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Open Season on Health Care Options

By Anonymous November 22, 2008 - 2:19pm
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It is about that time when open season starts and it is time to change medical insurance providers. I have searched through several different carriers and it appears that I am basing my opinion mainly on the monthly price and not the benefits. What are the best benefits to look for? Co-Pay? Health Savings Plans? Can someone please give me advice?

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EmpowHER Guest

Thank you Allison and Susan for the great information. There are so many options out there that it is pretty overwhelming.

I am going to take both of your advice and hopefully make a rational decision.

November 23, 2008 - 9:56am

What a tough decision! I've decided to wait until this summer to look at our health insurance (and, to make any changes), as I'm hopeful that Obama will be working on some changes to healthcare. (Can't say that anything will actually change that benefits us by that time, or even in the next four years....).

To me, it was a numbers game:
Option 1: low monthly premium (probably) equals high annual deductible. Low coverage on Rx and specialty-doctors.
Option 2: high monthly premium (probably) equals lower annual deductible. (can't speak to Rx or specialists)
Option 3: there is probably something in-between

Last year, I opted for "Option 1", as we didn't know what our monthly expenses would be, so our only option was lowest monthly costs.

Now that we know what we can afford monthly, and what we're paying monthly for Rx and "specialists", I can see if there is a plan that has better coverage, with the doctors we like, that we may pay higher monthly premiums but pay less overall b/c more Rx is covered.

It depends on your situation: what healthcare you need covered, how many Rx you have (and how expensive they are), specialists, preventative care, and then what you can afford for monthly premium AND other monthly co-pays. Our high deductible has been irritating, but because I see an allergist who is not "in network", I pay for that out-of-pocket and will never reach the annual deductible. So, it's something I budget in VERSUS what I would pay for a higher monthly premium.

It looks something like this:
Monthly premium: $300 for family

Doctor visits monthly: $200
Rx monthly: $150
TOTAL: $350 (not including premium)

So, if I can find better health coverage that has a monthly premium of $350 or lower, then I would opt for that. If not, then our $300 monthly premium helps with knowing we have coverage for emergency visits, etc.

We did have a trip to the ER this year with my son, so I will see how much we paid for that vs. what we would have paid with a higher monthly premium.

Anyways...I hope I explained that so it is somewhat understandable. The other thing I found is that there are not too many options out there, at least for our circumstances and our state. The options are limited for you, so though it seems daunting, you may be looking at only 2-3 companies who have 2-4 policies each.

Do you know what your monthly expenses are for health care? Are you good with spreadsheets? :-)

November 23, 2008 - 8:20am
HERWriter Guide

Good for you for researching this REALLY important aspect of your life!

Deductibles are very important. There is little point in paying a small amount every month and finding out that you have to pay a $5000 deductible if you are hospitalized!

You need to ask yourself a set of questions.

-Co-pays are a legitimate concern as is coverage. A "simple" trip to the ER can cost thousands - will it all be covered?

-How about certain elective procedures like a c-section. If you have an emergency c-section, you may want to elect for your next pregnancy to be a scheduled section- will it be covered?

-Do the doctors and hospitals connected to your preferred plan suit you? Are they well reviewed in general? Are the doctors and hospitals close by?

- Is preventative care covered? This can be just as important as treatment! Things like birth control pills, annual physicals, mammograms before the age of 40...check everything that applies to you personally and a woman your age in general.

- Is the referral process simple to use, and is seeing a specialist an easy task?

Ask your co-workers who have similar circumstances to you which plan they have and how they like it.

One important thing to remember is that all insurance companies do not have the same meaning for the same terms. They are not universal. In other words, what one company calls "preventative" another may not. What one company calls a "reasonable" health care request, another may deem unnecessary.

Try to pick a plan that matches your needs for the next couple of years the best. If your health is excellent in general and you need an annual visit with a workable deductible and co-pay, as well as good hospitalization, then choose a plan that is applicable. While you want to make sure you are covered in the event of an accident or unexpected illness, you probably will not need a more in depth plan that an elderly person needs or someone with a chronic illness who can expect to pay more for the plan.

I hope this helps. I'm sure others will be also be able to share what has worked for them and supply further tips!

November 22, 2008 - 5:57pm
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