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Publisher’s AcknowledgmentsWe’re proud of this book; please send us your comments through our Dummies onlineregistration form located at http://dummies.custhelp.com. For other comments,please contact our Customer Care Department within the U.S. at 877-762-2974, outsidethe U.S. at 317-572-3993, or fax 317-572-4002. For details on how to create a custom ForDummies book for your business or organization, contact bizdev@wiley.com. Forinformation about licensing the For Dummies brand for products or services, contactBrandedRights&Licenses@Wiley.com.Some of the people who helped bring this book to market include the following:Acquisitions, Editorial, andMedia DevelopmentDevelopment Editor: Kathleen DobieSenior Project Editor: Zoë WykesEditorial Manager: Rev MengleBusiness Development Representative:Sue BlessingCustom Publishing Project Specialist:Michael SullivanCartoon: Rich Tennant(www.the5thwave.com)Composition ServicesProject Coordinator: Kristie ReesLayout and Graphics: Carl Byers,Reuben W. DavisProofreader: Susan MoritzIndexer: BIM Indexing & ProofreadingServicesSpecial Help: Jill Griffiths, Charlie Klippel,Elizabeth Sell, Katherine Lee Balsamo,Erica Iorillo, and a team of Aetnareviewers; The Financial PlanningAssociationPublishing and Editorial for Consumer DummiesDiane Graves Steele, Vice President and Publisher, Consumer DummiesKristin Ferguson-Wagstaffe, Product Development Director, Consumer DummiesEnsley Eikenburg, Associate Publisher, TravelKelly Regan, Editorial Director, TravelPublishing and Editorial for Technology DummiesRichard Swadley, Vice President and Executive Group PublisherAndy Cummings, Vice President and PublisherComposition ServicesDebbie Stailey, Director of Composition ServicesThese materials are the copyright of Wiley Publishing, Inc. and anydissemination, distribution, or unauthorized use is strictly prohibited.03 540824-flast.indd v7/14/09 7:06:21 PM

viNavigating Your Health Benefits For Dummies, 2nd EditionThese materials are the copyright of Wiley Publishing, Inc. and anydissemination, distribution, or unauthorized use is strictly prohibited.03 540824-flast.indd vi7/14/09 7:06:21 PM

IntroductionNavigating Your Health Benefits For Dummies, 2nd Edition,guides you through the twists and turns on the roadto health. Signs posted along the route point to avenues youneed to visit and side trips you may want to explore. We hopeyou enjoy the ride!About This BookThis small book offers concise, easy-to-read, and easy-tounderstand explanations of many aspects of health benefits.This includes finding the right coverage, deciding whatoptions you want (the selections can seem overwhelming),using your benefits to your best advantage during variousstages of your life, and dealing with paying for it all.You pay good money for your health benefits and have a rightto know how they work. This book gives you information tohelp you understand them.All this in what we fervently hope is an enjoyable manner andin a format designed to let you dip in wherever you like to getcomplete information about the topic you’re interested in.Conventions Used in This BookWords and terms in italics are defined in the surrounding text.Boldface type indicates the key term in a bulleted list — thesalient point, as it were.Foolish AssumptionsThe only assumptions we make are that you read English andare interested in making the most of your health benefits.These materials are the copyright of Wiley Publishing, Inc. and anydissemination, distribution, or unauthorized use is strictly prohibited.04 540824-intro.indd 17/14/09 7:06:51 PM

