Fall Means Cooler Temperatures and Open Enrollment

Horizons in Hemophilia, September 2015

By Michelle Fitzwater, Director of Managed Care and Client Relations

Open enrollment is the time to review your health care needs. Open enrollment comes but once a year and commonly happens in September, October or November. This is the time period where you may enroll in or transfer insurance plans offered by your employer. This is a really important decision and you have to put in a lot of work to get a good result. After all, once you choose a plan it will be your insurance coverage for the next year. We are here to help you with this process. Here are some of the essential things you should know before selecting a plan:

Determine if factor is covered on your drug card or the major medical plan. Factor products are increasingly being moved to the drug benefit portion of benefits. While this typically means they are not subject to your deductible, there are some plans that have co-pay at percentage of cost.  Also, if it is covered on your drug benefit you could have a limited network. Many plans are selecting only one specialty pharmacy for their drug plan. This means that you will not have a choice in where your factor comes from or be able to control the costs.

Determine the out-of-pocket costs. Most people initially look at the premium and think that is what the plan will cost them. Unfortunately there are a lot of other costs to consider. Once you are able to put all of the costs together you will have a better picture of the whole cost of the insurance plan. For example, the premium may be significantly lower on a high deductible health plan (HDHP) versus an HMO plan. What you will realize once you look at the other numbers is that the annual deductible is $7,000 on the HDHP and only $1,500 on the HMO. That $7,000 will have to be paid by you before the plan will cover any other expenses.

Explore Flexible Spending or Health Savings Accounts.  If you can estimate your potential out of pocket costs, you will be better prepared to take advantage of the tax savings available in a flexible spending account. For example, if you know you plan to have surgery this year you can elect to contribute the amount of your deductible. This amount will be divided between your paychecks and taken out pre-tax. It is then available for you to pay the provider as soon as you are enrolled. This means that if your plan starts January 1st you can use the funds before you have fully contributed to it. This is very important if you have the HDHP mentioned above.

If you don’t already know the answers to the above questions, direct them to your employer’s benefit manager. They should have all the answers you need (or know where to find them) about the plans they offer. Factor products are tricky and it usually takes a few phone calls to your employer, broker or insurance company before you will be able to determine what your costs will be. Don't forget to check your network options for any doctors that are important to you or your family too. Check out our The Health Care Plan Comparison Worksheet in the pharmacy section of the website to compare the plans you are offered and please contact us with any questions! Call or email Michelle Fitzwater, Director of Managed Care and Client Relations, at 770-518-8272 or mmfitzwater@hog.org.