Healthcare reform is changing the way benefits plan coverage options are communicated and, in some cases, retirees may see significant changes to their health insurance coverage. This is a great time to learn everything you can about your healthcare plan to be sure you don’t face any unexpected challenges next year.
The first thing that is important for retirees to know is that under the Affordable Care Act (ACA) they will see changes in their annual open enrollment benefits materials. This includes the addition of a Summary of Benefits Coverage (SBC). SBCs are benefit plan summaries that are intended to provide “clear, understandable and straightforward information on what health plans will cover, what limitations or conditions will apply, and what they will pay for,” according to the U.S. Department of Health and Human Services.
However, retirees should not rely on the information in their SBC alone to make health insurance plan choices. To minimize surprises and make the most of health insurance plan options, consider these seven tips:
- Acquire your plan materials – Pay attention to how your former employer is making your SBCs Plan Booklets available to you.; Many are making them accessible online, and on paper. It’s good to know how you can access this information during open enrollment.; It’s also good to have access to them throughout the year, in case you want to review them again when you are in need of a particular medical service.
- Study up – It can really pay off to take the time during open enrollment to truly read through your plan materials, including the SBCs and Plan Booklets. This will make you more familiar with each of your plan options and give you the detailed plan descriptions you need to decide on the best plan for you and your family in the coming year.
- Think about your location – Consider where you plan to spend most of your time.If you live somewhere else during the winter, or if you are considering a move in the next year, it may have an impact on your plan choices. Where you live can change what plans are available to you and which doctors and hospitals may be considered “in-network.”
- Break out the calculator – Many employers provide cost calculators to help project your total cost for the coming plan year. The total cost includes the premium you pay as well as your share of the deductible and coinsurance. Take the time during open enrollment to think through your potential medical needs and calculate your anticipated expenses before selecting a plan. It may save you hundreds in the long run.
- Know which Preventative Services are covered at no cost. One of the benefits of health care reform is an extended list of preventive care benefits that must be offered by new health care plans for free. Preventive services such as colonoscopy screenings for colon cancer, Pap smears and mammograms for women, well-child visits, and flu shots for all children and adults must be offered without out-of-pocket costs.
- Don’t miss the deadlines. No matter what changes you may make, if any, during this year’s open enrollment period, don’t let your selection deadlines slip by without action. Doing nothing could end up costing you hundreds in 2013 in higher premium costs, lower coverage, or missed opportunities to optimize your health care dollars. Missing your open enrollment deadline will mean that you have to wait it out a full year before making changes that can help pad your bank account.
- Ask if your plan is subject to the health care reform law. Health care reform will be taking place over several years, by means of the Patient Protection and Affordable Care Act. This complex law affects some, but not all, retiree plans. By understanding whether your employer’s retiree plan is subject to the healthcare reform law, you will know whether the benefit mandates and other rights and protections provided under the law may apply to you.
