The site is buggy, but is it for you?

Published November 13, 2013 8:36 pm
Health reform • Most people won't shop for a personal policy, but employers change plans, too.
This is an archived article that was published on sltrib.com in 2013, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.

Atlanta • The new Health Insurance Marketplace is getting all the attention these days, but many consumers need to remember: The Obamacare shopping site probably isn't for you.

Those who get insurance through an employer or through Medicare don't need to shop on the site, which is now famous for its technical difficulties. But experts say these consumers still need to pay close attention to their health insurance options right now, because it's open enrollment season for just about everybody.

Most large employers send out annual benefit enrollment packets to current workers and retirees at this time of year. Those on Medicare are in the midst of an enrollment period that ends Dec. 7. While you may have liked your health plan exactly as it was this year, that doesn't mean your employer is going to keep everything the same in 2014.

"There is continuous change, and with or without health care reform, that was going to happen," said David Foster, an Atlanta-based benefits expert at Buck Consultants.

Companies try every year to save money on the constantly increasing cost of providing health insurance. That's the main reason your options may be changing again this year, whether you are a retiree, a part-timer or a full-time employee with benefits. Plus, the Affordable Care Act means that some company health benefits are getting better — with most plans now required to provide free preventive care.

Making sure you are getting the best deal, experts said, will probably take more than the typical 15-minute run through the company brochure or a Medicare pamphlet.

"Do your homework and spend the time to understand what coverage your company is providing and what might be changing — don't assume the status quo is OK for you," said Craig Rosenberg, Aon Hewitt's national leader for Health & Welfare Benefits Administration.

Here's what to think about as you study the materials: Have your medical needs changed? How has your plan changed? How have the costs changed?

For workers

Experts say that workers should look closely at the cost of covering family members on their employer plans. Some employers are now refusing to cover a spouse if that spouse's own employer offers coverage. Other employers might be charging more than in the past for a spouse to stay on the plan.

The Affordable Care Act puts limits on the cost of insurance for employees, but it's important to remember that those requirements don't apply to the family coverage, said Ann Murray, a benefits expert at the McKenna Long & Aldridge law firm.

"I think we're seeing a lot of employers offsetting or subsidizing some of the employee-only costs by making family coverage more expensive," Murray said.

That means that it might make more financial sense this year for each spouse to be covered by their own employer's plan instead of simply putting everyone on the same plan for the sake of simplicity. Also, check out which employer offers the best coverage at the best cost for kids, if you are a two-worker household. That's especially true for people who have maintained the same coverage for years without really studying the options.

If employers are significantly upping the cost of covering a spouse, it might even be a better deal to buy a separate, individual plan through the Health Insurance Marketplace or outside of the exchange.

"There are a lot more options people need to consider and put them all side by side," Murray said.

Experts also advised consumers to look into whether their employer is using a new insurance company this year and whether their network of doctors and hospitals has changed.

For example, Georgia's massive State Health Benefit Plan switched to Blue Cross and Blue Sheild of Georgia as the administrator of its plan. That means 650,000 Georgia teachers, state employees, retirees and family members need to determine whether the doctors and hospitals they like are still considered in-network for them.

Employers are also using financial incentives to push employees toward better health and more thoughtful spending when it comes to health care dollars.

Many employers are shaving dollars off the cost of a health plan if the employee takes a wellness screening, so make sure you tune into the deadlines for getting your blood drawn and your waist measured if you want to reap the financial benefits. Who knows, you might even find out something important.

"We have heard stories of someone who went to one of these screenings and found out they were a diabetic and didn't know it," said Rosenberg, of Aon Hewitt.

Also, some employers are pushing employees to high-deductible plans combined with Health Savings Accounts. That approach is designed to give employees more of a financial stake when getting health care. Others are giving employees vouchers that they can use to shop for their own insurance on private health insurance exchanges, where there are more coverage choices than most employers offer today.

Think about how much time you would take to research a new car or even a new washer and dryer. Devote at least that much to your health insurance, because you don't want to get hit with a surprise in the middle of a health care crisis, the experts say.

"The best thing people can do is ask for help, study the materials available and be well-informed — make the right decisions," Foster said.

For Medicare recipients

Most people on Medicare shouldn't expect major changes — but experts say many elderly people are concerned about changes that really have nothing to do with their health plans.

"I think there's general confusion about open enrollment and whether they should get onto the (Affordable Care Act) marketplace and how that relates to the coverage they have," said Patrick Willard of AARP, the national organization for people over 50.

The big message: The marketplace is not for Medicare recipients.

Willard said the biggest impacts of the Affordable Care Act on the Medicare population are positive: improvements in prescription drug coverage and preventive screenings.

People on Medicare are advised to think through the same issues this year as last year: Research whether you are on the best prescription drug plan, given your needs. Also, it's important for elderly Americans to understand whether traditional Medicare or a "Medicare Advantage" plan is their best option.

Medicare Advantage is a plan offered by a private company through a contract with Medicare. These plans usually provide a member's hospital and doctor coverage and often other benefits. But you may be limited to a set network for doctors and hospitals. About one in four Medicare recipients is covered by an Advantage plan.

Some experts say open enrollment is also a good time to look at the big picture when it comes to your benefits by also studying your 401(k) plan and your disability and life insurance, too.

"It's a good time to do a check-up," said Rosenberg, "and look at things holistically."

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