It’s Open Enrollment Season

If you are employed, you are likely navigating—or soon will be—Open Enrollment season, a crucial time for making informed decisions about your employee benefits, particularly health insurance. During this period, your employer provides the opportunity to adjust your existing plans or enroll in new benefits that best suit your needs.

It’s essential to stay engaged during this time, as overlooking key details can leave you with a plan that doesn’t align with your circumstances. For instance, a few years ago, my husband’s employer changed the Open Enrollment dates from November to May and altered the available plans. If we hadn’t acted promptly, we would have been left with an unsuitable plan.

Here are some critical questions to consider during Open Enrollment:

1. Have My Needs Changed?
   Consider your current life stage and health circumstances. For example, if you’re in your mid-20s and previously relied on your parents’ health insurance, turning 26 means you’ll need to secure your own coverage. Additionally, if you’ve recently had children, assessing their dental needs might prompt you to explore dental insurance options that weren’t necessary before.
2. What Are the Differences in Plans?
   Each year, premiums often shift, but other factors like copayments and coinsurance can change as well. Employers are increasingly offering high-deductible plans, which typically come with lower premiums but require you to pay a larger share of your healthcare costs until you meet a specific deductible. For 2024, the minimum deductible is $1,350 for individuals and $2,700 for families. This plan might be appealing if you’re young, single, and healthy with minimal medical visits. Conversely, if you have a family or manage a chronic health condition, this plan could lead to higher out-of-pocket expenses. Consulting with your plan administrator or benefits specialist can help clarify which option is best for your situation.

**Jill-splain: Coinsurance refers to the percentage of costs that your insurance covers. For example, with an 80% coinsurance rate, your insurance would pay 80% of your medical expenses, leaving you responsible for the remaining 20%.

Navigating Open Enrollment effectively can empower you to choose the right benefits for you and your family. Don’t hesitate to seek assistance if you have questions or need clarity on your options.

What does the change in providers mean? Sometimes, the health or other insurance provider will have changed completely, and now you may be looking at a plan that may not include your regular doctor. A few years ago, my husband’s dental insurance changed to a provider that almost no dentist took in our area. We ended up having to switch dentists to find one that accepted our insurance.  Or, you might have to declare a PCP-Primary Care Physician, have all your visits go through them, and obtain referrals from them to be able to see someone outside of that person. This is mostly true with HMO Plans.

If you do make changes, it’s important to also see how these changes will affect your take-home pay and budget. You may want to sign up for a Flexible Spending Account or Health Savings Account (only available if you have a high-deductible insurance plan) to help reduce your costs. In my next blog, I’ll talk about what these are.

**Jill Carr CPA, CFP®, CEPA®, CPFA®, Senior Wealth Advisor

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