When the autumn leaves fall and the weath­er turns cool­er, we know it’s time to start think­ing of open enroll­ment. Open enroll­ment sea­son can be a con­fus­ing time. As you begin your research into which plan to choose or even how much to con­tribute to your Health Sav­ings Account (HSA), con­sid­er eval­u­at­ing how you used your health plan last year. Look­ing back­ward can help you plan for­ward to make the most of your health care dol­lars for the com­ing year.  Here’s what you need to know about your work­place ben­e­fits to max­i­mize them:

1).  Know the Open Enroll­ment Dates

It is up to you to make sure you take advan­tage of the open enroll­ment peri­od. Be sure you know when your com­pa­ny has open enroll­ment because it can be your only time to adjust ben­e­fits for the com­ing year.

2).  Eval­u­ate Your Cur­rent Benefits

Before open enroll­ment starts, review the ben­e­fits you cur­rent­ly are receiv­ing. Your pay stub can be an excel­lent resource to find this infor­ma­tion; you should be able to find the ben­e­fits you are pay­ing for under the deduc­tions or with­drawals sec­tion.  Stan­dard deduc­tions might include med­ical insur­ance, den­tal insur­ance, 401(k) con­tri­bu­tions, life insur­ance, vision insur­ance, long- term dis­abil­i­ty insur­ance, health sav­ings account or flex­i­ble spend­ing account con­tri­bu­tions, and acci­den­tal death and dis­mem­ber­ment insur­ance.  Review those deduc­tions to make sure you know what you’re pay­ing for and whether you actu­al­ly used the benefits.

3).  Ask These Ques­tions to Decide What Ben­e­fits You Need

Everyone’s sit­u­a­tion is dif­fer­ent, but most employ­ees should have at least med­ical, den­tal and vision insur­ance and make con­tri­bu­tions to a 401(k) or sim­i­lar work­place retire­ment sav­ings account.

When eval­u­at­ing your ben­e­fits pack­age, con­sid­er what your needs will be or what life changes you can expect for the com­ing year:

  • Do you have a med­ical con­di­tion that requires ongo­ing care such as dia­betes or heart disease?
  • Are you try­ing to get preg­nant or are expect­ing a baby?
  • Are you get­ting mar­ried (or divorced)?
  • Is your child turn­ing 26 and can no longer be cov­ered under your health insurance?
  • Does your sig­nif­i­cant oth­er have cov­er­age, or will you need to include your part­ner in your health coverage?
  • Are you on track for retire­ment, or do you need to save more? Don’t for­get to take advan­tage of your com­pa­ny match in your retire­ment account. This is free mon­ey for the future.

All of these are essen­tial ques­tions to ask your­self dur­ing the open enroll­ment sea­son because they can make a dif­fer­ence in what ben­e­fits you choose to elect.  As you browse the dif­fer­ent options, ana­lyze the type of treat­ment and the amount of treat­ment you have received in the past. You can­not fore­see every expense but focus­ing on the trends will help you make a sound decision.

4). Com­pare Out-of-Pock­et Cost

Much like health net­works, out-of-pock­et costs are cru­cial when choos­ing the right plan for you and your fam­i­ly. Most health ben­e­fits sum­maries should high­light the amount you will pay in out-of-pock­et expens­es, includ­ing the pock­et limit.

Your goal in com­par­ing out-of-pock­et costs is to nar­row down the plans that pay a high­er per­cent­age of your med­ical expens­es and offer high­er month­ly pre­mi­ums. These types of plans are suit­able for you if:

  • You need emer­gency care frequently
  • You are plan­ning to have surgery soon
  • You often see a pri­ma­ry care physician
  • You have a pre-exist­ing con­di­tion or have been diag­nosed with a chron­ic dis­ease like can­cer or diabetes
  • Your house­hold income is suf­fi­cient to cov­er the month­ly premiums

5).  Do the Math

Peo­ple focus on the month­ly pre­mi­um, but you also need to look at the deductible. For instance, if you have a choice between a low­er sil­ver plan pre­mi­um of $345 a month for a plan with a $5,500 deductible, and a high­er gold plan pre­mi­um at $465 a month with a $1,750 deductible, you’re bet­ter off with the sec­ond plan if you antic­i­pate need­ing more than $1,500 in med­ical care. With the sec­ond plan, your total annu­al cost for the pre­mi­um and deductible comes to $7,330, a $2,310 sav­ings over the low­er pre­mi­um plan.

6).  Look at Out-of-Pock­et Costs

The deductible is just one out-of-pock­et expense; you also have copay­ments and coin­sur­ance. The three togeth­er are your max­i­mum out-of-pock­et costs. Under the Afford­able Care Act, the max­i­mum out-of-pock­et lim­it is $8,550 for a sin­gle per­son and $17,100 for a fam­i­ly policy.

7).  Uti­lize Tax-Free Benefits

Flex­i­ble spend­ing accounts (FSAs), health sav­ings accounts (HSAs), and depen­dent care spend­ing accounts pro­vide won­der­ful tax advan­tages because con­tri­bu­tions are made with before-tax income.  They can be used to pay for deductibles, pre­scrip­tions and health-relat­ed costs that are not cov­ered by your insur­ance (braces, eye­glass­es, etc.). At the end of the year, you lose any mon­ey left over in your FSA so it’s impor­tant to plan care­ful­ly and not put more mon­ey in your FSA that you think you’ll spend.  How­ev­er, with an HSA, funds roll over from year to year which makes it a great way to save for future med­ical costs.

8).  Review the Provider List

Most health plans today have “in-net­work” providers. If you see those doc­tors and vis­it those hos­pi­tals, you pay less out of pock­et than if you go out­side the net­work. So, if you want to keep your own doc­tor and go to a cer­tain hos­pi­tal, make sure they’re on the provider list.

When it comes to choos­ing the best work­place ben­e­fits plan for you, edu­ca­tion is your most sig­nif­i­cant defense against mak­ing sub­stan­tial finan­cial mis­takes, includ­ing not tak­ing full advan­tage of your employer’s ben­e­fits.  If you have ques­tions about any of the ben­e­fits offered, ask your HR depart­ment for help or clar­i­fi­ca­tion.  And remem­ber, look­ing back­ward on your past habits and expens­es can be an impor­tant tool to help you plan for­ward for next year.