BY DR. GARY GROSEL
Amid this year’s open enrollment season for health benefits, it is a good time to take stock of your current health status and coverage needs.
Whether you have health benefits through an employer or government-sponsored programs such as Medicare or Medicaid, it’s important to understand your plan options and how to make informed care decisions that support your physical, mental and financial well-being.
This can often be a challenge given the complexity of the U.S. health care system. In fact, 88% of U.S. adults lack sufficient “health literacy” to effectively navigate the health care system. If that’s the case for you, research shows this lack of understanding can contribute to worse health outcomes and higher care costs.
To help address this, here are five ways to become a savvier health care consumer before, during and after you make your benefit decisions for 2025:
Know the key dates. For people with coverage from their employer, open enrollment typically happens during a two- or three-week period between September and December. For those eligible for Medicare, the Medicare Annual Enrollment Period runs from Oct. 15 to Dec. 7 each year. Coverage selections made during the fall will take effect on Jan. 1, 2025.
Understand your plan before and after enrollment. A recent survey found that about one in four Americans said they feel prepared to choose the right health plan this year, and an equal number report spending fewer than 60 minutes exploring their plan options. One challenge is there are various terms you may need to understand to evaluate your different plan options, such as the difference between a copay and coinsurance. For help with that, visit sites like JustPlainClear.com, which provides definitions for thousands of common health care terms in English and Spanish. Improving health care literacy could prevent nearly 1 million hospital visits and save over $25 billion a year, according to one study.
Look for additional health resources. Many employers and health plans offer programs beyond traditional medical benefits, including ones focused on nutrition, financial planning, starting or expanding a family, cancer care, caregiving resources and more. Likewise, some plans may offer additional resources for people managing certain chronic conditions, such as type 2 diabetes. During and after open enrollment, look for information (e.g., emails or in-office/virtual presentations) that may highlight the programs available to you.
Consider a “copay-forward” plan. More and more consumers are opting for a copay-forward plan, which is designed to help people know the cost of medical services before walking into a provider’s office or facility. Rather than featuring deductibles and coinsurance, these plans use variable copays, which can vary depending on the care provider and facility selected. The aim is to take the guesswork out of comparison shopping for care while avoiding surprise bills that can often show up weeks or months after a service is performed under a traditional plan.
Bundle benefits. While people may tend to focus on medical coverage during open enrollment, it’s important to not overlook specialty benefits such as vision, dental, hearing and accident protection. In a survey, more than 80% of employees said having access to these specialty benefits is “important.” For Medicare members and caregivers, it is important to note that Original Medicare doesn’t cover most dental, vision and hearing services, but many Medicare Advantage plans do.
By considering these strategies, it is possible to gain a greater awareness of your options and understanding your own health. Using that knowledge may help you make more informed decisions during open enrollment, setting you up for as healthy of 2025 as possible.
Dr. Gary Grosel is the chief medical officer at UnitedHealthcare of Kentucky.