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Health Insurance Renewal: Higher Premiums, Choice of Alternative Plans...Any Advice?

By December 27, 2009 - 8:46pm
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My husband and I are both self-employed, and have individual health insurance. (We never realized how "good" we had it when we were employed by large institutions who offered great health insurance benefits...but that is another story...).

I recently received notice from our health insurer that our monthly premiums would be increasing. No surprise. What I am surprised about is that they offer an "Alternate Plan" with a reduction in monthly premium. I then assumed the deductible would have also increased, but this decreased as well! What did decrease (and not in our favor) is the co-pay would decrease from 80% to 70%.

I need to do some more research, as I am sure there is more to this story (and, I don't think for a minute that our Health Insurer would actually be helping us to save money!), but I am interested in hearing from others in answering these questions:

1. Did you receive the same renewal information notice from your health insurance that monthly premiums would increase?
2. Did your Insurer provide an "Alternative Plan" to consider that actually looks good, even better, than your current plan? (ie, premiums decreased, deductible decreased, in-network and/or out-of-network co-pays increased or stayed the same, benefits added, etc.).
3. Do you see any glaring red-flags in switching to the Alternate Plan? There is no indication that there would be any chance of denial of coverage, or for them to drop us or anything sneaky like this.

My biggest question is: is it worth calling their "enrollment specialist" and finding out more? Can I trust this person to tell me what's best for me and my family?

I hope to hear from others, as I'm wondering if this is a national trend for health insurance companies to try to keep us, of if this is done every year, or if I should stay away from any health insurance changes...that I would be signing something I would later regret?

Thanks for any suggestions and advice!

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HERWriter Guide

Hi Alison - You've asked a number of interesting questions, most of which are focused on the cost of buying the insurance. If you're strictly looking at numbers then you could do some financial models based on best case and worst care scenarios.

As far as "red flags" the questions you're asking seem to be coming from two healthy people who expect to continue to be healthy and are concerned about the policy costs. Having watched multiple horror stories unfold during the healthcare reform hearings I would also advise you to take a look at the plans in terms of the caps they may put on how much care can be provided. Additionally, I would want to know which procedures, which hospitals and which physicians are covered and have an understanding of the quality of care the plan provides to those it insures. You can learn more about that aspect of health plans through the nonprofit National Committee for Quality Assurance which provides "report cards" on health plans.


The recession has put pressures on health plans from both individual purchasers and corporate benefits administrators to offer more options and give the buyer more choices. Having more choices from your company doesn't really surprise me, but I think you're very wise to look at all aspects of what your choices mean before you decide which way to go. Good luck! Pat

December 29, 2009 - 6:14pm


This is a great question, and one I'm sure many, many people are facing. And questions abound, especially with the health care reform bill just around the corner.

I guess it seems like the insurance "enrollment specialist" could help if she or he could actually look at your spending records over the past few years and tell you that (a) the difference in a 70% copay and an 80% copay would have meant $xxxx dollars in past years, so you'll get an idea of whether the reduced premiums and deductibles would make sense for you.

If she or he can't look at your past records (and actually I can't imagine how they could, with the medical privacy limitations), then I can't see how it would be much help. But it couldn't hurt to listen to what they have to say.

With a baby on the way, that difference between 70% and 80% is big for you, I'm sure. Don't you wonder why things have to be so complicated? I hope health care reform does indeed make some things simpler.

Anyone else dealing with this?

December 29, 2009 - 9:52am
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