Open enrollment returns

You would think I’d pay attention to deadlines.  But I’m not the best at that.  So that may explain why I finally picked my 2014 benefits at around 10pm before my midnight deadline a few Fridays ago.

I went through this whole ordeal last year.  I also reviewed a bunch of the jargon related to health insurance plans. The  available options changed this year, so I needed to take another look.

I still had a similar question: Would I rather pay more up front (in premiums) so that I get cheaper coverage immediately than pay less but then have to pay most out of pocket?

I had 3 options this year.  They eliminated the option I went with last year (the Exclusive Provider Organization (EPO)), so I was left with the Point of Service (POS) plan and two “high deductible” options with HSAs.  Last year, I picked the option that allowed me to not think about things as much, i.e. the EPO.  Basically, if I was sick, or needed to see a specialist, I looked up a doctor in the network, and the price of the visit was just a copay.  No need to shop around for the doctor or facility that would be the cheapest.

With the High Deductible Health Plans (HDHP), or as they’re often called, Consumer Driven Health Plans, the idea is to put the spending decisions in the hands of the consumer.  The idea scared me last year, as I mentioned above, because I didn’t have a good way of knowing how much any doctor visit would cost.  For both of the plans, the coverage is a bit different.  Instead of paying a set amount per doctor visit/surgery/etc., the process can be a bit more involved.  You’re encouraged to shop around (which is often not possible if, say, there’s an emergency), and prices can be a bit confusing.  Many websites have started offering cost estimators, like the one at FairHealthConsumer.org, or through your insurer’s website.  There’s another collection of lookup options from this article in the LA Times or this article in the Wall Street Journal.  The insurance usually negotiates a discount, but then you are left responsible for some (if you’ve met the deductible) or all of the remaining cost (if you haven’t met the deductible yet).

The assumptions I’m making about my medical needs for next year:  hopefully don’t need many visits, and definitely not enough to meet the high deductible ($1500 for one, $2000 for the other).

All the plans have an out of pocket maximum, so the range between the “total expenses” for me (premium + out of pocket maximum) is $4-5k.  That’s the total amount of money that would be gone (granted much of it paid with pre-tax dollars).  Hopefully, it wont come to that, but it’s good to know that I wont go into debt forever if something bad were to happen to me (medically speaking).

I went with the plan with the lowest premium.  Then I set my HSA contribution to the difference between the lowest premium and the highest premium, so I wouldn’t feel so bad about having to spend the money on medical expenses.  This plan also includes a $750 contribution from my employer into my HSA.  So, I might use all this, or more of it, or less, but any money I don’t use can be kept in my HSA from year to year.

Another thing to consider:  Once my fiance and I get married, we can (and should) reevaluate our benefit elections.  It’s considered one of the many “qualifying life changes” that allows for us to modify our benefit elections.  It might be cheaper for one of us to join the other person’s plan.  We’ll see how the first half of the year goes, and see which of the plans works for us.  Knowing that I can change my health plan does help me feel a little less worried about my insurance choice.

So, which plans are you looking at?  A co-pay based system?  A high deductible plan with an HSA?  Has all this insurance stuff been confusing?  Are you one of the people in the individual market trying to navigate the options through the Affordable Care Act?  What questions did you ask yourself (or HR) to figure out what plan was best for you?  Let’s talk health insurance!