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Legal & Employment Guidance

Health Care Plan Selection Guide

NEA’s health benefit experts have put together questions to help you think through your health care options.
From national advocacy to individual support, NEA is working to ensure that education is affordable and accessible to all.
Published: April 25, 2022

Every educator should have access to the health care they need to keep them and their families healthy.

That's why NEA works closely with state and local NEA affiliates to secure quality, affordable, and comprehensive health care coverage for NEA members and their families.

NEA’s health benefit experts have put together a worksheet to help you think through your health care options.

Need help answering these questions? Check out our Health Care Glossary for breakdowns of important terms.

1. How are you receiving health care coverage currently?

Consider your options: Health care coverage can come from different places, including a parent’s plan, a spouse’s plan, a plan you buy separately, and Medicaid.

Expert tip: The Affordable Care Act (ACA) requires group health plans that provide dependent coverage for children to continue making that coverage available until the child turns 26 years of age. If you are still on your parent’s plan or a spouse’s plan, compare and contrast the cost and coverage differences of switching to your new employer’s plan.  

If you are under age 26 and decide to stay on your parent’s plan, check with HR staff about when you must make a switch to the employer plan or another plan. Also, if you, your spouse, and/or child (children) are currently covered under Medicaid or CHIP (the Children’s Health Insurance Program), wages from your new job may, at some point, disqualify you/them from these programs or may change your cost-sharing levels under these plans. Be sure to check the requirements of your current coverage.  

2. As a new employee, will you be enrolling in the employer’s plan? 

Expert tip: If you decide not to accept the employer’s health plan, talk to HR staff about how you and your covered dependents will obtain health plan coverage going forward. Some employers will ask you to provide proof of other coverage if you turn down employer plan coverage. 

3. If you answered yes to question #2 above, who will you enroll in the employer plan?

Consider your options: Health plan coverage may include individuals, spouses, and children. If your employer’s plan doesn’t cover your spouse or child/children, ask HR staff for assistance in helping you obtain coverage for them.  

4. What coverage does the employer offer? 

Consider your options: Does your health plan cover medical/hospital/surgical, prescription drugs, dental, vision, or some combination of these?  

Expert tip: If you or a covered dependent wear prescription lenses or need dental services (e.g., cleanings and checkups, orthodontics), you may save money by taking the vision and dental benefit, if offered. There is usually an extra cost to take this coverage, so be sure to budget for the added expense.  

5. What types of plan(s) does your employer offer?

Consider your options: Different types of plans include preferred provider organization (PPO), health maintenance organization (HMO), and exclusive provider organization (EPO). 

Expert tip: Having a hard time with the health care terms? Check out our glossary here.

6. What is the deadline for you to enroll in your employer’s plan?

Consider your options: When do you need to enroll in your employer's plan? When does coverage officially begin? 

Expert tip: Pay close attention to the enrollment deadline. If you miss the deadline, you may not be able to sign up for coverage until the next open enrollment period, unless you experience a life-changing event (e.g., marriage or birth of a child), which could result in a year or more waiting period. 

Clarify with HR the exact date that new employer health coverage begins. Allow sufficient time to transition out of any current coverage. Avoid a gap in coverage especially if you or a dependent are currently receiving services for acute or chronic medical conditions.  

7. Which of the plans include your (and your dependent’s) current providers?  

Consider your options: Check all your current providers, including your primary care doctor, any pediatricians or OB-GYNs, specialty physicians/providers, behavioral health providers that treat mental health and/or substance use disorders, inpatient and outpatient hospital care, pharmacy, laboratory/radiology/imaging, urgent care providers, and dentist  

Expert tip: If not keeping your current providers is a deal-breaker for you, make sure your providers participate in the plan you select. Many people are especially concerned about keeping their PCP, pediatrician, OB-GYN, mental health provider, and dentist. If the plan you select requires that you find new providers, get assurance from the plan that the new in-network providers are, in fact, accepting new patients.  

Cost Comparisons  

Now that you have thought through your options, download and fill out the worksheet below to compare the cost implications under each plan. 

Download Our Cost Comparison Worksheet

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