Open enrollment good time to evaluate coverage

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For those deciding between employer-provided insurance and shopping the marketplace, this can be a daunting time of year.

“I saw in a recent study that people don’t like choosing health plans,” said Minneapolis-based Craig Hankins, vice president of digital products for UnitedHealthcare. “They’d rather go to the dentist or do taxes than choose a health plan.”

EDUCATE, EDUCATE, EDUCATE

Open enrollment begins Nov. 1 and will run through January, providing those shopping for insurance an opportunity to change or update their plan. For employers providing coverage, the most important thing to do during the next few months is educate employees about any changes on the horizon, Hankins said.

“One thing to think about is how you help your employees understand options, particularly with new plan designs compared to prior years or because of a new insurer,” he said. “Make sure they understand what the changes are, and I often recommend explaining why, if plans are changing considerably.”

Employees are sometimes uncertain of what their health care needs are to begin with, he added.

“They often struggle with knowing if they’re making the right choice,” Hankins said. “What if they get a high deductible plan and something bad happens? But employers can make people aware of the range of resources out there and help employees make the wisest choice they can.”

Some of the onus lies with the employee as well, he said, adding that employees should be aware of their existing conditions and any related ongoing expenses. Consumers also should know how those expenses will be impacted by a new plan.

“For instance, if you’re diabetic, you know you’ll have to see an endocrinologist and have lab tests,” he said.

Many insurers offer online cost estimate tools and UnitedHealthcare can provide a personalized estimate based on a consumer’s current plan. Healthcostinstitute.org is also a useful independent resource for cost-of-care information, he added.

UnitedHealthcare, like many other insurers, created a mobile app so consumers can access health care costs on the go.

“With our mobile app, you can see the average cost for about 800 different services,” Hankins said.

Kaiser Permanente Colorado is also stepping up its efforts to educate consumers in Southern Colorado. This week, the company released a downloadable guide to the seven most important things for small-business owners to consider when it comes to health insurance.

Holly Kortum, executive director of operations for Kaiser’s Southern Colorado service area, said those topics include what coverage should be offered, what group coverage is, how it differs from other options and how much employers should spend on plans.

“For Kaiser Permanente in Southern Colorado, we have some very specific, unique things put together by our member experience team. We work with small groups and brokers and give them tours through our medical offices and highlight our integrated delivery system,” she said. “We have a dedicated local staff in Southern Colorado, which I think is different from other insurers.”

Kortum said Kaiser is also presenting a series of forums for current or potential small groups shopping for plans.

For more information, visit businesshealth.kaiserpermanente.org.

AN AFFORDABLE PLAN?

According to Antonio Briceno, a Colorado Springs insurance broker and Small Business Development Center consultant, speaking with a broker is the most important step employers can take when planning employee coverage.

Open enrollment, Briceno added, is an opportunity to change individual policies, because group plans can be changed at any time. But some employers incentivize individual plans.

Many small business owners often assume that a group plan is the way to go, Briceno said. But employees may get a better deal with an individual plan through the marketplace, if subsidies are involved.

“According to federal law, if you have a group plan, you’re not eligible for subsidies,” he said. “The government sees group plans as affordable coverage, whether it’s affordable or not. It’s based on the employee, but if he or she is married, the employee’s insurance might be $50 a month, but the family might cost $1,000 a month to cover. The government sees this as an affordable plan.”

Subsidies alleviate some of that burden. For instance, the Advanced Premium Tax Credit is a federal subsidy available to individuals and families who earn less than 400 percent of the federal poverty level. The subsidy helps to pay a portion of health insurance premiums.

Regarding cost trends, Briceno said group plan premiums have been dropping.

“We don’t have all the new rates yet, but we’ve been told by insurance companies that group rates are coming down,” he said. “However, I still think insurance should be looked at on a case-by-case basis.”

Finally, Briceno said consumers should look for a broker who can assist with the entire process.

“Often a broker will say, ‘You go do all the work and I’ll help you with the plan. Go do the [Colorado PEAK application for Medicaid], which you have to be denied to get a subsidy. Go fill out the Connect for Health application.’”

That’s not the way he handles it.

“I have them come into my office and discuss what’s important to them,” Briceno said. “As a business with a group plan, if your broker doesn’t sit down with you at every renewal and provide you other options, then you should look for a new broker. This day and age, brokers should be offering more, not just emailing a renewal each year.”

It often doesn’t cost anything to get a consultation from a broker, Briceno said, “but it could save you a ton of money.”

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Tips for insurance shopping:

• Review options. Don’t wait until the last minute to make benefit elections. Get your questions answered. Remember there’s more to each plan than co-payments, deductibles and premiums. Take a few minutes to check if your doctor is in the plan’s care provider network and that prescriptions are covered.

• Look for incentive-based wellness programs. Some health plans offer wellness programs that enable people to earn financial incentives for completing health assessments, signing up for a health coaching program, lowering cholesterol, going to a gym or using a fitness tracker.

• Take advantage of health care apps and online tools. Many health plans have created apps and online resources to help people locate professionals or check if their doctors are in-network, compare treatment costs, review claims and find more information about their health plans.

• Open a Health Savings Account. More employers are offering health plans that include a Health Savings Account option. An HSA is like a personal bank account specifically for health-related expenses. HSAs offer a triple tax advantage — money is deposited pre-tax from your paycheck and accrues interest tax-free, and withdrawals are not taxed as long as funds are used for qualified health-related expenses.

• Don’t overlook other important benefits. Specialty benefits, such as dental, vision, accident or critical illness insurance plans, are often lower-cost options that can protect you and your family from head to toe.

— Source: UnitedHealthcare[/su_note]