The time of year has again arrived. No, not Columbus Day, but for many it is like exploring a new world. No, not Halloween, but for many it is just as scary. No, not Thanksgiving, but many may get just as “fed-up.”

I’m referring to “Open Enrollment.” It’s when you get to make your health insurance choices and changes for the coming year, 2016. This year, Open Enrollment 2016 starts on November 1, 2015 and runs through January 31, 2016. After that, you are not permitted to make changes to your group health insurance options absent extraordinary circumstances (which I will discuss in another article). If you are satisfied with the selections that you made last year and want to keep them Open Enrollment is not an issue. However, even for those of you who will not make changes, be aware that health costs may increase, so prepare for that.

My goal is to make Open Enrollment 2016 easier. You need to understand personal factors to enable good choices. I want to get you thinking about the insurance products and plans that you picked last year. It is easy to maintain status quo. Don’t do “easy” for its own sake. If reading through this is not enough to answer your basic questions, call me. I’m neither an insurance agent nor a financial planner, but sometimes it is helpful to ask questions and bounce ideas around with someone who is independent but knows his way around insurance.

You know better than I how to do your job or profession. Because it is so important that you accurately grasp your insurance needs, those of your family, and the options available, it may be valuable for me to me prod a little and ask questions to get you to think about insurance issues that you may have not considered. I can also offer articles for you, your employees, or clients that explain common insurance issues. Tell me what you need, and I will do my best to help.

All of that said, if you are an employee and insurance benefits are made available through your employer or professional group, you are limited to the options (and to the variables within those options) that it offers. By “variables within those options”, I mean deductibles, co-payments, whether to choose a Health Maintenance Organization (HMO), a Preferred Provider Organization (PPO), or some other kind of health care delivery system, and the pros and cons of each. Also, please don’t let life insurance and disability insurance get lost in the mix while focusing on health insurance. They, too, are vital to your insurance well-being.

Open Enrollment also applies to Medicare recipients. Many considerations are similar to those for individuals who are still working, but some are different, as are the products available. I’ll discuss Open Enrollment as it pertains to Medicare in a separate article.

Open Enrollment Planning

If there is one overriding recommendation that I can give about Open Enrollment it would be: START PLANNING FOR IT NOW. Yes, the drop-dead date is January 31, 2016. But in the scheme of things, time spent getting Open Enrollment right is much, much more important than time spent planning the shopping route for Black Friday and waiting for the mall to open. Really, it is.

In no particular order, here are some of the factors that you must understand and factor into your planning for and choices during Open Enrollment:

• The type(s) of health insurance plans available to you. Currently, managed care arrangements are the norm, rather than the indemnity plans of years ago. Even among managed care arrangements there are differences in cost. If the employer is paying a portion, but not all of the premium, the responsibility for the balance will be yours. Your ability to pay the balance of the premium is a factor to consider in choosing a plan.
• There are other amounts for which you will be responsible to pay like deductibles, co-payments and coinsurance amounts.
• A deductible is the amount of medical expense that has to be met before the insurance pays anything.
• A co-payment is an amount (usually fairly small) that you have to pay whenever you see a provider.

Coinsurance is the split between you and the insurer of the overall cost of the medical care rendered (for example, 75/25 which means that the insurance company pays 75% of the allowable charge after you have met the deductible and paid the co-pay; you are responsible for 25%).
Although it is hard to predict future health costs, you can broadly gauge them from your historical ones. Therefore, if you have incurred high historical medical expenses and based upon your ability to pay a higher insurance premium, you might consider selecting a health insurance plan that assumes more risk in return for a higher premium; the overall premium may be less than the total of last year’s lower premium plus all of the other out-of-pocket expenses. Likewise, if your health costs have been low, you may opt to take the risk for a health insurance plan that offers fewer benefits (and “roll the dice”).

• Do you have a family or anyone else to provide for if you die? During Open Enrollment, it is common to be offered life insurance. Group life insurance is usually quite inexpensive and is frequently offered on a guaranteed issue basis. This means that past health history or current health condition will not prevent issuance. The amount available to you may be geared to your annual earnings, but more may be available.
• Disability insurance is designed to replace income if you are unable to work, but remain alive. Some employers offer short-term disability insurance as an employee benefit, nut the benefit may only be for 90-days or so. Sometimes, during open enrollment you may be able to purchase additional (long-term) disability insurance. If it is available and affordable for you, go for it.
• Your health history and that of your family may play a role during Open Enrollment. If you have a health condition that has required periodic hospitalizations, and can be expected to in the future, you may want to consider a policy that pays a daily benefit during hospitalization. Proceeds from these policies can usually be used as desired.

This is a confusing time for everyone who wants to change their healthcare plan. Remember, that The Insurance Problem Solver is here (that’s me, Luke Brown, retired insurance attorney from Tallahassee) to help you navigate Open Enrollment 2016.