2Navigating Your Health Benefits For Dummies, 2nd EditionHow This Book Is OrganizedThis book’s seven chapters each focus on one aspect of thehealth-benefits landscape: Chapter 1, Maximizing Your Health Benefits in a ToughEconomy, tells you how to make the most of your healthplan in an unkind economy. From the financial basicsof health plans to being paid to live a healthy lifestyle,this chapter tells you how to get the most benefits foryour bucks. Chapter 2, Choosing Your Health Benefits, takes youthrough the process of understanding the range of benefits to deciding which of those benefits you need andfinding a plan that has them. This chapter also offersinfo on dealing with the once-a-year Open Enrollmentopportunity to make changes to your benefits, if you areenrolled in a plan offered by an employer. Chapter 3, Making the Most of Your Health Benefits,offers insight into the nuts and bolts of dealing witheveryday issues such as finding a doctor, getting prescriptions filled, and dealing with emergencies. Chapter 4, Meeting Life Head-On, talks about the adjustments you face getting married or divorced, starting afamily or adapting to an empty nest, finding a job, losinga spouse, and easing into retirement. Chapter 5, Paying Up, lets you know what you have topay for and explains how your health plan keeps youinformed of your financial responsibilities. Chapter 6, Speaking Up, suggests ways to communicatewith your health plan and offers pointers on how to file aclaim and appeal a decision. Chapter 7, Tracking Needs for Next Year, shows youhow to evaluate your current benefits in preparation formaking an informed choice next time. Last but not least, no For Dummies book would be complete without a Part of Tens element. Here we give you ahandy Ten Money-Saving Tips cheat sheet chock-full ofways to, well, maximize your health benefits, what else?These materials are the copyright of Wiley Publishing, Inc. and anydissemination, distribution, or unauthorized use is strictly prohibited.04 540824-intro.indd 27/14/09 7:06:51 PM

Introduction3Icons Used in This BookFor Dummies books all use little pictures in the margins topoint to information of special interest. These are the icons inthis book.The Internet is a prime source of health information, and thisicon points you to useful and informative Web sites.The old string-around-the-finger image highlights tidbits tokeep in mind as you pursue the topic at hand.Advice that can make your health-benefits life a littlesmoother is indicated with this on-target bull’s-eye.Where to Go from HereSimply turn the page.These materials are the copyright of Wiley Publishing, Inc. and anydissemination, distribution, or unauthorized use is strictly prohibited.04 540824-intro.indd 37/14/09 7:06:51 PM

4Navigating Your Health Benefits For Dummies, 2nd EditionThese materials are the copyright of Wiley Publishing, Inc. and anydissemination, distribution, or unauthorized use is strictly prohibited.04 540824-intro.indd 47/14/09 7:06:51 PM

Chapter 1Maximizing Your HealthBenefits in a ToughEconomyIn This Chapter Understanding the workings of a health plan Stretching your health-care dollars Taking advantage of preventive careFace it: Today’s economy is challenging. People are cutting costs everywhere they can. They’re searching outsales and taking “stay-cations” instead of vacations. Sadly,some people are losing their jobs, and as a result, their healthbenefits. Others are just finding life’s expenses too tight andare foregoing health insurance altogether.But health benefits make the bite of everyday medical costsbearable and the specter of major medical problems a bit lessthreatening, at least from a financial viewpoint.In this chapter we talk about what a health plan is designed todo, which is to help safeguard you from the considerablecosts of hospital stays, surgical procedures, visits to thedoctor, prescription drugs, and routine preventive care. Wealso talk about the fact that with medical costs continuing torocket ever higher, you need as strong a shield as you can get.How a Health Plan WorksIn return for paying a premium (basically the cost of a healthplan), you gain protection from the potentially high cost ofThese materials are the copyright of Wiley Publishing, Inc. and anydissemination, distribution, or unauthorized use is strictly prohibited.05 540824-ch01.indd 57/14/09 7:07:23 PM

