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Comparing health plans offered by your employer

How to compare employer health insurance plans

When you start a new job or it’s time for annual open enrollment, you’ll need to make decisions about health insurance – especially about the coverage you and your family will need in the year ahead.

Figuring out your coverage for the next 12 months can feel like a big decision. After all, the choices you make now can impact your health and finances later. But we’re here to help. With our guide, you’ll have the information you need to make informed and confident selections.

When it’s time to enroll in a health insurance plan, your employer will usually send you plenty of information to look over. Every employer presents information about open enrollment differently. If you’re not sure where to get started, reach out to your HR department for help.

There may be a website that’ll detail everything you need to know – including links to documents about the plans your employer will offer, plus where and how you can enroll. Your employer may also invite you to an annual benefits presentation or send you an enrollment guide. Or your employer may give you paper copies of everything you need to know.

The most important thing to look for is coverage and cost information for the plan or plans your employer offers. Looking through this information is an excellent way to get a high-level idea of how each option will fit with your needs and budget.

If you have additional questions or need more details, each plan should come with a Summary of Benefits and Coverage, also called an SBC. This is a full description of everything you need to know about the plan and makes a great reference before and after you enroll.

It’s the question on most people’s minds: “How much will this plan cost me throughout the year?” But before you look at a plan’s costs, it’s a good idea to re-familiarize yourself with some key insurance terms:

  • Premiums – The pretax amount taken out of your paycheck to help cover the cost of your health plan.
  • Annual deductible – Until you reach your plan’s annual deductible amount, you’ll pay 100% of your medical expenses, except for in-network routine preventive care. After you reach your deductible, your plan starts to help pay for your medical care.
  • Copay – After your deductible, this is a flat fee you pay each time you receive a service or procedure, with your plan covering the rest.
  • Coinsurance – After your deductible, this is the percentage of the total cost you pay for care, with your plan covering the rest.
  • Out-of-pocket maximum (OOP max) – This most you’ll pay out of pocket within the plan year. If you reach this amount, your plan will fully cover eligible expenses until the end of the plan year.

Premiums, deductibles and choosing the right plan for you

The affordability of a plan depends on how different premium and deductible amounts affect each other. Usually, a plan with a lower premium will have a higher deductible and out-of-pocket maximum. Likewise, a higher premium can mean a lower deductible or copay. The best choice for you and your family can depend on what you think your care needs will be in the upcoming year:

  • Lower premium, higher deductible plans – These plans tend to be good for individuals and families who don’t need a lot from their health insurance benefits. If you usually just need basic preventive care along with a safety net in case something happens, you might not mind having a larger deductible. So, a lower premium could save you money overall.
  • Higher premium, lower deductible plans – If you have a chronic condition that needs care throughout the year (like diabetes or depression), you might reach your deductible faster. By paying a higher premium in exchange for a lower deductible, you could save money by having your plan take on a larger share of costs sooner.

Take some time to reflect on the care you’ve needed in the past few years, and use it as your guide to decide which type of plan makes the most sense for the next 12 months. It can also help to look ahead: For example, if you know you have a major surgery coming up or you’re expecting a baby, events like these may factor in to the plan you might want to choose.

Your employer’s health plan likely covers care provided through a network of doctors, specialists, clinics and hospitals. Network providers agree to care for plan members at a discounted rate. If you seek care that’s out of your plan’s network, your plan may not cover much or any of your costs.

What this means for you depends on how you like to get health care. Some people have deep connections with their family doctor or a trusted care system they’ve used for years. Others don’t really mind who they see, as long as they’re convenient, close to home and affordable.

What to do if you want to keep seeing your current doctor

If keeping your same doctor and care system is a high priority for you, see if they’re included in your new plan’s network. The insurance company behind your plan should make searching the network easy, either online or with the help of a plan representative.

