Looking Ahead to Annual Enrollment: What to Know When Choosing a Medical Plan
Selecting the appropriate employer-sponsored medical insurance plan can really impact your personal finances and healthcare needs. It’s essential to evaluate each plan’s features and how well they match your financial circumstances and need for various medical and pharmacy care. This involves comparing both costs and coverage options.
When choosing medical plans, keep these factors in mind:
Explore the various healthcare options that you may be eligible for
Familiarize yourself with key health insurance terminology. EverTrue has put together a document that may be helpful, click here.
Consider your own and your family’s healthcare needs (both current and anticipated)
Evaluate plans based on benefits, provider networks, and costs (both the costs of premiums as well as the cost of care when provided)
At EverTrue, we offer two types of medical insurance plans – a Preferred Provider Organization (PPO) and a Consumer-Driven Health Plan (CDHP).
A Preferred Provider Organization (PPO) offers flexibility by letting you see any provider without a referral. Although PPOs have a network of preferred providers, you can receive care outside the network, but at a higher cost. This setup benefits those who need frequent specialist visits or need set amounts for their healthcare.
EverTrue offers three PPO plans with differing premiums, deductibles and benefits.
Gold PPO Plan – has the lowest deductible offered, but has the highest employee premiums of the PPO plans offered.
Silver PPO Plan – is the mid PPO plan offered. The deductible and premiums are both between the Gold plan and the Bronze plans
Bronze PPO Plan – has the highest deductible, but their premiums are the lowest among the plans PPO offered. One important factor to note about the Bronze plan is that it has greater network restrictions than the other three EverTrue medical plans, meaning less providers are considered “in-network”.
The Consumer-Driven Health Plan (CDHP) features lower premiums, but higher deductibles, and require the member to take a more active role in managing their healthcare choices. A CDHP plan requires you to meet the full deductible before insurance starts to share the costs with you through a coinsurance. These plans are not right for everyone but they can be a great option for anyone given the right circumstances. CDHPs qualify for a Health Savings Account (HSA) allowing pre-tax contributions for medical expenses. You can learn more about HSA’s by visiting the HSA page on the EverTrue Benefits website (www.evertruebenefits.org/hsa).
It is also important to consider your pharmacy costs as well. Prescription drug benefits depend on each plan’s formulary, a list of covered medications organized into tiers, as well as each plan’s cost-share model. Lower-tier drugs, like generics, have lower copayments, while higher-tier drugs, including brand-name and specialty medications, cost more. Reviewing the formulary and cost-share model will help you anticipate medication costs based on your own circumstances.
It is just as important to consider the cost-sharing mechanisms – copayments, coinsurance, and out-of-pocket maximums when assessing what plan is right for you. Copayments are fixed amounts for services like doctor visits or prescriptions. Coinsurance is a percentage of costs that you pay after meeting your deductible. The out-of-pocket max limits your yearly responsibility for expenses related to services received. Once you meet the OOP max for the year, your insurance pays 100%. This includes deductibles, copayments, and coinsurance; however, it does not include premiums.
Understanding these points will help you select a plan that will fit your needs.
EverTrue has a quick reference when comparing plans, which you can find located on the EverTrue Benefit Website or by clicking here. For more information and educational video presentations on the medical and pharmacy benefits at EverTrue, please visit the EverTrue Benefits Website www.evertruebenefits.org/health-benefits or www.evertruebenefits.org/pharmacy-benefits.