USA TODAY International Edition
Unsure of insurance options, I ask experts
Tips make it easier to tackle intimidating task
At 8: 10 a. m. on a Wednesday in late November, I’d been working online for nearly an hour to wrap up a few things before running an errand.
A text from my mom rang in my head: “You are all set up for health insurance now right?”
The day before my company had kicked off its yearly open enrollment period, a window of time when people can pick new health care plans, and I hadn’t had a chance to look over the offerings yet.
I decided to read over my choices before heading to Trader Joe’s.
By 8: 15 a. m., I had given up.
I had a full day of work ahead of me, and after five minutes of tooling around Fidelity to try to understand my options, I was intimidated enough that I decided to put off making my final choices a little longer.
But I knew I needed help with open enrollment.
This marks my first time enrolling in health care after turning 26 earlier this year. Before that, I had the good fortune to remain on my parents’ health care through the end of the calendar year.
Since I was clearly a rookie, I chatted with some experts to help me navigate the health insurance landscape: I chose Nancy DeRusso, head of Financial Wellness at Goldman Sachs Ayco Personal Financial Management; and Mya Roberson, assistant professor of health policy at Vanderbilt University School of Medicine, who is also a chronic disease patient.
Question: What tips would you give someone going through open enrollment for the first time?
Nancy DeRusso: A good first step is getting familiar with your plan options. Keep an open mind, ask questions and seek financial guidance if available to you – especially if your employer provides a financial wellness benefit. Remember, open enrollment is more than just health care, it’s an opportunity to review benefits such as life insurance, long- term disability and any other offerings that may help address your personal needs.
To choose the right plans, you need to understand the vocabulary involved. Everyone should make sure they understand the meaning of terms like deductible, out- of- pocket maximum, in- network and out- of- network. Always confirm if the doctors you currently work with would remain in- network and if current prescriptions are covered. HMOs typically have a restrictive network.
You should not look at your benefits in a vacuum – look at your spouse or partner’s options as well to determine how you can best optimize benefits for your personal situation.
Keep in mind that the quality of care doesn’t change with the plan. It’s im
portant to consider your personal situation and medical needs when choosing a plan that’s right for you.
Mya Roberson: There is a lot of terminology that can be very confusing and overwhelming at first. I recommend keeping a glossary handy ( like the Marketplace one) for terms you may not know. Some of the key terms to know are premium, deductible, copay, coinsurance, HMO, PPO, in- network. It is also helpful to ask yourself honestly how much could you afford to spend on a medical emergency right now as that is something that can certainly factor in when choosing a plan. For individuals who meet certain income thresholds, subsidies may be available to offset the cost of acquiring health insurance. Kaiser Family Foundation has a tool to see if you qualify for a subsidy and for how much.
Q: How can I decide what options are best for me?
DeRusso: Always review your situation from the current year and prior years. Consider things like: What benefits did you use? What changes do you anticipate in your situation for the coming year? Are you getting married, having a child, or adding other family needs? Is there anything in your medical history you need to consider?
It can be helpful to look into any analysis tools your employer offers. After adding in some personal information, these tools can help you evaluate which benefits make the most sense.
Always look to maximize your benefits. Make sure you are considering any incentives that your company may offer like contributions to an FSA or HSA, premium discounts for an annual physical or wellness credits.
Roberson:( Know) if you are seeking coverage for just yourself or additional members of your family, like a spouse or children, as the number insured on a policy affects the cost. ( Know) if there is a specific doctor or hospital you want to be covered under the policy you choose so you can select a plan that has them in- network. Also, ( think) about your average health care utilization in a year: Do you just go in for routine care? Do you take prescriptions? Do you have a condition that requires access to ( specialists)?
Q: And what are the best options, in general, financially speaking?
DeRusso: The best benefits for you will really depend on your personal situation. For some individuals, a highdeductible plan with a lower premium might make more sense financially. For others, a traditional PPO or HMO might make more sense. The plans and benefits that were right for you last year also might not be best next year – depending on how your situation has changed. One of the mistakes people often make is treating open enrollment as a task and just selecting what they did last year.
Additionally, plan out your cash flow needs. Budget for your expenses in advance by considering the use of taxadvantaged saving vehicles – but make sure you understand how these vehicles work before you use them. FSAs ( flexible spending accounts) typically don’t roll over, and the money in them is “use it or lose it.” HSAs ( health savings accounts) can roll over to future years and can even be used in retirement.
Roberson: This largely depends on an individual’s financial situation, tolerance for risk, and health needs. If someone has enough money saved for a medical emergency and they don’t need much medical care beyond routine visits, then maybe a lower premium ( monthly payment), higher deductible ( the amount you pay before insurance kicks in) plan is right for them. For me, as someone with a chronic disease, a higher monthly premium to have a lower deductible works out better financially. I also acknowledge that I am in a financial position to weather higher premiums, and many are not.
Not so confusing after all
Heeding DeRusso and Roberson’s advice, I went through the steps to choose health insurance, dental insurance and vision insurance on my employer’s platform. Once I sat down and committed, the process of selecting health insurance became less intimidating and more about personal choice.
And I found I wasn’t going through the process alone with a ton of confusing jargon and costs listed out. Instead, a bot called “Alex” was there to help.
Alex laid out plans, deductibles, premiums and what that meant – including co- pay rates, prescription details, and more – in diagrams and recordings. Given that I tend to be a visual learner, it was extremely helpful.
I’m unmarried and without kids so I elected benefits for myself. I had to choose between different plan levels on each kind of coverage, something that took me a bit of time to consider.
The first consideration that came to mind was the biweekly cost of each plan and how much I was able to swallow, financially, coming out of my paycheck.
Then, I took a step back. What did I need in terms of health care? That was more important than cost alone. I elected for the highest premium plan with the lowest deductible which will be $ 109.10 biweekly before tax for health insurance. I’ll hit my deductible at $ 1,000. I decided the cost was worth it to have the safety net and lower co- pays in the future, taking into account a regular prescription I need and the unpredictability of health needs.
With dental, I also chose the high premium plan coming to $ 17.58 every other week before tax. And for vision, I chose the low plan at $ 2.70 biweekly before tax. I got my first pair of glasses last year to use for work and am not terribly worried about additional costs this year.
I feel good about my selections which provide me security and comfort. But it’s safe to say with an additional $ 258.76 in expenses each month I’ll be ordering less on DoorDash.