If HealthPartners administers plans for your employer, all our group health plan networks are ready for you to search – just use the network name your employer gives you in your enrollment materials. Our extensive networks feature thousands of trusted doctors, clinicians and locations.

Sometimes, you might not be able to find your current doctor or care team in your plan directory. If that’s the case, you’ll need to decide whether you want to pay more to still see them outside your network. If you’re willing to switch to an in-network doctor, your plan may be able to help make the transition easier by helping you find a new high-quality provider.

What to do if you’re open to seeing a new doctor

If you don’t mind which doctors you see when your new plan year begins, it’s still important to search your new plan’s network before you enroll in a new plan. Take a few minutes to explore your future network to see which options are available close to where you live. Having a few names in hand during the enrollment process can save you time later in the year when you need care.

If you take regular medicines to help control cholesterol, blood pressure, depression, diabetes or another condition, it’s important to see how they’ll be covered by your new plan’s drug list (formulary).

By searching your plan’s drug list, you can see how your medicines are covered, how many months’ supply you can get at a time and how much you can save by using a generic form of your prescription. All this can help give you a good idea of how much you’ll potentially spend from month to month. If you’re looking at HealthPartners plans, our drug lists are online and easy to search.

Search for pharmacies near you, too

To help keep prescription prices low for plan members, insurers have a network of pharmacies they contract with. You can save money and time by doing a quick search to see which of your local pharmacies are in this network. (For example, HealthPartners has our pharmacy networks available to search online.) You can also see if your plan has an option to use a mail-order pharmacy, which can come with even deeper discounts for multi-month medication refills.

Many employers offer special accounts for health-related expenses. There are three types of these accounts, each serving a different purpose while helping you save money on health care, services and items. Before you enroll in a plan, see if any of these accounts are available. If you’re not sure, ask someone from your employer’s HR department.

Flexible spending accounts (FSAs) and other reimbursement accounts

With flexible spending accounts (FSAs) and other reimbursement accounts, you can direct pretax money from each paycheck to use for a variety of eligible expenses. Depending on the type of FSA you open, you can use your funds for health, vision or dental care. Other reimbursement accounts help you set aside money for child and elder care while you’re working, or work-related transportation and parking expenses.

Health savings accounts (HSAs)

If your employer offers a high-deductible health plan (HDHP), you can also set up a health savings account (HSA). These bank accounts are used specifically for medical costs – doctor visits, medication, eyeglasses, and similar products and services. They’re also funded by pretax money from each paycheck. But unlike an FSA, your HSA money is yours to keep forever, rolling over from year to year and traveling with you if you leave your job.

Health reimbursement accounts (HRAs)

Finally, your employer might offer a health reimbursement account (HRA). An HRA is a special account created and funded solely by your employer with money you can use on eligible medical expenses (also determined by your employer).

Your health insurance plan can be much more than just coverage for when you have to go to the doctor. That’s why you should see what your plans offer beyond coverage for health care and prescriptions. Many of today’s plans come with additional discounts and perks for everything from eyewear and gym memberships to meal prep services and home-delivered produce – as well as extras like travel support and on-call nurse advice.

Check to see what else your employer is offering with their plan options. Details should be available during open enrollment. If you’re looking for something specific, check in with your HR department.

How HealthPartners plans help members get more

Most HealthPartners members have ways to save money while living healthier. Through Healthy Discounts℠, most members can save money on fitness equipment, eyeglasses, contacts, hearing aids, community supported agriculture (CSA) share boxes and plenty more.

Our members can also get travel assistance through Assist America®, just in case something happens while away from home. Most members also have access to a 24/7 nurse CareLine℠ so they’re never more than a phone call away from help.

Where to go if you need help

If you have questions about choosing a new plan, you don’t have to go it alone. A contact phone number should be included in your enrollment materials. If not, reach out to your HR department.

Comparing HealthPartners plans offered by your employer? Give our Member Services a call at 800-883-2177. We can help you understand your options, answer your questions and much more.