Before you head into a new calendar year, now’s the time to take inventory and prepare yourself for the unexpected with your health insurance plan. Here are a few items to consider:
- Is your health plan changing?
- Remember, deductibles and out-of-pocket credits don’t rollover
- Did you get your preventive care check-up this year?
- Spend your FSA plan balance or risk loosing it
While the majority of health plans renew as of January 1, a small number of plans renew at some point during the calendar year so these items can be applied when your plans’ renewal comes up.
Is your health plan changing as of January 1?
Whether your insurance company is changing (moving from say Aetna to Cigna) or you elected a new health plan through the same insurance company, pay attention to slight variations that may impact you personally.
Changing your health plan could mean a change in the In-Network providers. Is your doctor still in the plan? If you have out-of-network coverage with your plan, you can continue to see your doctor if they are no longer in-network, but you will now be required to pay higher out-of-pocket costs. What if you have a medical procedure scheduled for early next year or you frequent a specific laboratory for frequent blood work, will your procedures be covered as expected?
Prescription benefits can change even if your plan is remaining the same, especially the formulary drug list. A formulary drug list is a list of prescription drugs covered by a prescription drug plan. Lists are typically created as a means of negotiating better prices to due volume. You could have been taking one medication made by one manufacturer, but come to find out that it’s no longer on the formulary list. You may be forced to take a new drug made by a different manufacturer, or pay a higher price to keep the prior one.
Speciality medications are becoming more prevalent and also cost more money. As a result, special procedures and firms are now managing the fulfillment of speciality drugs. You may not be able to just visit your local pharmcy to get a drug filled. Specialty medications are often triaged to a pharmacy team at your health plan to help you manage your condition. This requires planning to ensure drug supplies are delivered timely, and if necessary that healthcare professionals are in place to administer the drug in your home. Check to see if your health plan instituted a new specialty medication process.
Deductibles and maximum out-of-pocket credits earned during the year do not rollover
You may want to get that visit in now before December 31 especially if you’ve met your deductible and you only have to pay co-insurance. Come January 1, your deductible resets to zero and you’ll have to pay out of pocket from dollar until you meet your deductible again.
Preventive Care is Covered Annually, Every 365 days
Whether its your medical, dental or vision plan, many services including preventive care are covered annually. However, this does not mean if you get your physical on November 15 you can get another physical on January 15. Most plans require you wait 365 days before your next preventive care visit is covered at 100%. Otherwise services will either be denied or covered like a sick visit (subject to deductible or not at 100%). In rare cases, your plan may cover preventive care on a true calendar year basis. Dental plans may cover check-ups in this manner.
Also, keep in mind that preventive care may be tied to your age. Most health plans must cover a set of preventive services — like shots and screening tests — at no cost to you when provided by a doctor or other provider in your plan. This includes plans available through the Health Insurance Marketplace®. You or your children may have crossed over into a new age bracket whereby preventive care tests may or may not be covered anymore. Recommend you read your health plan’s Summary Plan Description or the Summary of Benefits & Coverage to learnn more about what’s covered. You can also visit the Healthcare.gov site to learn more about preventive care.
Flexible Spending Accounts: Use it or Lose It
Healthcare FSA plans typically have a rollover feature for unused balances at the end of the calendar year. If you have more than the rollover limit, ideal for you to spend the excess funds now or make sure to submit your receipts to reimbursement before the claims deadline. The IRS rollover limit for 2021 is $550, but that does not mean all plans are required to allow the limit. In 2022, the IRS will allow plans to carryover $570 into 2023.
Summary of Action Items
- Read your 2022 health plan materials and communications now to learn what changes to expect for 2022.
- Visit your health plan online account to verify where you stand on your deductible and maximum out of pocket met YTD. Schedule visits before the end of the year.
- Check to see if your prescription drug will be covered by the new plan.
- Review your FSA account to identify balances and file claims timely. Visit the FSA Store if you need a way to spend down your FSA funds.
- Contact your Human Resources/Benefits team or health plan to ask questions.
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