11 Crucial Questions To Ask Yourself — And Your Employer — During Open Enrollment

Photographed by Megan Madden.
It might be helpful to think of open enrollment in the United States — the time of year when workers can sign up for or adjust existing healthcare plans — as Christmas for grownups. You go shopping for things that ideally make life better.
Workers who aren't covered by an employer-sponsored plan can shop for plans on the Affordable Care Act exchanges starting on November 1, through December 15. Those who want to change their current plans from an employer must do so by a date specified by their company or organization.
Before you make any choices, consider how your life has changed over the last year, and how you might expect it to change in the coming year, advises Edukate CEO Chris Whitlow.
Advertisement
"If you're planning on growing your family, going back to school, taking a big vacation, or know you'll have a large medical expense, you'll want to factor those things in when choosing your benefits," he says.
You'll likely want to speak with the human resources point person (or team) at your job who oversees employee benefits, but don't expect them — or anyone else — to tell you what to choose. They're there to outline your options, not decide what you should do with your life.
"Asking your employer for specific advice is a touchy subject. While your HR team may want to help you with selecting the right benefits, there are potential legal ramifications for them if they provide you with specific advice. When it comes to selecting your benefits, knowledge is power and no one knows your situation better than you," Whitlow explains. "This is also true when asking your coworkers what they selected; their needs may not be the same as your needs."
Don't want to play an endless game of 20 Questions with your health and retirement savings? Look through these 11 questions you should ask yourself or your job to find the plan that's best for you.
1 of 11

What are the employee contributions for benefits?

Some companies offer highly impressive — and fully- or partially-comped healthcare benefits, even for people who aren't at the executive level. If you don't work in one of those rarified atmospheres and aren't in the C-suite, you should expect to pay something, says Policygenius CEO and cofounder Jennifer Fitzgerald.

"Unless you are at a generous company, you'll be required to contribute part of the cost. Be clear on what this is for you, and your dependents if you have them," she advises. "Your employer will likely have a sheet they can share with you that outlines different contribution requirement amounts."
2 of 11

What benefits am I automatically enrolled in? What benefits are voluntary?

"Each employer is different and you should ask yours for specifics," Fitzgerald says, "but most company benefit programs often feature a mix of auto-enrolled coverage (commonly health, dental and vision) and voluntary coverage where you must sign up to receive them (commonly life and long-term disability insurance)."

She advises that employees sign up for any voluntary benefits offered by their employers "as a rule," as doing so is "often much less expensive than getting individual coverage."
Advertisement
3 of 11

What does each plan mean?

A lot of acronyms will get thrown at you when you start looking through health plan options, and each one determines the kind of coverage you will get, and how much you will pay.

"Each type of health insurance plan has a set of requirements for receiving insurance coverage," says Eligible CEO Katelyn Gleason. "The plan type usually tells you from whom, and where, you can receive care."

Here is what each one means, according to Gleason:

Health Maintenance Organization (HMO): In this plan, you'll be limited to receiving care from doctors who are part of, or contracted by, the insurance company. Also, this plan will not cover out-of-network care except in cases of emergency. You'll want to make sure the doctors you want to see (or options near your work or home), are in-network if you want to continue seeing them.

Exclusive Provider Organization (EPO): This is similar to the HMO plan: You’ll receive coverage for care that is in-network, and out-of-network care will not be covered, except in some emergency cases.

Preferred Provider Organization (PPO): The PPO plan is more flexible. It will cover care from in-network doctors, specialists, and hospitals, and cover out-of-network care to some extent. Be sure to check the out-of-network costs before making your choice.

Point-of-Service (POS): This plan is an HMO/PPO combo: You choose an in-network primary care physician, and then through them you can get referrals to visit in-nework or out-of-network specialists. For the latter, there's usually a deductible and only partial coverage.
4 of 11

How large is the network?

When you are younger and/or have fewer anticipatory health needs, you might want to go as small (and inexpensive) as possible. But if you have chronic illness or just want more options, a wider network may be worth looking into.

"If you're choosing a plan that is less flexible when it comes to out-of-network care, you want to make sure the network you’re signing up for has all of the medical options that you need," Gleason explains. "Also, if you have a go-to doctor that you visit, you’ll probably want to make sure that they’re in the network. Out-of-network care is always more expensive!"
5 of 11

What are the out-of-pocket costs?

