How to choose a health insurance plan at work

You were offered a new job and you’ve accepted the position. Congratulations! Once you’ve signed the employment contract, you may be faced with another work-related decision: picking health insurance coverage. Each plan can have its own set of advantages and limitations, so certain key factors need to be addressed. Here are some essential questions that should be answered to help you select the best policy.

If you—or anyone else in your family who would be covered under this plan—has a preexisting health condition, it’s imperative to know if the necessary appointments, tests, prescriptions, and services would be included in this policy.

According to the 2022 guidelines under the Affordable Care Act (ACA), no insurance plan can deny coverage, charge additional money, or refuse to pay for essential health benefits due to a preexisting medical condition. The majority of health plans are also required to offer some preventive care services at no cost, as long as the screening is delivered by a healthcare provider (HCP) in the network. Thse may include periodic screenings for conditions such as blood pressure, cholesterol, diabetes, depression, and breast, prostate, and colorectal cancer.

Tally up the approximate number of health services you expect to use each year; this will help to determine how much money you will spend over a 12-month period. Make sure to include expected appointments and medications, along with birth control and mental health counseling, if necessary.

All FDA-approved contraceptive methods prescribed by a physician must be covered under your plan unless you are employed by a religious organization. Plans aren’t required to cover pregnancy prevention services like vasectomies, or medications and surgeries to end pregnancies. All plans must cover mental and behavioral health treatments, yet specific benefits vary by plan and by state.

If you want to continue seeing your healthcare providers (HCPs), you should find out if they accept the type of health insurance policies being offered. The four basic types of plans—Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Exclusive Provider Organization (EPO), and Point of Service (POS)—differ in rates and coverage, as well as the HCPs, hospitals, and clinics that are part of each network. Also, keep in mind that some plans require a referral from a primary care physician (PCP) for you to meet with a specialist, while other plans do not.

The total costs for health insurance include the monthly premium and out-of-pocket costs, which are any expenses that will not be reimbursed. These costs may include:

• Deductibles: the amount of money you pay before your benefits take over a percentage of the cost
• Copayments and coinsurance: the amount you might pay after your insurance company kicks in their share.

It’s also necessary to take into account other services that may or may not be covered, such as prescriptions, laboratory tests, vision, dental, and various types of therapies.

A Flexible Spending Account (FSA) is a type of savings account that offers tax advantages to help you save for qualified medical expenses. It’s established by an employer and allows you to spend the savings on services and items that may not be covered by an insurance plan, such as dental coverage, deductibles, copayments, prescription medications, and vision, as well as over-the-counter medicines with a HCP’s prescription. FSA funds can also be used to purchase medical equipment (like crutches), medical supplies (like bandages), and diagnostic devices (like blood sugar test kits).

Your employer may contribute to this account; your portion is taken pre-tax from your paycheck. For 2022, the maximum contribution is $2,850, according to Healthcare.gov. Keep in mind that funds not used by the end of the year may be forfeited. Certain employers may offer a grace period, however, or may allow you to carry some funds over into the following year.

A Health Savings Account (HSA) is another type of tax-advantaged account that helps you save for certain medical expenses. It’s an option if you have a certain kind of High Deductible Health Plan (HDHP), which, according to 2022 guidelines, is a health insurance plan with:

• A deductible of at least $1,400 for an individual or $2,800 for a family
• A limit of $7,050 per individual and $14,100 per family for out-of-pocket medical expenses
• No coverage until you hit that deductible, except for preventive and wellness care, vision and dental, accident coverage and health insurance premiums

In 2022, you can contribute up to $3,650 to an HSA if you have individual HDHP coverage and up to $7,300 for family HDHP coverage. The employer and employee can contribute on a pre-tax basis, and any money withdrawn or any interest gained will not be taxed. This money can pay for deductibles, copayments, coinsurance, and other approved expenses. Many HDHP plans do not qualify for an HSA, though, so definitely ask your employer.

Need additional guidance or questions answered? Reach out to your Human Resources (HR)   department or head to HealthCare.gov, which, in addition to the current laws, breaks down terminology, costs and much more.

Over the course of time, you may also need to make changes to your coverage based on life events such as marriage, divorce, birth, or adoption of a child. See if you can enroll or change plans based on a qualifying life event. Your company’s Human Resources department can assist you with this process. Ask for help along the way.