How to Choose a Health Insurance Plan at Work
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How to Choose a Health Insurance Plan at Work

Ask these five questions to save money and ensure you and your family get the right care.

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By Amy Capetta

You were offered a new job and you’ve accepted the position—congratulations! Once you’ve signed the employment contract, you may be faced with another work-related decision: picking health insurance coverage. Each plan can have its own set of advantages and limitations, so certain key factors need to be addressed. Here are five essential questions that should be answered in order to select the best policy for your lifestyle.

What health conditions do you need covered?

2 / 6 What health conditions do you need covered?

If you—or anyone else in your family who would be covered under this plan—has a pre-existing health condition, it’s imperative to know if the necessary appointments, tests, prescriptions and services would be included in this policy. According to the current 2018 guidelines under the Affordable Care Act (ACA), no insurance plan can deny coverage, charge additional money or refuse to pay for essential health benefits due to a pre-existing medical condition. Also, the majority of health plans are required to offer some preventive care services—including periodic health screenings for multiple conditions, such as blood pressure, cholesterol, diabetes, colorectal cancer and depression—at no cost, as long as the screening is delivered by a doctor or other provider in the network. (It might be helpful to learn the current health insurance laws as outlined by HealthCare.gov.)

What do these conditions generally cost you on an annual basis?

3 / 6 What do these conditions generally cost you on an annual basis?

Tally up the approximate number of health services you expect to need each year; this will help to determine how much money you will spend over a 12-month period. Make sure to include expected appointments and medications, along with birth control and mental health counseling, if necessary. All FDA-approved contraceptive methods prescribed by a physician must be covered under your plan unless you are employed by a religious organization, which is now an optional benefit. Also, all plans must cover mental and behavioral health treatments, yet specific benefits vary by plan and by state.

Does this plan cover your regular doctor, as well as your regular specialists?

4 / 6 Does this plan cover your regular doctor, as well as your regular specialists?

If you want to continue working with your physicians, you should find out if they accept the type of health insurance policies being offered. The four basic types of plans—Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Exclusive Provider Organization (EPO) and Point of Service (POS)—differ in rates and coverage, as well as the doctors, hospitals and clinics that are part of each network. Also, keep in mind that some plans require a referral from a primary care physician (PCP) in order to meet with a specialist while other plans do not.

What are the costs of each plan?

5 / 6 What are the costs of each plan?

The total costs for health insurance include the monthly premium and out-of-pocket costs, which are any expenses that will not be reimbursed, such as deductibles (the amount of money you pay before your benefits take over a percentage of the cost), copayments (also referred to as copay) and coinsurance (the amount you might pay after your insurance company kicks in their share). It’s also necessary to take into account other services that may or may not be covered, such as prescriptions, laboratory tests, vision, dental and various types of therapies.

What are the FSA/HSA provisions?

6 / 6 What are the FSA/HSA provisions?

These are types of savings accounts offering tax advantages in order for the insured to put money aside to pay for qualified medical expenses. A Flexible Spending Account (FSA) is established by an employer and allows you to spend the savings on services and items not covered by an insurance plan, such as dental, deductibles, copayments, prescription medications and vision, as well as over-the-counter medicines with a doctor's prescription. FSA funds can also be used to purchase medical equipment (like crutches), medical supplies (like bandages) and diagnostic devices (like blood sugar test kits). Your employer has the option to contribute to this account; your portion is taken pre-tax from your paycheck. According to the most current 2018 laws, the max contribution is $2,650. Keep in mind that funds not used by the end of the year may be forfeited. However, your employer may offer a three-month grace period or may allow up to $500 to carry over into the following year.

A Health Savings Account (HSA) is an option if you have a certain kind of High Deductible Health Plan (HDHP), which, according to the current 2018 guidelines, is a health insurance plan with:

  • A deductible of at least $1,350 for an individual or $2,700 for a family
  • A limit of $6,650 per individual and $13,000 per family for out-of-pocket medical expenses
  • No coverage until you hit that deductible, except for preventative and wellness care, vision and dental, accident coverage and health insurance premiums

In 2018, you can pay up to $3,450 for individual HDHP coverage and up to $6,900 for family HDHP coverage. Funds can be contributed by the employer or the employee on a pre-tax basis, and any money withdrawn or any interest gained will not be taxed. This money can be used to pay for deductibles, copayments, coinsurance and other approved expenses. Unlike the FSA, funds can be carried over from year to year, even if the employee is no longer working for the company. Many HDHP plans do not qualify for an HSA, so it’s important to inquire.

Need additional guidance or questions answered? Reach out to your human resources department or head to HealthCare.gov, which, in addition to the current laws, breaks down terminology, costs and much more.

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