Group Health Plans
What you need to know about job-based health plans and other group health plans.
Some things to keep in mind during open enrollment:
Is my current provider included in my plan's network?
Check your current plan to ensure your provider of choice is covered in your group plan for 2014. If your preferred provider is out-of-network, your employer may have another option available that includes your doctor. If not, you may be able to shop for a plan on the Health Insurance Marketplace that covers care by your doctor.
What will my out-of-pocket expenses be?
Pay close attention to the plan's deductible – the amount you pay before insurance kicks in – as well as maximum out-of-pocket costs. It's also important to pay attention to the co-payment, or the fixed amount you'll pay for a covered healthcare service. Keep in mind that many preventative care services, including Type 2 Diabetes screening, HIV screening, diet counseling and vaccinations and much more, are free under all health plans when provided by a network provider.
Are my prescriptions covered?
Check the plan's formulary, or preferred drug list, to see if the plan covers your prescriptions.
Is my employer's plan the best fit for me?
A group plan through your employer often grants you benefits at reduced or no cost. However, if you're in good health or you think you're paying an unnecessary premium for care, you may be interested in getting a policy of your own in the healthcare exchange.
What am I really paying for?
Make sure to look at more than just the premium (monthly cost) of the plan. Oftentimes, a lower premium means higher co-pays and more out-of-pocket expenses when you need care.
Does the plan offer accounts that have tax advantages?
There are three common types of tax-advantaged accounts that can help you pay for medical costs:
- Health reimbursement accounts (HRAs) are employer-funded group health plans from which employees are reimbursed tax-free for qualified medical expenses up to a fixed dollar amount per year. The employers funds and "owns" the account and funds can be rolled over year-to-year.
- Health savings accounts (HSAs) often go hand-in-hand with high-deductible health plans. Funds in the savings account are tax exempt and are used to pay for qualified medical services. Unlike a flexible spending account, unspent funds roll over from year-to-year.
- A flexible spending account (FSA) helps you pay for qualified medical services not covered by insurance such as co-pays, deductibles, some drugs and other out-of-pocket expenses. Funds for the account are not taxed and are usually drafted out of an employee's pay on a monthly or quarterly basis. Funds do not roll over from year-to-year.
Is your plan grandfathered?
"Grandfathered" plans are exempt from many changes required under the Affordable Care Act. If your plan is grandfathered, you may not get certain rights and protections offered through other plans. Health plans must disclose if they are grandfathered. If you're not sure, ask your employer or benefits administrator.
The Health Insurance Marketplace
Shopping on the Health Insurance Marketplace? Here's what you need to know.
What is the Health Insurance Marketplace?
The Health Insurance Marketplace, also referred to as the "Health Insurance Exchange," is a new way to find health coverage that fits your budget and meets your needs. The Marketplace can help if you don't have coverage now or if you have it but want to look at other options. You can learn your coverage options by answering a few questions on HealthCare.gov.
What if I already have health insurance through my job?
If you have job-based health insurance and you're happy with it, you obviously have the option of keeping it. Any job-based health plan you currently have qualifies as minimum essential coverage, which means you will not have to pay the penalty that uninsured people will be required to pay in 2014. If your employer provides a health plan and you choose to buy a plan on the exchange instead, your employer is not required to make a contribution to your premiums.
Can I qualify for the marketplace (and potential savings) if I already have access to a job-based plan?
Whether you qualify for lower premiums and out-of-pockets costs will depend on what kind of coverage your employer offers. If your job-based coverage is considered affordable (no greater than 9.5 percent of the annual household income) and meets minimum value (designed to pay at least 60 percent of the total cost of medical services for the standard population), you won't be able to get lower premiums or out-of-pocket costs in the Marketplace.
Here's how to make the most of the Marketplace during open enrollment.
- Ask your employer if it plans to offer health insurance during 2015
- If not, your employer may be issuing a stipend to shop on the Marketplace
- Learn your options and information
- Gather basic information about your household income
- Set your budget
- Learn about the different types of health insurance. Visit HealthCare.gov for a comprehensive guide to the different types of health insurance plans
- Make a list of questions prior to choosing your health plan
Find local help. Navigators, application assistance, certified application counselors and other resources are here to help. Visit Localhelp.HealthCare.gov to find help in your area