5 tips for acing open enrollment

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Employees renewing their 2011 health insurance plans during open enrollment will have good news in the form of more options for free preventive care and coverage for young adult children.

The bad news? Insurance plan costs will also rise.

Employer-sponsored health expenses will rise nearly 9 percent in 2011 over last year, according to the National Business Group on Health. A lot of employers are passing along these costs to employees via higher out-of-pocket costs and copays.

“These changes are significant,” says Brigen Winters, a principal at the employee benefit firm Groom Law Group. “They do have an impact on policy costs.”

This year during open enrollment, read your health insurance booklet especially carefully.

Adding to the complexity, not all health plans will offer these benefits. Some plans are grandfathered, meaning they may be exempt from some health care reform changes.

“Employees should look at what’s grandfathered in their plans,” says Julie Stone, a senior consultant at Towers Watson, a benefits consulting firm. “See what — if anything — is changed.”

There will be even more changes in 2012. For now, companies are mainly doing the bare minimum, says Stone. “There are so many regulations from Washington, D.C., to comply to,” she says.

Here are five tips for making the most of employee health care reform changes:

Scrutinize higher copays and premiums. Copays — such as for emergency services and specialty care — will likely be increased, says Helen Darling, president of National Business Group on Health. Employers are also increasing premium prices.

To save money, check out your company’s insurance plan options. Big companies usually offer at least three. Calculate costs by going to the company — or plan — website and entering parameters on the calculator. “It will calculate the best plan for you,” says Darling.

Employers also offer incentives to employees to improve wellness while reducing premiums, such as getting health assessments or maintaining a healthy lifestyle. “You can save about $386 per year,” she says.

Another alternative is checking out a spouse’s plan, says Winters, because it may not be as costly.

Check out free preventive services. Beginning Jan. 1, 2011, there will be more free preventive services than ever. They include cancer screening, weight-loss counseling and well-child visits. Go to the government’s health care reform and information website for more information.

“There’s a wide range of programs,” says Stone. “Make the most of them to get healthy and stay healthy.” Some companies are already paying 100 percent of preventive service costs.

Sign up for adult child coverage. Your employer must now offer coverage for your adult child up to age 26. But you must enroll for this coverage. And your company must give you a 30-day enrollment window, says Stone.

This benefit is also broadly defined. Your child doesn’t have to live with you and can even be married.

Consider high-deductible plans. Given higher plan costs, more employers are now offering high-deductible plans. “We expect to see more of them,” says Stone.

To consider this option, know your out-of-pocket costs. Why? Essentially, you’re playing medical roulette. Doctor visits and prescription drug costs will come out of your own pocket. Preventive services are free, though. Most deductibles for these plans are about $2,500.

“If you have a health savings account, look at high-deductible plans carefully,” says Darling. “If you’re a smart consumer, you might be better off with one.” The exception: family plans, in which there are more costs.

Remember, if the high-deductible plan doesn’t work for you, you can always change your plan next year.

Look at how drugs are now covered. If you take lots of aspirin, your expenses won’t be covered by your health care flexible spending account, unless your doctor writes a prescription. Usually these accounts use pretax dollars to cover unreimbursed medical expenses. But now, only prescriptions from doctors are covered.

Darling says that many people don’t make any changes during open enrollment. “Use company tools and resources,” she says. “If there’s an 800 number, call it. A lot of people spend more money than they should.”