No matter what differences there are in our daily responsibilities, there’s a few things we all do that require some serious “adulting.” One of those is establishing or renewing our health insurance plan.
Few people understand the details in full, and we may have to make a choice that we’re not altogether sure about. Maggie Martel, Enrollment and Member Support, Healthcare and Insurance in the Office of Personnel Management offered some guidance for navigating open season.
Top Need-to-Knows:
Open Season began this week and continues through Dec. 12. Every employee needs to review their plans, even if they don’t anticipate adjusting their plans.
Plan comparison tools show the differences in costs and specific health benefits, including premiums, coinsurance, deductibles, hospital care, and prescription coverage.
2023 plans have new benefit offerings in maternal health, gender affirming care, obesity treatments, COVID-19 countermeasures, telehealth, assisted reproductive technology and other services.
And Back the Basics:
Mertel reviewed some of the basic terms in the health plan landscape.
What are premiums? What you pay each month for your health insurance, automatically deducted from your paycheck. Martel called it “the first cost to consider.”
What is cost-sharing or a copay? When you go to the doctor, you pay a small fraction of the cost of the visit. The plan comparison tool can show you your copay under various plans.
What is a deductible? Your deductible is the amount you pay for covered health care services before your insurance plan starts to pay.
What is coinsurance? While regular office visits and preventive care may be covered by your plan, some care — typically hospital care and specialists — is not fully covered. Coinsurance is the percentage of the cost of a covered health care service that is your responsibility after you’ve met your deductible. Many plans offer an out-of-pocket cap on these costs.
Who can be covered by my health plan? Family members are defined by law, so spouses and children up to the age of 26 are covered. Unmarried partners are not eligible.
Is there any way to change my health plan during the year? A qualifying life event allows you to adjust a health insurance plan — getting married, having a child, changing jobs, or someone in your household losing or changing employment.
What is a Flexible Spending Account? It’s a pre-tax benefit account that’s used to pay for eligible health care expenses that aren’t covered by your insurance, and for dependent care. Money is automatically taken from your paycheck to put into your account(s) before taxes are taken out, so you pay less in taxes. If you don’t spend all the money you put into the health care FSA you can carry over up to $610 for expenses in the next plan year. The dependent care FSA does not allow carryover.
What’s the difference between an FSA and an HSA? An HSA is tied to a high-deductible plan only — it doesn’t come with the lower-deductible, higher-premium plans. The full amount left in the HSA always carries over.
What about if I am eligible for Medicare? Most plans would have lower cost-sharing or co-insurance if you are also enrolled in Medicare, but you pay a Medicare premium on top of the federal health plan premium.
Is there anything I need to consider if I’m getting close to retirement? In order to continue a health plan into retirement, you need to be enrolled for five years beforehand.
These definitions and tips can help you make choices that work for you for the upcoming year, but check out the recording of Martel’s online training for more guidance.
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