It's that time of year again. Nope, not holidays, hunting or Halloween. We're talking open- enrollment season for health care coverage.
For those still fortunate enough to have health insurance through work, now until early November is typically when you have to choose your coverage options for 2012.
Poring over the paperwork can be a pain, but with employees shouldering an ever-bigger chunk of their health care costs, it could be financially worth your time to look at your choices.
"People hate to do this. It's like having a root canal or writing a will: They don't want to think about it," said Nancy Metcalf, a senior program editor at Consumer Reports magazine. "But if you get sick and have the wrong insurance plan, it's too late."
According to a nationwide survey in August by Aflac insurance company, 76 percent of U.S. workers admit to making mistakes with their health benefit decisions in the past. And 42 percent of workers say they've wasted money because of those mistakes.
The most common errors: Not electing available benefits such as vision or dental; choosing the wrong level of coverage (too much or too little); or not putting enough in a flexible-spending account.
To ensure that you don't get shorted by your health care coverage, here are some open enrollment tips from experts.
'Don't go on autopilot'
That's the advice of eHealthInsurance.com expert Carrie McLean, who said too many people just plug in the same choices year after year, without looking at the details.
"You need to do your homework. Pay attention to what your employer is changing, so it's not a surprise next year," said McLean.
Since surveys show a majority of employers are raising premiums or changing coverage for 2012, this is not the time to skip over the details.
Use comparison tools
Try online tools, like the state's Department of Managed Health Care or the Office of the Patient Advocate websites, which let you compare health plans by types of care (cancer, maternity, heart disease, etc.) and other factors.
Similarly, most health insurance companies and consumer sites like eHealthInsurance.com offer comparison-shopping of health plans.
Get past the premium
If it's cheap, there's likely a reason. Either the benefits are very limited or you'll pick up a bigger share of the cost.
"The plan that seems to cost less can really cost you more if it does not cover the services that you need," says California's DMHC website.
Beyond your monthly premium, look at the amounts for annual deductibles, drug prescriptions, co-pays and the cap on co-insurance, says McLean.
For instance, if your co- insurance cost is 20 percent and you run up a $100,000 bill, your share could be $20,000 unless there's a cap on what you have to pay.
Consider high deductible
They're becoming more prevalent, says Consumer Reports, which last week released its rankings of 830 health plans nationwide. (For a look at California's top-rated private health plans, see box.)
A high-deductible plan can yield a significantly lower premium, but be sure you have enough set aside to cover your out-of-pocket expenses before you've met your deductible.
HSA or FSA?
They're both ways to set aside dollars to pay for out-of-pocket medical costs.
A flexible spending account, or FSA, lets you set aside a certain amount of pre-tax income for items not covered by insurance, everything from Lasik eye surgery to prescriptions. But be careful: Any unspent FSA money reverts back to the employer on a "use-it-or-lose-it" basis. Currently, the annual amount you can set aside is set by your employer; starting in 2013, it will be capped at $2,500.
A health savings account, or HSA, is paired with a high- deductible plan and typically lets you carry over the balance year to year, or take it with you when changing jobs.
Consider going solo
Last year, the average family paid about $15,100 in premiums for employer-provided health insurance, according to a recent Kaiser Family Foundation study.
In some cases, it might cost less to move a spouse or a son or daughter to a separate plan. If you and your spouse are both working, compare your employers' plans to see which is most cost- effective to cover your family.
An adult child, who can now stay on a parent's health plan to age 26, may pay a hefty premium for that privilege. A separate plan might cost less.
Is a layoff likely?
If you think company layoffs might hit your workplace next year, consider getting a lower-priced policy, in case you have to pick up the premium costs through COBRA.
And for some additional year-round ways to cut health care costs:
Look for Rx savings: When it comes to prescription drugs, use generics. Take advantage of cheaper order-by-mail programs, if available. Look for pharmacy discounts offered by chains such as Raley's or Walmart stores. "All of those are great cost savings," said McLean, of eHealthInsurance.
Get healthier: More employers, McLean said, are considering new incentives either rewards or penalties to encourage healthy behaviors such as losing weight or quitting smoking. Taking advantage of such programs can result in lowered premiums or other rewards.
Don't stray: If you are in an HMO, don't stray from doctors who are covered by your plan, so-called "in-network" physicians. Always check that any doctor you're seeing is covered by your health plan, even those recommended by your personal physician.
Otherwise, said McLean, "It can be hugely costly."
What's in/out: Under the new health care reform act, many types of preventive care well-baby visits, annual physicals, certain immunizations, colonoscopies, etc. are free and not subject to co-pays or deductibles. But if a problem shows up and more diagnostic work is needed, it likely won't be covered. Be aware of what's free and what you'll have to pay for yourself.
Avoid the ER: Even if you're covered by insurance, avoid the emergency room unless it's truly critical. Instead, check if your health plan offers after-hours office visits or urgent-care clinics.
Offer to pay cash: Some doctors and dentists will give you a discount for paying directly by cash or check.
And here's an interesting idea: If you're bothered by the frustration of haggling over medical bills, a new Bay Area startup company, HealthCPA.com, says it'll do the work for you.
Launched this week, HealthCPA offers to help manage medical bills, figure out treatment costs before surgeries, fix billing errors and handle denied claims.
It's a "concierge-style" service for those who want to cough up a $20 monthly membership and $75-per-hour fee for negotiating with your hospital or insurance company.
TOP-RATED PRIVATE HEALTH PLANS IN CALIFORNIA
According to a new analysis by Consumer Reports magazine, the Kaiser Foundation Health Plan ranks highest for quality care in California. The rankings looked at 390 private health care plans that people enroll in at work or on their own. The results, which cover all 50 states and appear in the November issue of Consumer Reports, are based on prevention, treatment, consumer satisfaction and other data from the National Committee for Quality Assurance (NCQA), a Washington, D.C.-based nonprofit.
Here's the list of the highest ranked plans in the state:
Kaiser Foundation Health Plan of Southern California
Kaiser Foundation Health Plan of Northern California
Western Health Advantage
Blue Shield of California
HealthNet of California
UnitedHealthcare of California
Cigna HealthCare of California
Anthem Blue Cross
Aetna Health of California
Source: www.ConsumerReports.org, November 2011 issue
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Have a personal finance question? Call The Bee's Claudia Buck at (916) 321-1968.
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