Open enrollment for medical insurance...how to decide?

**Valerie in WA** · 10-25-2005, 05:38 PM

This is the time of year where many American employers offer their employees the chance to change their medical coverage for the following year. We can go with the cheapy plan that costs less per month, but may cost you more down the road - depending on your health. Or we can go with the top of line plan, which costs more on a monthly basis, but has small out-of-pocket expenses. We also can add on or take off family members.

So, I'm wondering how other people make their decisions. In the past, I've estimated our usual number of office calls, prescriptions, etc occurring in a year. Then, I calculate the out-of-pocket total and the premium total for a year. I repeat that calculation for each of the plans offered. And I usually choose the least expensive. The risk is when something unexpected happens.

This year it's even more difficult, as we are offered four plans, ranging from a high deductible plan to an HMO.

What are some other things to consider? BTW, all the plans have the same doctors, so that's not a factor.

**staceyy** · 10-25-2005, 05:59 PM

My dh's company offers several different plans. We previously chose the 80/20 Blue Cross/ Blue Shield plan where we had to come up with 20% of all costs out of pocket but we could choose any Doctor we wanted. We found we were going into our pockets too much and last year we swiched to a Blue Cross/Blue Shield HMO plan where we could go to any Blue Cross/Blue Shield doctor. Well since most doctors belng to Blue Cross//Blue Shield we decided to switch to this plan which cost less per month.

Several months ago I became desperately ill and had to be rushed to the hospital. This plan paid for everything. I think I ended up with a bill for $20 after being in the hospital for 2 weeks and requiring major surgery. The plan also paid for a visiting nurse to come to my home for a month.

We are so glad we switched to this plan as otherwise we would have ended up having to pay thousands of dollars out of pocket. One word of caution though, please double check the form before sending it to your company to make sure you have completed it properly and double check your paystub to make sure the correct deductions are being made as there was a mixup on our medical reimbursement plan and as a result we were not able to take the deductions for this year.

**Valerie in WA** · 10-25-2005, 06:24 PM

Wow, Stacey, how fortunate for you, financially.

As I've sat here and started the calculations and thought about it, I think the heart of my question is this How much risk are you willing to assume? Do you want to assume that you might get rushed to the hospital and stay there for two weeks, or do you want to assume that you'll only need to see the doctor for one illness throughout the year (on top of any known chronic issues)?

**Telephus44** · 10-25-2005, 06:38 PM

I guess the question of how much risk you want to assume depends on your family history/situation. We have the plan with the highest out of pocket cost, but DH and I both have desk jobs, no children, and no particularly expensive chronic/recurring conditions (or any that run in our families). I suppose I would think differently if DH still worked as a package handler at UPS, or I was on the road all the time, or we had lots of active kids. Also, I would consider what if anything your out of pocket is capped at and how much you have in your EF - right now our out of pocket is capped at $2,000 a year and I generally keep my EF at $5,000 - so I feel comfortable with it.

**forestdale** · 10-25-2005, 07:25 PM

Valerie, we always had the top cover for medical, dental and hospital when our kids were growing up. That was in the days when we wasted a lot of our money. Today if I had to make the same choice, I'm sure I'd be more selective.

In Australia there is an online facility that helps you choose, depending on what options are important to your family. I just tried to find a similar one for your country but with no success. I did, however, find these. They may help with your decision. Good luck.

http://www.ahrq.gov/consumer/hlthpln1.htm
http://www.ahrq.gov/consumer/insuranc.htm

**Valerie in WA** · 10-25-2005, 10:50 PM

Those links were helpful, Rhonda. Thank you.

I did all the math - we actually have 5 options: the four that my employer offers and a fifth, which is the catastrophic insurance that my dh currently has. So, I calculated the premium for each and I gave my best guess as to what services we would use next year. Basically, the cheapest premium also equals the least total out-of-pocket (premium + copays + deductible, etc), based on our health being as we expect it to be. The annual amounts we could expect to spend for the bottom three programs are, respectively: $6,108...$6,563...and $7,023. If ANYTHING unexpected happens (such as an ER visit or dh being put on cholesterol medicine), we're going to want the middle or top of those three. The other two programs (ones I didn't provide amounts for) are more expensive and do not offer significantly better benefits for the cost.

Dh says that since our EF is not yet fully funded, he wants us to buy the better coverage ($7,023 per year). That coverage is actually called 'basic' and it is. The other lower two are high-deductible plans (sort of 'sub-basic'). I think with this plan we'll pretty much break even, if we do the expected. If one unexpected thing occurs, we'll be glad we made this choice. I think we're buying just a little bit more insurance than we'll need.

Ugh, my head is spinning, and I actually LIKE math.

**sunshine** · 10-25-2005, 11:05 PM

We have to consider dh's condition (he has ALS) . . . . many of my options won't cover stuff for him because he's not "fixable". . ..

We don't have a lot of prescription meds, so we decided to stay with the PPO, rather than HMO. The HMO wouldn't cover tube feedings, splints, etc. Even though dh has said he doesn't want tube feedings, I want it to be his choice, not that we can't afford it.