Some aspects of the Affordable Care Act (ACA) have far reaching impact, especially for retirees.
To help retired employees navigate their options during this year's open enrollment period, HighRoads, a provider of employer health care regulation compliance and benefits management, recently offers eight easy tips for retirees during health insurance open enrollment season. By considering these tips, retired employees can optimize their health benefits and minimize surprises, the Company noted in a release.
"Even if retirees have been on their health insurance plan for a number of years, they may be surprised to see changes this year as a result of health care reform," said Cynthia Weidner, vice president consulting, HighRoads. "Now is not the time to just cruise through open enrollment on 'auto pilot.' Health care 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 health care plan to be sure you don't face any unexpected challenges next year."
HighRoads said that 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) document. 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 eight tips:
1. Acquire your plan materials - Pay attention to how your former employer is making your SBCs and the traditional Summary Plan Descriptions (SPDs) available to you. Many are making them more accessible online, via mobile apps as well as 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.
2. 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 SPDs. 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.
3. 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."
4. 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.
5. Determine if a Medicare exchange is an option. With the Affordable Care Act and economic pressures, private exchanges are surfacing at a rapid pace for retirees who are eligible for Medicare. Your employer may offer you the opportunity to enroll in private, individual medical coverage through an exchange. A private Medicare exchange is a third-party resource hired by your employer to help you choose a plan based on your needs and financial situation. Be sure to consider it because it could be that you will get access to a plan that gives you coverage that meets your needs better than the plan offered by your employer.
6. 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 health care reform law, you will know whether the benefit mandates and other rights and protections provided under the law may apply to you.
7. Know if your plan is "grandfathered." 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. However, these benefits are only for new health plans and don't apply to "grandfathered" plans - plan that haven't changed in a few years. If your plan is grandfathered, your plan materials must say so. Find out if your plan is considered to be "grandfathered" and identify exactly what preventative services are covered for free.
8. 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.
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