Whether shopping in the Patient and Protection Affordable Care Act marketplace or obtaining health insurance through an employer, consumers need to be prepared for big changes during the 2015 enrollment period, according to a Kaiser Health News report.
To understand the changes in workplace plans, consumers should ask these six questions, according to the report:
1. Is my primary care physician still in-network? Due to changes in provider affiliations and the shift of some employers to HMO plans with limited physician networks, consumers should not assume their physicians or hospital still accept their plan.
2. Has my company hired preferred vendors? Some employers have changed where employees can receive lab work and medication for more expensive treatments, meaning going out of network for infusions and special prescriptions can be extremely expensive.
3. How much has my deductible risen and are co-payments still available? Many employers are absorbing less of the overall cost increases of health plans by shifting the medical expenses to worker benefits. That said, deductibles have increased at many companies and some are getting rid of co-payments by instead having employees pay the full amount and applying it towards their deductible.
4. What price comparison tools are available to me? As employers encourage their workers to shop around for health plans, information on prices and quality should be provided. Whether in the form of an online app or some other resources, employees should find out how best to compare plans.
5. What are my options regarding flexible spending accounts and health savings accounts? Employees should find out if their tax-free money can be used toward out-of-pocket payments. Some options to consider include using a flexible spending account to contribute pretax dollars toward medical costs before a set deadline or chipping into a health savings account without deadlines that can be used even after leaving the company.
6. How are prescriptions covered? Considering how expensive medications can be, it is crucial for employees to find out if employers are splitting pharmacy benefits into additional tiers to determine cost-sharing and if long-term prescriptions are covered, if applicable.