Benefits election season is coming for everyone (for the EXCHANGES it’s 11/15/14 through 2/15/15). If you’re lucky enough not to see further erosion of your benefits and higher costs in terms of what you’re paying for those benefits, you’ve escaped with your skin for this year. Most of us will not see that.
First, do not ASSUME that your same plan for the same price will be available. Even if the plan has the same name, make sure to read about changes.
Second, compare new plan options, additional plans offered, if there are any in terms of how much worse a cheaper plan is than your current plan. Sometimes it makes sense to get a somewhat worse plan in terms of deductible amount when you compare the differences in cost. If you need to call your current provider and ask them whether they intend to accept a specific plan for the coming year.
Third, pay special attention to changes in how much money you will lay out. While premiums get a lot of attention because Obamacare helps those on exchanges with premium payments, most other outlays of money will go up. This includes higher deductibles, co-payments and the more treacherous co-insurance rates (more treacherous because co-insurance is a variable number, a percentage based on what you’re charged).
Make sure that you’re aware of out-of-pocket maximums. Like other increasing costs to consumers, increases in these amounts have not been well publicized for consumers. For this coming year out of pocket maximums have been raised from $6350 in 2014 to $6450 in 2015 for individuals and from $12,700 in 2014 to $12,900 in 2015. (http://www.irs.gov/pub/irs-drop/rp-14-30.pdf)
Also make sure what dollars you pay DO NOT count towards these out-of-pocket maximums because those are real dollars you spend that get you no closer to reaching the out-of-pocket maximum.
According to healthcare.gov, “This limit does not have to count premiums, balance billing amounts for non-network providers and other out-of-network cost-sharing, or spending for non-essential health benefits, https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/.
These numbers matter. Make sure you’re aware of WHAT COUNTS TOWARDS YOUR OUT-OF-POCKET MAXIMUM because you can and will end up paying FAR MORE OUT-OF-POCKET than you think in most instances where you have real health care NEEDS to maintain or regain health.
Fourth, if you plan on having dental or vision coverage, don’t be misled by such coverage for children, you’ll have to purchase that separately.
