Most employees sign up for the workplace health-care plan during open enrollment, and then don’t think much about it afterward.
But there are steps you can take at the start of the new year to get the most out of your coverage and to avoid surprising bills, experts say.
Here are some of them.
Learn all of your plan’s costs
The costs of your health insurance plan go far beyond your premium, or the monthly amount you pay an insurer to participate in a health plan. (Your employer typically deducts this sum from your paychecks.)
You also need to learn about your deductibles, co-insurance, co-pays and out-of-pocket maximums.
It’s complicated. So if you are confused, you are most likely not alone.
- Deductible: How much you’ll have to shell out before your employer’s plan kicks in.
- Coinsurance: the share you’re on the hook for with covered services.
- Co-payments: The fixed amount you’ll pay for certain health care services after you’ve paid your deductible.
Your out-of-pocket maximum is a limit on the total amount you’ll have to pay during the year — including co-pays, co-insurance and deductibles. After you’ve hit this ceiling, your insurer can’t ask you to pay any more.
Remember, these charges reset every year.
Check for changes from 2023 to 2024
It’s likely that your employer-sponsored health plan is a little different in 2024. As a result, you should review your coverage come January.
“Usually, when you sign up for a plan, you receive in the mail a full plan benefit guide,” said Caitlin Donovan, a spokesperson for the National Patient Advocate Foundation.
You should also be able to learn about your covered benefits on your plan’s website. If you don’t know how to access this information, contact your human resources department.
On the positive side, you might find your coverage has expanded.
For example, 15% of large companies offered menopause benefits in 2023 or planned to do so in 2024, compared to 4% in the years before, according to Mercer. More firms are also extending pet insurance and elder caregiving benefits to workers, it found.
Meanwhile, Donovan said she’s seen a “rapid expansion” in the coverage of alternative services, “like doulas, acupuncturists, reiki and massage therapists.”
Many health-care plans will cover all or part of a gym membership, Donovan said.
“Others may cover certain types of wellness apps, from Weight Watchers to meditation,” she said.
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On the flip side, you may discover that your plan has rolled back its coverage in a way that impacts you. Still, that’s important to know.
“You don’t want to go to a doctor and find out they are not in your insurance network as that can get very costly,” said certified financial planner and physician Carolyn McClanahan, founder of Life Planning Partners in Jacksonville, Florida.
You should be able to check if a certain provider is covered under your plan on their website or portal. If you see a doctor is in-network, Donovan recommends taking a screenshot.
If the information turns out not to be accurate, you shouldn’t be held liable for out-of-network charges under the No Surprises Act, she said.
Plan your care for the year
In January, you want to make a list of your medical needs for the upcoming year, said McClanahan, who also is a member of CNBC’s Financial Advisor Council.
“If it is enough to hit the deductible, I go ahead and get it done, knowing that the rest of the year will be deductible free,” she said. “Then towards the end of the year, I get as much done as possible so I can hopefully decrease my utilization the next year. This includes filling up on all my prescription medications as much as can be allowed.”
It’s also best to schedule any particularly expensive treatments or procedures once your deductible has been met.
Remember that your health insurer likely must cover preventive services, including mammograms, coloscopies and wellness visits, at no charge to you, whether or not you’ve hit your deductible.