Open Enrollment

This month, my employer hosted the annual benefits fair and open enrollment for our new benefits year that begins April 1st. Well – call me an April fool, because I have been working for the same company for 3 years, and each year I have had to pay more for the same or worse coverage.

The insurance my job has contracted for is a PPO system. When I started, we could choose between 90/10, 80/20, or 70/30 coverage. My employer ‘contributes’ a certain amount to the coverage, and then we pay the difference – if there is one. I chose the 80/20 plan my first year, mostly because that was the one that ‘broke even’ – I didn’t have to pay any extra for coverage.

The next year, they had gotten rid of the 90/10 coverage, and added one below 70/30 called Risk/Reward. Instead of 80/20 being the plan that ‘broke even’, now it was 70/30. Besides the cheaper premiums, one of the other differences with a Risk/Reward system is that instead of paying a co-pay at doctor’s appointments, you would pay a percentage of the bill. Great if you never go to the doctor, but I have seen my Explanation of Benefits (example of an EOB) for some of my appointments, and that would get expensive very quickly. However, the difference that makes this choice impossible to me is the difference in the deductible. The deductible for the Risk/Reward option is three times as much as the 70/30 plan.

Last year, the only people who could choose the 80/20 option were the ones already enrolled in that plan. And they added a plan below Risk/Reward, with its clearest difference being its smaller provider network (‘marketed’ to us as a ‘more exclusive network’). Thankfully, the 70/30 plan was still the ‘break even’ plan so I stuck with it.

Can you guess where this story is going?

This year, they have decided that the employer contribution will be equal to the Risk/Reward plan. This means that my contribution to my health insurance will increase $123 per month. I don’t need to tell you that that is a lot of money. I haven’t completely finished running the numbers but I think it is still cheaper than paying 20% of the costs of my appointments and having a much higher deductible.

I’m a little frightened about what they are going to do to our benefits next year.


  • I am so glad that Greg has good insurance because my employer went to what amounts to a catastrophic health plan. $5000 deductible that must be met before anything is covered, even co-pays and prescriptions. Given we probably don’t meet that in a given year (remember Greg is on MDI), our out-of-pocket expenses would be outrageous.

  • Meant to mention above that the employee contribution for such plan was MORE than what Greg’s plan/employer has us contribute. Sheesh – we’d definitely do cobra if he were to lose his job.

  • I’m so nervous about where health insurance is heading. So many companies are offering all sorts of different options for people who are not heavy users, but for people like us our choices are limited!

  • Sucks!

    Right now I have a $4,000 deductible. And it’s $8,000 out of network. And I pay $300+ per month for my prescriptions ($160 per month for the insulin alone). Since diabetic supplies don’t come in ‘generic’ nor does my anti-depressant or psoriasis medication, I really get screwed. If my dad weren’t reimbursing me for most of this stuff, there is NO WAY I could afford it even WITH health insurance!!

  • Oh man, I could go on and on and on. My company discontinued an HMO that I’d used for over 10 years. And now, after just 2 months, I have already spent $1100 out of pocket (not including the premiums, which I don’t count because the $ has already left my check).

    The HMO always paid 100% for all labs, and now I have to pay a portion of that too. Plus, all prescriptions are done by an independent mail order pharmacy, and will not apply to the out-of-pocket max, which I always thought would be my safety net. Phooey.

    Like Scott, I don’t want to think about coverage for the coming years………………………………..and, how on earth is a person supposed to be able to make a wise choice with all of the options you have? (The only options I had were the $100 deductible, or the $500 deductible.)

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