Decisions, Decisions

Ah, fall! If you ask most people, it is their favorite season of the year. Crisp weather, all things apple cinnamon and pumpkin, beautiful leaves, and the anticipation of holidays and family get-togethers. But there is another important event that comes every fall that may not be top of mind for most people: Benefits open enrollment.


Sorry to burst your good vibes bubble, but benefits open enrollment is something that should involve more than checking a box indicating you want to stick with the same health plan. Your life does not stay the same from year to year, so why should your health plan? Time to dust off the thinking cap, crack open your benefits enrollment guide, and start evaluating which plan best fits your current situation.


“Why should I change? My health plan works just fine for me.”


Your plan may work “just fine” for you, but there might be an available plan that fits your needs even better. Think of open enrollment as a new chance each year to reevaluate and match your needs with the best health benefits package for you. Consider the following as you review your benefits enrollment guide:


Plan Changes


Each year, there may be changes in the offered health plans. Therefore, even if you think you are going to stay with the plan you are currently enrolled in, carefully review your benefits enrollment guide for changes to:

  • Out-of-pocket costs, such as premiums, deductibles, out of pocket maximums, co-pays or co-insurance

  • Physician network coverage

  • Prescription drug coverage

  • Spouse and dependent coverage

Life Event or Planned Health Changes


Married? Divorced? Planning to have a baby or adopt? Planning a surgery? These should all factor into what plan you choose for the upcoming year, so that you can ensure that you are getting the coverage that you need for your family and yourself. No one has a crystal ball, but the more you can anticipate, the better off you will be.


Don’t Leave Money on the Table


Every little bit helps. If you have employer-sponsored insurance, your employer may contribute to your health savings account. They may also offer financial incentives for participating in wellness activities and screenings, as well as discounts for various health services. Read your enrollment guide to avoid losing out on valuable healthcare dollars.


“But Heather, reading this enrollment guide is like reading a different language! Nobody has time for that! It’s just easier to stick with what I know.”


Yes, going through the enrollment guide can get confusing, but do not let that discourage you. Here are a few tips to make going through the guide a little easier to digest.


Learn the Lingo


Understanding the meaning of words is essential to any learning process. Your enrollment guide may include a section of commonly used health insurance terms and definitions, but if not, you can access a glossary of health insurance terms here.

Think About Total Costs


You will often see your plan options laid out in a table, showing side-by-side comparisons. While this can be helpful to an extent, you need a way to apply this information to your situation.


It may be tempting to choose the plan with the lowest monthly cost (also known as a premium), but you also need to consider how much you will be on the hook for out-of-pocket costs if something does happen to you or a family member’s health. If you or a family member has a known health condition, planned procedure for the upcoming year, or even just child dependents (children get sick a lot more than most adults), any of these can affect how much you may be paying in healthcare costs. You can get a general idea of potential health care costs by asking yourself a series of “What if” questions:

  • What if a family member or I have to go to the emergency room? Urgent care? Have a hospital stay? Sick visit to a primary doctor?

  • What if one of us needs a specialist visit? Lab work? X-ray or other scans?

  • What if we need prescription drugs?

Then make a cost comparison table by using the listed services costs for each of the different plans listed in the enrollment guide, as well as the monthly premiums for each plan. By going through this exercise, you will get a better idea of which plan better fits your needs from an overall cost perspective. Sometimes what looks like the least expensive plan, ultimately may actually cost you more in the long run if you or a family member requires more medical care than expected.


Get Assistance if Needed


There is no shame in asking for assistance when enrolling for benefits! Simply asking questions may help you avoid unnecessary costs down the road. Talk to the advisors in your human resources department if you receive insurance through your employer, and they should be able to provide you with resources to help you with your plan choices. There are also enrollment resources available to those who are enrolling for Medicare plans, as well as through the health insurance marketplace.


Take on open enrollment with confidence, and choose a plan that is right for you!


Guidepost Rx is Here to Help


Stuck with a lemon of a plan? Guidepost Rx can make some pretty tasty lemonade. Guidepost Rx is here year-round to assist you with your pharmacy benefit questions or issues, and help you optimize the plan you have chosen.

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