Although the Affordable Healthcare Act is again before the Supreme Court, chances are excellent it will be a factor in our health care and financial decisions for 2021. That means the rules around the ACA are essential, and you need to enroll or re-enroll as soon as possible. The current deadline is Dec. 15, 2020, but exceptions such as a job loss allow for later enrollment.
Enrolling in any health care policy can be a complicated, confusing, high-stakes process. It’s stressful for anybody, but you can make it less stressful if you go into shopping for health insurance fully prepared. Do that by taking notes on the following vital questions about your health and financial needs for the coming year.
10 Mission Critical Questions for 2021 Open Enrollment
1. Are You Happy With Last Year’s Plan?
Ask yourself what parts of your health coverage you were happy with last year and what factors frustrated you. Go beyond your feelings about it, diving into the aspects of your policy responsible for that experience.
For example, was the premium high enough to cause financial stress? Was it hard to get a referral for the specialist your child needed? Did you have to wait weeks for a physical or dental cleaning?
Identify things that made you unhappy and look for plans that help you avoid those specific complaints. Likewise, find out if the stuff you liked is available only under your current insurer or it’s shared across multiple vendors.
2. What Major Changes Have Taken Place?
How different is your health situation now, compared to this time last year? Each change might mean tweaking your plan.
For example, did you have a child? Did a child leave your insurance policy? Were you diagnosed with a condition that requires more doctor visits? Did your doctor retire or move an inconvenient distance away?
Come to your open enrollment shopping with a list of changes and what those changes might mean for your health care and insurance needs in the coming year. More than one person has spent unnecessary money or been surprised by insufficient coverage because they just continued with the previous year’s plan.
3. How Full Is Your Health Savings Account?
A health savings account (HSA) is a bank account you can contribute to with pretax dollars, with the stipulation that you use it only for health-related expenses. You keep it funded to cover the deductible and related costs for your medical needs through the year.
If your HSA is at a balance equal to or higher than your maximum out-of-pocket expenses under your current plan, you might consider changing the features of your coverage. For example, you could opt for a plan with a higher maximum out-of-pocket limit for the year and continue contributing to your account with the money left over from the plan’s lower premium.
The specific impact and complexity of your HSA balance can vary widely. But if your balance is high, dig deep into how that might interact with your policy needs, your cash flow, and any other related factors.
4. Did You Use Up Your Deductible?
Deductibles come in two forms: per-incident and maximum out-of-pocket. The per-incident deductible is the amount you pay when you go in for any given procedure, checkup, or visit. The maximum out-of-pocket limit is the most you will pay in a given year, no matter how many times you go in.
If you reached your out-of-pocket limit last year, that means you’re getting good value out of your health insurance. If you didn’t, it might be worth it to shop for a policy with a different limit. In some cases, it will be worthwhile to pay a little extra monthly to reduce the limit. In others, your annual expenses will be so low that you’re better off saving on premium costs by getting the plan with the highest limit available.
When thinking about this, also keep in mind how you reached your out-of-pocket expenses this year. Was it a bad year, medically speaking, and unlikely to repeat? Or was it more or less business as usual, meaning things will likely be the same in the coming year?
5. Do You Have Any Big Changes Coming?
Do you anticipate any significant changes in your health care needs for the coming year? Every significant difference might mean you’re better off making changes in advance than trying to alter things in real time.
Pregnancy is one of the most prominent examples here. Even though you can add a new family member to your plan at any time, the expenses associated with prenatal care and childbirth might mean you need to change your coverage. Some other things to consider are changes in your job status, a child aging out of your policy, or an elective procedure like a vasectomy, hernia surgery, or joint replacement.
Consider what changes you anticipate, then research how they might impact your health insurance needs. Armed with that information, you can enter into open enrollment with confidence.
6. Will You Need Eye and Tooth Care This Year?
Vision and dental insurance is super-expensive, so much so that you’re almost always better off paying for routine visits out of pocket.
That said, every few years, you might need more extensive care than usual. You may need several cavities repaired or even a root canal. Your last vision test might suggest serious treatment or a new pair of glasses.
If you think that sort of thing is likely, run the math on how much insurance might save you if you get coverage just for this coming year. It doesn’t always work out, but it can make a powerful difference in your bottom line when it does it.
7. Do You Want to Use Your Existing Doctor?
This may be the simplest but most important consideration on the list: Do you like your existing doctor?
If you do, do you like them enough that having to change doctors is a deal breaker, even if it saves you money on health care? If you don’t, would you be happy with a new doctor within the same health care organization, or do you feel the need to leave them entirely and start someplace new?
These considerations help you cross off possible options from a sometimes bewildering array of choices. If you want to keep your doctor, that disqualifies insurers who won’t allow it. If you’re going to move on, you can forget HMOs that require you to stay in-system.
8. What Routine Care Do You Need?
If you’re in your 20s and don’t have dangerous hobbies, your routine care needs will be limited. If you’re in your 50s with a chronic heart condition, you’re likely to need monthly checkups or something even more frequent.
The answer to this question can interact with health insurance options in essential ways, potentially costing you or saving you thousands of dollars over a year. If you need little in the form of routine checkups, opt for plans with high deductibles since you’re unlikely to need the coverage. If you need lots of regular visits, then low deductibles or a copay plan with low out-of-pocket fees per deductible might be the better choice.
9. How Much Will You Travel?
This covers two related questions: Will you frequently travel this year? Does your plan cover you while you’re in the places you plan to travel?
Answering each of these questions with a yes or no gives you four separate courses of action:
- You plan to travel, and your plan will cover you. In this case, you don’t need to make changes to suit your travel plan.
- You plan to travel, and your plan won’t cover you. You should look into how much it would cost to broaden your coverage and compare that to short-term travel medical insurance for your desired destination.
- You don’t plan to travel, and your plan covers travel. Look into whether your premiums would be lower if you didn’t have travel coverage.
- You don’t plan to travel, and your plan doesn’t cover travel. In this case, you don’t need to make any changes.
This has potentially high rewards if you have major travel plans.
10. What Prescriptions Will You Regularly Need?
Prescription coverage often feels like an afterthought when shopping for health insurance, but it can make a huge difference in your overall health care costs.
Look at how much you spent on prescription medication over the past year, and use that as a metric for comparing any changes or new policies you will consider during open enrollment. If you think your prescriptions will change, use those new numbers as well when making your decisions.
This is one of the more clear-cut considerations when walking through your health care options. You can find out, to the penny, how much you spent on prescriptions last year and (assuming no changes) calculate precisely how much it will cost you on different plans moving forward.
Of course, we can’t tell you what plan you’ll need. Everybody’s situation is different. But if you go into your open enrollment with these questions already answered, you’ll be better able to decide between the options available to you.