Is it Time for a Health Insurance Coverage Check-up?

Think you’re all set with your health insurance coverage? You might want to take a closer look. In today’s rapidly evolving healthcare landscape, what worked for you last year might not be the best choice for this year, and just as you schedule regular check-ups for your health, your insurance coverage deserves an annual review.

Why annual insurance check-ups matter

The healthcare industry is always changing. From shifting provider networks to updates in medication coverage, what you signed up for initially might look quite different today. “The costs and the benefits and the laws change every single year and sometimes more frequently,” says Rebecca Yates, CEO of Ark Insurance Solutions. These aren’t minor adjustments. They can significantly impact both your wallet and your access to quality healthcare, which is why it’s important to know how they’ll affect you personally.

It’s also worth considering how your own life changes year over year. Your needs may have evolved, and the medications covered under your current plan may have changed. All of these factors can affect not only the cost of your plan but also its effectiveness in meeting your healthcare needs. Without regular review, you might find yourself paying more than necessary or even worse, lacking coverage in crucial areas.

Recent changes make reviews more critical than ever

New developments in the healthcare sector have made insurance check-ups absolutely crucial. The government has implemented new security measures to protect consumers after incidents involving rogue insurance brokers making unauthorized changes. While these measures provide additional protection, they also illustrate the importance of regularly reviewing your coverage to make sure it aligns with your expectations and requirements.

Insurance companies regularly update their networks, change their formularies, and adjust their coverage terms. Without regular reviews, you might miss important changes that could affect your access to care or your out-of-pocket costs.

Signs you need an insurance check-up

There are a few red flags that suggest it’s time to review your health insurance coverage:

1. Your healthcare needs have changed since last enrollment, such as recent medical issues, new medications, or a recent expansion of your family. These life changes often require adjustments to your coverage so that you’re getting the care you need at the best possible rate.

2. You’re unsure about your current coverage. If you can’t confidently say what your plan covers or what your out-of-pocket expenses might be, it’s time for a review. Understanding your coverage shouldn’t feel like solving a puzzle – if it does, you could benefit from some expert guidance and clarification about your coverage.

3. Your preferred healthcare providers or medications have changed. Network changes can affect your ability to see specific doctors or obtain certain medications at preferred rates. A review can help ensure you maintain access to the care and prescriptions you need without unexpected costs.

4. Your employer has experienced growth or restructuring. Changes in employee numbers or company structure can impact group insurance plans and might open up new, more beneficial options.

What to expect during your insurance check-up

A comprehensive insurance review examines your plan in a few key areas:

Network Evaluation

This is a thorough examination of your current healthcare providers and whether they remain in-network. This includes primary care physicians, specialists and preferred hospitals. Your broker will help identify any potential network changes that could affect your access to care and suggest alternatives if needed. They’ll also look for opportunities to optimize your network access based on your specific healthcare needs.

Prescription Coverage Review

By conducting an in-depth analysis of your current medications and their coverage status, your broker can help you identify if there are more cost-effective options available, or if recent changes might affect your out-of-pocket expenses. They can also help you understand if there are pharmacy benefit programs or mail-order options that could save you money while maintaining access to your necessary medications.

Cost Analysis

A cost analysis is a detailed review of your premium costs, deductibles, and out-of-pocket maximums compared to your actual healthcare usage and budget. This analysis goes beyond simple premium comparisons by looking at your actual total healthcare spending and identifying opportunities for savings. Your broker will help you understand how different plan structures might affect your overall costs based on your specific healthcare needs.

Benefits Assessment

This is a comprehensive evaluation of whether your current benefits align with your needs, including specialized services, mental health coverage and wellness programs. This assessment looks at both your current healthcare requirements and anticipates potential future needs to ensure your coverage provides enough protection for the coming year.

The value of professional guidance

While you might be tempted to handle this kind of review independently, working with a licensed health insurance broker can provide invaluable insights and save you considerable time and effort. Brokers stay current with market changes, policy updates, and new offerings from different insurance providers. And much like you’d call an accountant to do your taxes, or an attorney for a legal matter, brokers know the health insurance landscape inside and out, and will look out for your interests.

One common misconception is that working with a broker adds extra costs to your actual insurance. However, this isn’t the case. “The best part is it doesn’t cost you anything extra to work with us. You can go to the carrier or you can go to us directly. Those premiums are the same,” says Yates.

Making the most of your check-up

To maximize all of the benefits of getting an insurance review, you should come prepared with the following:

– Gather together your current plan documentation and any recent medical bills or prescription costs. This information helps your broker understand your current healthcare spending patterns and so they can identify potential areas for savings.

– List any changes in your healthcare needs or preferences over the past year. Include new medications, healthcare providers, or potential future medical procedures.

– Don’t be shy about asking questions pertaining to your coverage, or discussing areas that you find confusing or concerning. Your broker can help clarify complex terms and ensure you fully understand your benefits.

– It’s a sensitive topic for most, but be ready to discuss your budget and any financial constraints affecting your healthcare decisions. This helps your broker find solutions that balance coverage and your costs effectively.

Making sure your coverage works for you

For the average person, healthcare needs are always evolving, and insurance options will continue to expand and change. By maintaining regular check-ups of your coverage, you can ensure that your health insurance remains a useful tool in maintaining your personal health and well-being — rather than becoming an obstacle to accessing care.

Remember, just as you wouldn’t skip your annual physical, don’t overlook the importance of reviewing your health insurance coverage. If you haven’t yet had a chance to get an insurance check-up, there’s still time. You can revisit your coverage and make changes that will take effect on February 1. But it’s important to reach out for an appointment well before the January 15 deadline.

Now is the time to get a handle on your current and future health insurance needs with a professional who cares about your well-being. “When you call us, you’re going to get a real human that answers the phone, and that real human is going to connect with you and care about you, learn about your family, and figure out what you need,” says Yates.