing health needs or goals you must address this year. Your family should have a fairly good idea of the health concerns that need attention before the time for open enrollment comes around again.
Some health goals should be discussed even if your focus is just on preventative care. Things like pregnancy and pre-existing illnesses need additional attention.
Compare Explanation of Benefits (EOB) Documents
Review and compare all plan EOB documents carefully. There might be a ton of information to go over, but the best place to start is by gathering the documents that list the benefit information for each plan.
Get these from both spouses’ workplaces if you're married, then go through them to determine and compare the plan premiums, the deductibles, and the out-of-pocket costs for office visits, ER visits, and prescriptions.
Look Into State Benefits
Go through the process of inquiring about state marketplace benefits. Head on over to the health care reform website and find your state's health marketplace. Login and enter the demographics for your family, including your annual income, and all family members in your household you'll be covering.
You'll end up getting several quotes, so be sure to review these EOBs along with what you already have.
Required Minimum Coverage
Select the health care plans that offer required minimum coverage at the best rates. Go with the plan that offers you the best possible percentage cover amounts for your networks, the least amount of out-of-pocket costs and deductibles, and the best perks for your family.
Some plans might offer similar coverage amounts, but the monthly premium will be different. You could get a plan that's equal to or better than what your workplace offers with less cost to you if you qualify for a government subsidy.
Sign Up Early
Sign up for the company-sponsored health savings arrangement if one is available to you. Do so after you've selected a suitable health care plan for your family, especially if it's a high deductible plan. You can save money by purchasing any prescriptions and paying for non-covered costs using pre-tax dollars.