Open Enrollment & Insurance 101

How to Choose the Right Plan for Your Family

by | Oct 24, 2019 | Blog, Community | 0 comments

I think we can all agree that insurance of any kind is very confusing.  Most people do not understand how health insurance works, nor do they know what kind of coverage they have.  I own a physical therapy clinic, work with insurance every day and had my own surprise about how our health benefits worked.  I took my two-year-old to urgent care because I thought she might have an ear infection. I thought that I had a $40 copay for these things, but it turned out I had to meet my deductible before the copay plan kicked in. So I had to pay 100% of the bill.  I’ve never had an insurance plan like that and was totally surprised. Then my husband had to have a few things checked out for a possible hernia. I thought we would have to pay about 20% for imaging like ultrasound and MRI, but, you guessed it, it all went toward the deductible.  I do not like this kind of surprise and I know you don’t either!

 

Here are three things to consider when picking out your insurance plan for next year. 

1.  How do you use insurance?

    1. Are you and your kids (spouse or whomever may be on your plan) basically healthy except a few times a year going to urgent care for possible infection or to see if you have strep throat? You may want to consider a high deductible plan.  You will pay a lower monthly premium but then will be expected to pay 100% of all bills out of your pocket anytime you go to the doctor.  

      Do you go to physical therapy (ahem)? Chiropractic? Allergist?  Planning to have a knee replaced? 

      It may be worth it to pay a higher monthly premium in order to have those things covered, or at least to know every time you go you will have to pay a certain amount.  This may be a $25 copay or 20% co-insurance of the total bill (or both). With this plan you’ll know that your insurance plan will kick in to help cover the cost.

    2.  Take the time to crunch the numbers.  

      1. As I just talked about in #1, you have to take the time to add the numbers up.  Does your employer cover any premium costs? Take your monthly premium for each plan offered (typically employers will give you three options) take it times twelve months.  Check the difference between the plans and you can try to “guess” how you will use your insurance. 

        Rough example for my family of 2 adults and two children:

        High deductible plan:  Monthly premium $1029 with a $4500 deductible for each individual and a family deductible of $9000

        Yearly I will pay $12,300 for insurance (gag)

        Any time I go to the doctor I have to pay 100% of the bill.  

        Urgent care = $280 per visit
        Physical Therapy = $115 per visit
        And so on and so on until I pay $4500 (per family member or $9000 total)

        vs.

        $40 traditional copay plan (if I call and know it doesn’t go toward my deductible first):  Monthly premium is $1140 = $13,680/year

        Urgent care $40
        Physical Therapy $40

        Between the two plans, in one year there is a $1380 difference. It’s up to you to decide if you can save that money and pay for things 100%, or to pay that difference to have lower costs on the backside.  Totally confusing? I know.  

        In this case, if I am going to be using my insurance, you can see it definitely benefits me to pay more per month to not have to pay 100% of the bill towards my deductible.

      3. Read the fine print

        1. Copay plans are not what they used to be.  This is what I just learned the hard way, and what we have many people realize once they’ve scheduled an appointment.  I thought I had picked a copay plan, however I had to meet a $4000 deductible before the copay plan kicked in (ouch again).  I’ve never had insurance that worked like that, so I was totally surprised. If your employer has people to talk you through the different plans offered, definitely use your resources!

          Do you go to physical therapy (ahem)? Chiropractic? Allergist?  Planning to have a knee replaced? 

          It may be worth it to pay a higher monthly premium in order to have those things covered, or at least to know every time you go you will have to pay a certain amount.  This may be a $25 copay or 20% co-insurance of the total bill (or both). With this plan you’ll know that your insurance plan will kick in to help cover the cost.

        We all know insurance is confusing, but we all have to have it.  If having a high deductible plan limited your access to things like physical therapy, look at paying a little more per month so that you don’t have to pay toward a deductible.  My goal is to have all of you pick a plan to best meets your needs and based on how you use insurance, so that no one is surprised (like me!) All of you should always call the number on the back of your card to check for your insurance benefits before going to any provider.  They will always give you the best information about your plan. Don’t assume you know what your plan will cover (like me)!