Health Insurance Advice

I have to advise people on our plans. Pretty much they cover the same it is cost that is different. Ours are easy, we have three plans, a high deductible plan, a modified that has a higher deductible for hospitals but other procedures have copays and it has a prescription copay plan, and the third is a copay type HMO.

My employer also funds half the deductible via an HSA for the high deductible plan. What I tell the employees is add up the max you would have to pay for the high deductible plan divide that out by your pay periods so you can compare it to the rest. Even with fully funding the deductible every year, which you never have to do, it is 60 dollars a period less than either of the other two plans.

So just pulling numbers, HSA plan is 250 a pay period for a family, modified is 310 and you still have to fund deductibles and copays, the HMO is 400 a pay period and you still have all the copays. So it becomes a big duh, take the high deductible.

So look at the differences in costs, add in normal costs like copays and prescriptions, then pick the cheapest one since the cover the same thing.

Not sure if that makes sense, it would be easier if I knew the particulars of your plans.

Each of the insurance carriers on the plans offered by your husband's company will have representatives whose job it is to explain the plans. You can call the 800 number or you can ask HR for the name of their contacts there, but have all your conversations with the carriers.

Before you do that, look at a full year's worth of medical bills. Get a handle on what you spend on visits (regular check-ups and specialists), prescriptions, lab work, and hospital visits. If last year was unusual in any way, make a note of that.

You want a balance of paying a reasonable premium vs. out-of-pocket expenses. If you are unlikely to use a hospital but need it "just in case", you can choose a lower-premium plan with a higher hospital deductible. If you have a lot of prescriptions, you need to think about what a lower co-pay will mean for you. Look at your prescriptions and whether they are tier 1, 2 or 3. Tier 1 is the low cost generics, tier 2 is in the middle (usually name brands but not the outrageous ones) and tier 3 is higher. So you might have a 10/30/50 prescription plan, with $10 as your fee for the Tier 1. If you have a lot of expensive prescriptions, that adds up but if you hardly have any, then a higher plan might not be a bad trade off for a lower premium.

You should also find out when the open enrollment period is - there is a month each year (usually at the company's plan renewal time but sometimes based on the calendar) when employees can switch without any questions, but insurers are wary of people who just switch when they have a problem that occurs and suddenly they want more coverage. Otherwise you can't always switch whenever you want to.

Don't be afraid to say to the insurance people that you don't understand what they are saying and can they please define their terms or explain it another way.

You need to take into account what the needs of your family are, and make sure that you have coverage for those needs. For example, if you have a child that needs speech therapy, you need to make sure it is covered. Look closely at the exclusions list to be sure nothing is on it that you can't live without. I second the person that told you to call the 800 # of the insurances you are considering. They will be able to answer any questions you have (usually). If you go to the doctor more than 1-2 times a year you need a plan that doesn't have a huge deductible; likewise if you have any conditions that require frequent specialist visits. Feel free to pm me if you have specific questions - I am a medical biller.

Normally an insurance broker could do that but brokers need to sell individual plans. Furthermore a broker isn't going to know the ins and outs of a plan provided by an employer.

Most employers provide a decent plan comparison. I start out by comparing the difference in the annual premium to the difference in the deductible. I also take into account annual max and if most office visits charge a copay or coinsurance. Usually coinsurance counts toward out of pocket max while copay generally don't.

Personally I won't buy into a plan where I can't self refer.

I'm in HR. So, I find your comment about HR annoying. When we do open enrollment, we have reps from our carriers here to have conversations with the employees. Did he receive a packet? If so, all the information is in there. You will need to review each policy and decide which works out for your family. HR can't tell you which policy to go with. Not sure how big the company is but if your husband was asking all these questions with HR again, they should have pointed him in the direction of the representatives. Its not that they are useless or didn't want to take the time but open enrollment is a big production and in my experience, the questions asked are the ones that were explained in the meetings.

If you want to have a discussion, contact the HR department and politely ask who the broker(s) for benefits is/are. Let HR know that you want to discuss the policies with a professional and they should give you the information OR they will ask for your information and ask their broker to contact you. Now, I say nicely because I can't tell you how many times a wife will call our department and DEMAND information.

Another avenue would to contact the carriers directly and discuss with them. However, you might get different answers depending on who you speak with. That is why I always recommend discussing with the broker.

Open enrollment is a busy and confusing time.

My husband is self employed so we have individual insurance. Just read the policy and you will know what is covered what is not, how much office visits are at a primary doc vs specialist, how much for an ER visit, how much for hospital stays etc.

Take Southern Yankee's advice. It's spot on!

Your HR rep should be extremely immersed in the healthcare policy. They should be able to explain the differences between plans, etc.

One tip - the one thing NOT to skimp on is hospitalization. You want the most that you can afford.

How many plans do you get to choose from? Can you tell us more? Or PM me.