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Health 411: Answers on healthcare and Medicare open enrollment

November 14, 2011|By Lisa Zamosky, Special to the Los Angeles Times
  • Going to an out-of-network doctor can mean paying a higher out-of-pocket fee.
Going to an out-of-network doctor can mean paying a higher out-of-pocket… (Jupiterimages / Getty Images )

If you get your health insurance through your job and haven't yet looked at your 2012 benefits package, wake up! You're about to miss your chance to pick insurance coverage for next year.

Open enrollment periods, which take place in companies across the country, typically close sometime in November. If you haven't missed your window of opportunity, now's the time to get busy reading those health insurance pamphlets because employers are making changes this year that can have a significant effect on your wallet.

Medicare beneficiaries are also in the throes of an annual open enrollment period, which started last month and ends Dec. 7, nearly one month earlier than in years past. Now is the time to make changes to — or sign up for — a Medicare Advantage or Part D prescription drug plan.

To help with what many people find a confusing process, here are answers to your most pressing questions about open enrollment.

The cost of my employer's plan went up again this year. Can I find less expensive coverage someplace else?

Maybe. But experts say that even with rising costs, you're still likely to get the best deal on a health plan through your employer.

If your spouse has the option of getting insurance through work, compare his or her coverage with yours to see if it makes sense to sign on there. If that's not an option, you can look to the private insurance market.

Private plans are becoming more attractive, with richer benefits and prices that are in some cases comparable to plans offered by employers, says Keith Mendoza, a consumer specialist with the online insurance broker The healthcare reform law requires all insurers — even those selling individual policies directly to patients — to include benefits such as preventive care with no cost-sharing and to eliminate lifetime maximum spending, Mendoza says. Just remember that, unlike employer health insurance, you can still be denied coverage on the private market due to a preexisting medical condition.

If your employer-sponsored insurance options have gotten more expensive, you're not alone. According to the National Business Group on Health, the country's largest corporations expect to see health insurance costs rise by about 7.2% in 2012. For mid-sized to large companies, costs are projected to rise about 5.9%, according to a survey by Towers Watson, a human resources consulting firm.

"Employees won't necessarily pay more out of their pocket through their payroll deduction, but they will pay more when they go to see the doctor," says Michael Thompson, of PricewaterhouseCoopers' Health and Welfare Practice.

One potential option for saving money is to consider a consumer-directed health plan, which more employers are offering. These are high-deductible plans that "usually cost the employee less but they require them to pay more out of pocket," says Helen Darling, chief executive of the National Business Group on Health, a nonprofit that represents large employers on health policy issues.

The cost of insurance for my family is extremely expensive, and I'm not sure I can afford it. What do I do about my spouse and my children?

Not all family members need to be on the same plan. Mendoza suggests that people mix and match coverage. Often you can save by insuring younger, healthier family members with a plan you purchase on the private market. That may be a good option considering that 73% of employers will require employees to pay more for dependent coverage next year, according to the Towers Watson survey.

You can compare plans side-by-side at or speak with one of their licensed agents by calling (800) 977-8860. You can also find a licensed insurance agent in your area at the National Assn. of Health Underwriters website. Go to, click on "Consumer Information" and choose "Find an Agent."

If I choose a different health plan for next year, will I still be able to see my doctor?

Not necessarily. If you switch plans, the provider network may change too, even if you stick with the same insurance company. And visiting a doctor who is out-of-network means greater out-of-pocket costs.

If you decide to hold on to the same plan you had this year, it's still wise to confirm that your doctor will accept your insurance. You can do that with online tools typically made available on insurers' websites. But it's always a good idea to call your doctor directly to ask.

Will all of my prescriptions still be covered?

Again, don't count on it. Formularies — an insurer's list of covered drugs — can change from year to year. What might have been a preferred brand in the past won't necessarily be so going forward.

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