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Looking for A New Plan? Here Are Some Tips.

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By Christopher J. Gearon
Special to The Washington Post
Tuesday, October 14, 2008

The rise in health insurance premiums is slowing a little, but you can still expect to pay 5 to 9 percent more next year for work-based health insurance. As you head into open-enrollment season, here are some tips on how to stay a few dollars ahead of rising costs:

1. Don't Shop on Premium Alone

Choosing a plan based on the size of your paycheck deduction could be an expensive mistake. Low premiums typically mean you will pay more in deductibles, coinsurance and other charges when you seek care. That can work out well for healthy people or those who can afford hundreds, even thousands, of dollars should illness strike.

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But those with chronic conditions, those who expect to need medical care and those who are simply risk-averse might want to pay a higher premium for more-comprehensive coverage. Remember that most large employers pay the lion's share of premiums. Also, your premiums are paid with pre-tax dollars, but in most cases you spend after-tax dollars for health-care services. "Complacency can really cost you," warns Tracy Watts, a health benefits expert and principal with health-care benefits consultant Mercer.

2. Review How Much You Spent on Coverage and Care Last Year

If it was a typical year, calculate what those costs would have come to under other plans. Many employers provide a comparison tool to simplify these calculations.

It's also very important to figure out how much you would pay out-of-pocket under a worst-case scenario, whether a major accident or the onset of a chronic illness.

3. Understand How Your Plan Works

Maximize your benefits by using in-network providers, and check whether the plan offers discounts for using so-called high-performance doctors or hospitals.

4. Look for Drug Discounts

Can you get drugs more cheaply by mail order? If you have a chronic illness such as diabetes, see if the plan reduces co-payments on maintenance drugs.

5. Take Advantage of Special Tools and Services

Does the plan offer a wide range of tools to help you stay healthy? If you are sick, can you call the plan's nurse line? Is your employer offering tools that will help you determine the quality and cost of competing hospitals and doctors?

6. Take Advantage of Financial Incentives

Increasingly, companies are offering cash or reduced premiums when you complete a detailed health questionnaire, get checkups or join disease management programs.

7. And Remember

One of the best ways to avoid medical expenses is to take care of yourself by getting preventive care, eating well and exercising.

Comments: health@washpost.com.


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