09-25-2024 Primetime - Flipbook - Page 30
30 A Special Advertising Section of Baltimore Sun Media Group | Wednesday, September 25, 2024
HSA right for you,
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Open enrollment,
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you’ve done in the past,” he says.
“Barring unforeseen circumstances
which definitely come up, we encourage people to take a look at what they’re
doing right now.”
Purchasing a less expensive plan
may seem like a bargain, but adding the
higher deductible and copays could end
up raising the total cost of coverage in
the long run.
cipal reason for being there is to receive
medical care; a telephone for a hearing
impaired person to enable them to communicate more effectively than regular
telephone; and the cost of a wig purchased upon the advice of a physician
for the mental health of a patient who
has lost all of their hair from disease.
Additionally, those with a health savings account can use funds for everyday purchases at a drug store such
as first-aid adhesives, laxatives, allergy
medications, and even aspirin.
However, if you take money before
you’re 65 from your HSA for non-medical costs, or medical costs that don’t
qualify, you’ll have to pay the federal
income tax and a 20% tax penalty. If
you take funds from your HSA after
you’re 65 for non-medical costs, you
won’t have to pay the 20% tax penalty,
but you’ll still have to pay the federal
income tax on that amount.
“If you were to be laid off or otherwise unemployed, you can also use a
health savings account to help pay for
COBRA where you can retain your jobbased health insurance, but you have
to pay for the full premium yourself,”
Wilson says. “This can be expensive,
so having those HSA funds can be
extremely helpful.”
Wilson says using funds from a
health savings account is very easy. “It’s
just like a savings account, and you will
have checks and a debit card to use just
like you do now from your bank. You
can log in online to check your balance
to ensure that you have enough funds
that you anticipate you will need that
year,” he says.
Keeping Providers In-network
For those who have established relationships with certain providers, like a
primary care physician or an orthopedist, for example, it’s important to conduct the proper research before signing
on the dotted line.
Not all insurance plans use the same
network of providers, Gross explains.
That’s why it’s important to review the
networks in the plans you are considering to be sure your providers are participating. Also make sure that the urgent
care centers and hospitals of choice
close to home and work also participate
in the network. Using providers and
facilities that are out of network result in
higher copays and out-of-pocket costs.
Evaluating Costs for Services
While being a participant in a health
plan offers you the lowest cost a provider can charge based on their contract with the insurance company, it is
recommended that individuals evaluate
all costs for services. This applies to
physician visits and facility fees, but also
other services.
Physical therapy is one service with
varied coverage depending on the plan.
Some plans limit care to a specific number of visits per calendar year, while others dictate care based on the condition.
In addition, prescription costs another variable worth evaluating each year
during open enrollment. Some medications jump “tiers,” which signifies the
level ranking of the drug. The ranking
determines cost of the medication and
the copay for the patient. This is especially important for individuals on maintenance medications for conditions like
diabetes, hypertension, cardiac issues
and high cholesterol.
“If you do have specific maintenance
medications that you’re taking regularly,
it’s always a good idea to just double
check that they’re still in the same tier
level that they were the prior year, so
that when you’re making your selection,
you know exactly what co pays you’re
looking at,” Gross says.
A Short Time Frame
The good thing about open enrollment is that decisions are made for the
upcoming year only. While some individuals get overwhelmed with the process,
which he calls “analysis paralysis,” decisions do not have lifetime ramifications.
“That’s the nice thing about open
enrollment. It does come around every
year,” Gross notes. “If you’ve done
something that you feel may not have
been your best decision, you have the
opportunity to change it next year.”
Review Before you Renew
Health plans can change drastically
from year to year, or they may make
subtle changes. That’s why it’s important to review your plan each year during the open enrollment period.
Become a student of the plan. Know
exactly what the plan includes and what
changes have occurred.
“That way, you know when you go to
a provider or you go to the pharmacy,
you’re not surprised,” Gross says.
If, after reviewing all of the plans
and options, you may still be confused
or unsure. Reach out to an insurance
professional who is versed in the industry and can help guide you along the
process.
Glossary of Key Terms
Affordable Care Act
The 2010 Patient Protection and
Affordable Care Act (ACA) requires
states to establish and operate a health
insurance exchange by 2014, or to participate in a federal exchange. Maryland
opted to create Maryland Health
Connection, a marketplace for residents
to enroll in health plans.
Coinsurance
Your share of the costs of a covered
health care service, calculated as a
percent of the allowed amount for the
service. You pay coinsurance plus any
deductibles you owe. For example, if
the health insurance or plans allowed
amount for an office visit is $100 and
you’ve met your deductible, your coinsurance payment of 20% would be
$20. The health insurance or plan pays
the rest of the allowed amount.
Copayment or Copay
A fixed amount you pay for a covered
health care service, usually when you
receive the service. The amount can
vary by the type of covered health care
service.
Deductible
The amount you owe for health care
services that your health insurance or
plan covers before your health insurance or plan begins to pay. For example,
if your deductible is $1,000, your plan
won’t pay anything until you’ve met your
$1,000 deductible for covered health
care services subject to the deductible.
Some services may be covered before
you reach the deductible.
Health Insurance
A contract that requires your health
insurer to pay some or all of your health
care costs in exchange for a premium.
Network
The list of the doctors, other health
care providers, and hospitals that a
plan has contracted with to provide
medical care to its members. These
providers are called network providers
or in-network providers. A provider that
hasn’t contracted with the plan is called
an out-of-network provider.
Qualifying Life Event
A change in your life that can make
you eligible for a special enrollment
period to enroll in health coverage.
Examples of qualifying life events are
changes in your family size (for example, if you marry, divorce, or have a
baby), pregnancy, certain changes in
your income or losing current coverage.
Source – Maryland Health Connection
