Opinion: Time to evaluate 2021 health plans

Matthew Aug

As open enrollment time is here for many of us and we are nearing the end of the year, it’s a good time to review your health insurance coverage and do some planning. There are important items to consider whether you are covered by an employer health plan or have coverage through the individual market as you make decisions for your 2021 coverage:

• Are there any changes to the out-of-pocket costs or coverages for 2021 compared with your current benefit plan?

• Has your family situation changed where you need to review alternative coverage options for a spouse or children?

• Are there additional benefit plan options being offered this year by your employer or through the individual market that would be a better fit for your current needs?

• Did the prescription drug formulary change or are there modifications that may affect the price or coverage of a particular drug that you are taking?

• Is there a change to the provider network under the health plan, and if so, is your primary care or specialty care physician still in the provider network? If not, how can you establish care with a new primary or specialty care physician?

Changes in your health insurance plan may also affect other open enrollment decisions:

• If your benefits plan has an increase in out-of-pocket costs, you may want to consider setting aside or adding to a contribution of pretax dollars under a flexible spending account if offered by your employer.

• If a health savings account qualified plan is being offered by your employer or through the individual market, it may be a good opportunity to begin setting aside pretax dollars that can be rolled forward into future years’ savings if not used in 2021.

Other considerations
More than half of the U.S. population has one or more chronic health conditions. These are our leading causes of death and disability, and also a leading driver of health care costs, according to the Centers for Disease Control and Prevention. Eating well, being physically active, avoiding tobacco and excessive drinking, and getting regular health screenings can prevent most chronic diseases.

Along with reviewing your specific benefits plan offerings, it would be prudent to make sure you are taking advantage of the many benefits of your health insurance coverage, even if you are healthy. Most health plans offered in both the employer and individual markets cover important preventive services at no cost to the insured. Particularly this year with the pandemic, a flu shot is important for everyone and, in most cases, covered by your plan at no cost to you.

The pandemic may have also caused some delays or cancellations in annual checkups or screenings. If not already scheduled, consider arranging an annual wellness visit with your provider and your annual screenings. Important screenings include mammograms or colonoscopies. These screenings are valuable tools for early detection of possible health conditions and again are covered by most health plans at no cost for the insured. Double check with your health plan to determine whether these visits are covered based on the calendar year in which they are scheduled or specifically a 365-day window.

If you aren’t taking advantage of these services, 2021 is a great time to start. In addition, if you do not have an established relationship with a primary care physician in your provider network, this is important for your overall health. A primary care physician can be a first point of contact for health care needs, help navigate the appropriate health care channels and help prevent unnecessary emergency room or urgent care visits.

The pandemic has also brought about additional telehealth options and capabilities that are essential for access to “no contact” care. Most health plans provide telehealth coverage as part of their standard offering. The technology makes this type of visit very convenient and affordable.

Health care resources
We are very fortunate in southwest Missouri to have nationally recognized and accredited health care systems and providers that help keep our community healthy. Your health insurance plan is a tool to help access that care in the most efficient and cost-effective manner.

Our region is also privileged to have professionally licensed insurance brokers and consultants who are a great resource for benefit questions and guidance. Whether you are a business owner, an employer plan administrator or an individual needing some advice on a personal policy, it’s always best to reach out to a trusted insurance adviser.

The insurance market can be overwhelming and complex, but there are experts who can help you make the right decisions for your specific needs.

Matthew Aug is the president of Cox HealthPlans. He can be reached at maug@coxhealthplans.com.