5 Tips for Health Care Plan, Medicare Enrollment

Oct. 10, 2011 — -- With the arrival of fall, those Americans fortunate to have health insurance through their employer -- 55.3 percent in 2010 according to Census data -- often re-enroll in their health plans without much thought.

Most of provisions of President Obama's Patient Protection and Affordable Care Act will not be implemented until 2014, but consumers should be mindful of the re-enrollment period, which occurs in October for many plans. Nancy Metcalf, senior program editor with Consumer Reports, has these tips for the insured.

1. Watch those deadlines.

"First, don't blow it off," Metcalf said. The insured are often busy and take for granted their health options. Around fall, most employers also send out at least an email or two that can disappear in your inbox.

Medicare's open enrollment also ends earlier this year – Oct. 15 to Dec. 7 – as opposed to through the end of the year. Those 65 and older who are eligible should take note in case they want to change their drug plans, for example.

2. Analyze changes in options or personal situation.

Metcalf said provisions of a plan can change, such as a different deductible, or your family situation might have changed, such as a marriage, divorce or a new baby, which can alter the optimal options for you.

3. Consider trade-offs of an HMO, PPO, or POS.

A health maintenance organization (HMO) requires the insured to have care from provider in the plan's network, often restricted to a certain geographical area, and is coordinated by your primary care physician, according to the November issue of Consumer Reports, which ranks 830 private, Medicare, and Medicaid health insurance plans.

A preferred provider organization also has provider networks but you can see an in-network specialist without a referral. The insured can also see a doctor out-of-network but for a higher cost.

Point-of-service, or POS, plans are a hybrid of an HMO and PPO: the insured choose a primary care physician and you need a referral to see a specialist. As with PPO plans, the insured can see a doctor out of the network.

4. When to choose a high-deductible plan.

Insured usually choose a plan with a high-deductible payment to lower monthly premium costs. Metcalf said these are usually paired with a health savings account (HSA) with money taken from your paycheck tax free to pay for certain medical expenses.

Those with lower health care costs may find lower premiums off-set those high-deductible costs. Or those who have a good idea of their costs – such as planned vision or dental work – can usually calculate how much their costs will be within their health insurance plan. But that takes requires detailed planning, so start talking to your doctor, dentist and optometrist now.

5. Learn about the healthcare act's provisions that have taken effect.

As of now, only a few healthcare provisions have taken effect. First, children up to age 26 can remain on their parents' plans regardless of whether they live in the same household, or even if those young adult children are married. About 1.2 million people have taken advantage of that benefit this year, according to Consumer Reports.

Other provisions that are already in effect are cheaper drugs in Medicare and free preventative care through insurance plans.

Metcalf said many people have misconceptions about the healthcare act, such as what it provides and when provisions will be implemented. She suggests visiting healthcare.gov which she calls a "great" and clear resource.