Open Enrollment: Looking behind the doors

First of all, I am so thankful to have a job that provides quality health insurance. It is such a privilege to have options in health care.

As we head into the last few days of 2013, I am looking at the different plans available during my open enrollment period. As with many other health care choices, choosing between the available plans means deciding which aspects of my care are most important to me.

cat avoiding
Or I could just cover my eyes and take a nap!
  • Is it more important to me to have a lower co-pay for each appointment (with a GP or a specialist), or have the ability to see any doctor I want without a referral?
  • Is it more important to have a lower cost for prescriptions or more prescription options available?
  • Is it more important to have a lower deductible or more services that only require a small co-pay, which doesn’t apply to a higher deductible?

If you have different health care options available to you, how do you decide what is right for you and your family?

Have you heard about the Monty Hall problem? That was an interesting rabbit trail I ended up on last night…


  • It’s not easy. Especially when each family member has different health status and needs! With all the pundits speaking about how costs are escalating and people need to take responsibility for their health care use, I can’t refrain from pointing out that it is very, very difficult to compare benefits and expenses of various plans. And estimating costs? From experience, I can do that for my chronic condition supplies, but don’t have the crystal ball that tells me what “might” happen to my family’s health or our finances in the coming year.

  • At least for me, prescription coverage amounts to a bigger factor than any other thing. Dexcom sensors and pump supplies amount to a much bigger sum than office visits. Seeing my endo without insurance costs less than a copay on a supply reorder with lousy prescription benefits might.

  • I wish that my family had more plan options. Since we both work at small companies, they pretty much have one plan each. My husband’s company insurance and my company insurance are essentially the same basics, but my company pays premiums and we have access to the Cleveland Clinic so it was a no brainer. Both plans are very high deductible so on the up side we know exactly how much we’ll spend on my healthcare each year. We found out that we can use my insurance but his HSA benefit (at our bank) which makes it easier.

    I like the certainty of the current plan over when we had copays because I know exactly how much it’ll cost. We looked into private insurance at one point to see if we could find a better fit for me and it was just too expensive.

    Good luck picking your plan!

  • Sara, I recognize that this only works for me, but… If the overall costs on my available plans are close, I’ll choose the one that requires a)The least amount of hassle (define yours here), and b)The one that allows me to sleep soundly at night without worrying.

    As always, YHPMV (your health plans may vary).

    • Right? Without doing serious math (a hassle in itself), I am not sure really how different the costs will be. I am thinking not needing a referral for everything might just be the deciding factor.

  • After wading through the forest of ACA, it turns out that an low income self employed indvidual can get $11,300.00 in subsidies for a silver BCBS plan that has a out of pocket limit of $1400.00. After that (my first month’s prescriptions) I will get free health care, I’m accually afraid that the USA will go bankrupt.

  • The company I work for only has 2 choices for the area that I work in and they are both from the same insurance company. Option A is for young healthy people who never go to the doctor. The cost of the policy is covered by the company. Preventative care is covered at 100% before the deductable. But the deductable, out of pocket and co-insurance are quite high. Option B is for people like me who really must see a doctor often and for other than preventative care visits. I pay a good portion of the plan. Preventative care is covered at 100%. There are only 3 appointments out of the many appointments that qualify for that standing. My deductable, out of pocket and co-insurance are low when you consider what they are with most plans. Every visit, medical device etc goes toward my out of pockets and deductible. It is the best choice that I have. I suspect that at some point the company will decide it can no longer cover the plan and force me to either change to option A or go into the exchanges. But for now I’m very grateful for my insurance.

  • I recently has to do this and my cpfirst reaction was, wow open enrollment, my first time with full insurance in two years just give me any plan! But then, as you mentioned, I knew serious math was going to be involved, so I tried to make it as simple as possible and just break it all down. I decided that a lower prescription cost was better than a lower co-pay bc my wife is now on thyroid medication and we both now see an endo every 3-4 months but the cost difference was still lower than the cost difference of the prescriptions. And now my head hurts as I’m relieving that math night, but I think you get my point. It’s all about choosing what is most important and easier for you.

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