6Navigating Your Health Benefits For Dummies, 2nd Editionmedical care. Even when you add in other costs, such as thedeductible (the fixed amount you have to pay before yourinsurance starts kicking in its share of your health-care costs),a copayment and/or coinsurance (a set amount or percentageyou pay to a health-care provider), the cost of paying forhealth benefits can be far less than paying for medical care onyour own. Plus, belonging to a health plan opens the door to anetwork of medical providers who agree to accept lower ratesnegotiated by the health plan.A health plan offers a wealth of information to help you makethe best decisions about your and your family’s health. Toolsprovided by your plan can help you choose a doctor, and programs can offer ways to help you work toward achieving yourhealth goals.Stretching Your DollarsWant to hear a secret? Your health benefits can save you money.You may be able to put thousands of dollars per year back intoyour bank account and say “adios” to your “stay-cation.”The next sections offer ways to stretch your health-care dollars.Be sure to also check out the handy tear-out sheet at the end ofthis guide for top tips on maximizing your health benefits.Being uninsured is hazardous to yourhealth — and your financesGroups such as the National Coalitionon Health Care that have looked athow health-care coverage affectsyour health have discovered thatbeing uninsured is related to severalundesirable tendencies: You receive less preventive care,including screening tests thatcan detect health problems inearlier, more treatable stages. You delay going to the doctor.And, a late diagnosis may limityour treatment options. You are 30 to 50 percent morelikely to end up in the hospital foran avoidable condition.So, even if times are tough, it’s easyto see that going without healthbenefits can put you and your familyat serious health and financial risk.These materials are the copyright of Wiley Publishing, Inc. and anydissemination, distribution, or unauthorized use is strictly prohibited.05 540824-ch01.indd 67/14/09 7:07:23 PM

Chapter 1: Maximizing Your Health Benefits in a Tough Economy7Anticipating savings “in the mail”Many health plans offer discounts if you use mail-orderpharmacies. You may get a three-month supply of a routinedrug for the cost of a two-month prescription. You’d certainlytake advantage of a “buy two, get one free” deal at the grocerystore, so why not do it with your prescriptions as well? Andthe convenience of home delivery can’t be beat!Be sure you understand the ramifications of using a mailorder prescription drug service. It takes a few days to getyour meds, so plan ahead. You may also have only tendays to return an order if there is a problem (perhaps youdidn’t receive all your pills). Be sure to contact the mail-orderpharmacy right away if you need a situation fixed.Going genericIn 2008, the average brand-name prescription drug cost about 85 more than the average generic. By switching just one prescription for a medication you take routinely to generic, youcould save more than 1,000 a year!Talk to your doctor if you have concerns, but generallydoctors are in favor of generic drugs.Staying inside the networkMake sure your doctors are in your health plan’s “network” ofmedical providers — and if they aren’t, ask them to join. Evenif your health-benefits plan has “out-of-network” benefits,using an in-network physician usually costs considerably less.A simple outpatient procedure such as a colonoscopy couldcost you significantly more if you go out of network.Visiting your doctor onlineSome doctors offer online consultations, which are oftenmore convenient than in-person visits — and you save ongas and time. Talk to your doctor or your insurer to find outwhether online visits are available and covered, and how touse online visits properly as well. (Turn to Chapter 3 for tipson maximizing talks with your doctor.)These materials are the copyright of Wiley Publishing, Inc. and anydissemination, distribution, or unauthorized use is strictly prohibited.05 540824-ch01.indd 77/14/09 7:07:23 PM

8Navigating Your Health Benefits For Dummies, 2nd EditionTaking advantage of discountsYou may be able to access money-saving discounts throughyour health plan, like discounts for vision and dental care, oron services such as acupuncture, nutritional supplements,and massage therapy. Consider taking advantage of discountson gym or health club memberships, exercise programs andequipment, smoking cessation programs, and more. Youwouldn’t throw away valuable coupons from the Sundaypaper, so why not take advantage of these discounts?Being Paid to Be HealthyMany health insurance companies as well as more and moreemployers are offering wellness incentives — rewards for livinga healthy lifestyle.Just for making healthy lifestyle choices and tracking yourprogress, you could earn wellness rewards, in some cases upto 600 per year — enough money for about ten fill-ups at thegas station, unless you’re stuck driving a gas hog. Keepingyour health insurer updated on your health also enables yourdoctor to tailor your health program to fit your needs.Personal Health Records are a great way to maintain yourhealth information. (Chapter 3 has details on these records.)Get routine health screenings to help you identify problemsearly; doing so can increase your options for treatment. Lookto local agencies for free or low-cost programs (Chapter 4 hasmore about these programs).Maintaining your health — by living a healthy lifestyle thatincludes eating right, exercising, and not smoking — mayreduce your risk of getting cancer as well as serious, chronicdiseases.Health is not merely the absence of disease; it’s a lifestyle.Whether it’s getting enough sleep, taking a walk after astressful day, or enjoying a hobby, it’s important to balancework, home, and play.These materials are the copyright of Wiley Publishing, Inc. and anydissemination, distribution, or unauthorized use is strictly prohibited.05 540824-ch01.indd 87/14/09 7:07:23 PM

