Choosing the right health coverage has never been easy, and the health reform law has made things more complicatedespecially for those choosing among plans provided by their employer. Besides sorting through differences in premiums, deductibles, and copayments, you need to consider new provisions in the law that have recently kicked in and could impact your coverage for the coming year. The following tips can help clear away the confusion, and help you choose the right plan during the open enrollment season.
1. Check for grandfather exemptions. If your employer makes no substantial changes to your insurance plan, it may be “grandfathered in” and not subject to certain required provisions in the health reform law. These include free coverage (with no copay) for preventive services like blood pressure or depression screening, smoking cessation programs, and immunizations. Plan materials will indicate whether or not the plan is grandfathered, along with the benefits it provides.
2. Decide which plan type best meets your needs. There are generally three types of plans: health maintenance organizations (HMO), preferred provider organizations (PPO) and point-of-service plans (POS). An HMO requires that you use physicians within a specific network, giving you less flexibility but a more affordable cost. A PPO allows you to stay in-network or go out of network for a heftier fee; out-of-pocket costs are usually higher for PPO’s than for HMO’s. POS plans combine elements of HMO’s and PPO’s. They give you the option to pay more for venturing out of network, but usually require you to choose a primary care physician within the network and get a referral from that physician before seeing any specialist.