Gleason adds that employees should be clear on costs that are not covered by insurance but that they will still be responsible for. Gleason explains the basic terms:

Premium: Your premium is the amount of money you pay each month for health insurance. If you're getting health insurance through your work, your employer will usually pay for a portion of the cost.

Copay: Set by the health insurance company, this is how much you pay when you see a doctor or a specialist. As this cost vary widely, by provider and by cause, you'll want to know what it is in advance.

Deductible: This is the amount you have to pay before your health insurance jumps in to cover part of the claim. So, if your deductible is $2,000, your healthcare provider won’t begin to pay for everything (except for your coinsurance responsibility) until after you pay the first $2,000 of healthcare costs.

Coinsurance: Coinsurance is the percentage of healthcare costs for which you’re responsible after you hit your deductible limit. For example, if you visit the doctor and receive a bill for $1,000, after you hit your deductible, you would pay $200 and your insurer would pay $800.
6 of 11

Is there any benefit to me if I *don't* take the company benefits?

You may not have to go empty-handed if you forego certain benefits, or if none apply to you, Fitzgerald adds.

"Some companies offer financial compensation if you're not taking company benefits, which is why it’s a good idea to ask if there’s any reimbursement for not choosing one of your company’s plans," she says.

However, it's important to keep in mind that if your employer provides affordable health insurance coverage, you won't qualify for federal subsidies in the Marketplace. So if you decline coverage, it might be difficult to find a cheaper option.
7 of 11

Can I keep keep some company-sponsored benefits and drop others?

This depends on your employer, but employer-sponsored plans are usually unbundled so you can get health insurance, but decline dental or vision coverage if you wish.
Advertisement
8 of 11

Can I drop my company benefits in favor of a plan on the exchange?

Fitzgerald says a common, but intricate question is: "If I find a plan on the exchange, can I drop the company benefits now and stop paying? Or do I have to wait until the company's open enrollment period?" In this instance, the best thing to do is wait until you've spoken with your human resources department.

"If you want to cancel your employer-based health insurance, you’ll [have to] talk with your HR associate or benefits provider," she says. "Thanks to IRS Notice 2014-55, the circumstances under which people can cancel their employer-sponsored health insurance was expanded; employees can cancel their employer’s group plan if they’re planning on buying a Marketplace [exchange] policy."

In other words, opting out of an employer's insurance is allowable if an employee is then signing up for healthcare through the exchanges — but only at specified times. If it's outside those times, it has to be a special circumstance, such as having a child.
9 of 11

How do low-cost plans and company flexible spending accounts (FSA) work together — or not?

As a follow-up to the previous question, Fitzgerald says some employees wonder if they can still participate in their company's FSA (and use those funds to pay for eligible medical costs) if they decide to shop the exchange for a low-cost plan.

The answer is no. "You’re only eligible for an FSA if you’re on an employer plan," she clarifies. But she adds that you might qualify for an HSA, depending on your plan.
10 of 11

What ancillary benefits are available?

"Over the past couple of years, employers have become more aware of how physical and financial health affects a company in terms of productivity and culture overall," says Edukate CEO Chris Whitlow. "Employees tend to think 'benefits' [only] means health insurance and a 401(k) to contribute to; however, employers are beginning to offer more wellness programs that address an employee's physical, mental, and financial well being."

He says these options may include student loan help, gym memberships, on-site yoga classes, access to mental health resources, and financial wellness benefits that can address the whole of the employee and their individual needs at specific times in their employment.

Fitzgerald urges employees to look into these "free-money" opportunities, as they "basically boost your income" in other ways.
11 of 11

Does my 401(k) provide automatic enrollment or auto-escalation?

Whitlow says more employers are offering automatic enrollment and auto-escalation for employees (which makes it easy for workers to start saving), but he advises that all employees make sure that option is best for "their goals and financial situation."

"The 401(k) is still one of the best options for saving for retirement, but it may not be right for all people," he notes. "If someone has a significant amount of debt or doesn’t have money set aside for an emergency fund, enrolling in the company 401(k) may not be the way to go, as these are are generally more important to your healthy financial well being."
Advertisement