Chapter 2Choosing Your HealthBenefitsIn This Chapter Making sense of the plans Making your choice Gearing up for Open EnrollmentYes, you may make bigger decisions — choosing whoto marry or whether to marry, which house to buy,whether to accept that job overseas. Yet, deciding on yourhealth-benefits plan has a strong impact as well, at least in theshort term until Open Enrollment or another opportunity toadjust your benefits comes along.This chapter takes you through the factors to consider as youenter the wild and wonderful world of health benefits.Picking Up the Basicsof Benefits PlansMultiple types of health benefits abound, with acronymsranging from HSA to HBO, er, make that HMO. Helping youunderstand the difference between a health savings account(HSA) and a health maintenance organization (HMO) — aswell as the rest of the health alphabet — is what this sectionis all about. (Home Box Office, or HBO, doesn’t come into playunless you’re laid up for a while.)These materials are the copyright of Wiley Publishing, Inc. and anydissemination, distribution, or unauthorized use is strictly prohibited.06 540824-ch02.indd 97/14/09 7:31:28 PM

10Navigating Your Health Benefits For Dummies, 2nd EditionAnd, as long as we’re in back-to-basics mode, what is a healthbenefits plan anyway? Well, at a basic level, a health-benefits planprovides payment for certain health-care services. Plans rangefrom those that cover only specific services such as hospitalization or dental care to plans that offer more complete benefits fornearly every health need and everything in between.You generally join a health plan through your job (or yourspouse’s or partner’s job), in which case your employer maypay all or part of the premium, which is the cost of a healthplan. You can also purchase coverage on your own (see theupcoming section, “Buying your own benefits”).States offer coverage of health-care costs through Medicaidor the Children’s Health Insurance Program for folks at lowincome levels who can’t afford health benefits. Contact yourstate’s health and human services department to find out more.Find out about resources in your state for finding freeor low-cost health insurance programs by visiting www.PlanforYourHealth.com/insure.Expanding on the plansIf you have health benefits through your job, your employerselects the coverage options available through your healthplan. If you want coverage of something your plan doesn’thave — chiropractic care, for example — talk to your company’s health benefits or human resources director.Your company may offer more than one type of health planto encompass most of your health needs. The next sectionsexplain the major types of health-benefits plans that covermedical expenses, such as hospital stays and services, andmay include coverage of prescription drugs, dental, andbehavioral/mental health services.The evolution of health-care plans has gone from traditionalplans (in which you pay a percentage of the cost of your medical care after meeting a deductible, the fixed amount you haveto pay before your insurance starts kicking in its share of yourhealth costs) to managed care (in which you have a networkof physicians as well as programs to help manage your care)and on to newer plans (in which you have the option to directhow your health-care money is spent).These materials are the copyright of Wiley Publishing, Inc. and anydissemination, distribution, or unauthorized use is strictly prohibited.06 540824-ch02.indd 107/14/09 7:31:28 PM

Chapter 2: Choosing Your Health Benefits11Honoring traditional plansIn a traditional fee-for-service plan, you are reimbursed fora percentage of the cost of covered services you receive(although the payment may go directly to your doctor orother care provider).The upside is that your applicable fees (such as deductibles,copays, and coinsurance) are the same for any doctors youchoose, regardless of whether they’re in the health plan’snetwork; the downside is that the doctors you choose maycharge more for some services than the insurance companypays. You may b

Tracey A. Baker, CFP, is a CERTIFIED FINANCIAL PLANNERTM professional and Vice President of CJM Wealth Advisers, Ltd., located in Fairfax, Virginia. Ms. Baker is an active member of the National Capital Chapter of the Financial Planning Association (FPA). She supports the Foundation for Financial Planning, a