It’s Benefit Enrollment Time – Medical Insurance Part 1 – Evaluating What You’ve Got

This post is part of a series on choosing benefits.  Today I will look at our choices for Medical Insurance and how I will decide which route to go.

Most people, especially young people, don’t carefully consider their health insurance choices.  They’re young, they’ve never been sick, there’s other  things they’d rather spend their money on.

To those of you who say you’ve never been sick, well, no one has ever been sick until they get sick.

I’ve always worked for companies that offered excellent health coverage, so I didn’t really have to think about too much.  My last employer offered an excellent PPO (Preferred Provider Organization), and they paid 100% of the premium.  I was allowed to see any doctor I chose, and had to pay a $500 deductible and 80% coinsurance (90% if I stayed in network) with an out-of-pocket maximum of $3000 for the year.  Most years I never even spent more than my deductible.  The only year I came close was the year I had Son, and I maxed it out that year (a Cesarean Section will do that).  Still, by negotiating with the hospital and then being rewarded by my insurer for finding errors on the bill I was able to reduce what I actually spent to about $1800 (I really should write a post about that!).  Meanwhile, my friends with HMO’s paid $25 for their entire pregnancy.

I stayed home with Son for three months after he was born, and we’d decided that I would leave go back for six months before leaving permanently (we had delusions of grandeur that we’d be moving out of state).  Our income would be cut in half, so we already were reassessing all our expenses.  We’d added Son to Husband’s insurance (also a PPO) as soon as he was born because we knew I’d not be working long and because it was less expensive than adding him to mine.

I wound up leaving after  three months, and since the PPO they offered at the time was $200 more per month (for the three of us) than the HMO ,we went with the HMO.

Why am I telling you all this?

Step 1 in evaluating and choosing our medical benefit is to take a look at our lives, our current health, and our plans for the next year.

These are the factors that are going to influence our choices this year:

  1. Our financial situation – we are a one income household, and the economy is…challenged.
  2. Husband has diabetes,  meaning we’re going to use our policy for his treatment.
  3. Son has asthma, though I am hopeful that we will begin to see him outgrow it this year.
  4. I have some of my own health challenges that will rear their ugly heads again next year.  We need to plan for that.

Step 2 is to figure out how our current plan did for us last year.

  1. How much were the premiums?
  2. How many times did each person in our family go to the doctor this year, and how much did we pay for co-payments? We’ve been to the doctor or lab thirty-two times this year and paid $375  in co-payments.
  3. Were all our doctors on the plan, and were we happy with them? Yes, and mostly. We’re going to look for a new primary care physician that isn’t thirty miles away.  And there was the one  time that Son’s pediatrician diagnosed MY illness (that my doctor had missed, but when I went back and told her what he’d said she said,  “Hmmm.  Yeah.  That IS what you have…”).

Now that we know where we’ve been we can properly evaluate next year’s choices.  Tomorrow’s post will look at the actual plans, and what they will really cost us.

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Read the rest of the series!

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Read the rest of the series!

It’s Benefits Enrollment Time, Series Overview

It’s Benefit Enrollment Time – Medical Insurance Part 2 – The Plans and What They Really Cost

It’s Benefit Enrollment Time – Flexible Spending Accounts Mean More Money in Our Pocket!

It’s Benefit Enrollment Time – Dental Insurance and Why The Math is So Important

It’s Benefit Enrollment Time – Life Insurance a Bargain For Us

It’s Benefit Enrollment Time – Seeing the Vision Plan Clearly. Finally.

It’s Benefit Enrollment Time – Disability and Long Term Care Insurance are Good to Have

It’s Benefit Enrollment Time – Legal, Pet Insurance and Lots of Little Perks

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One Response to “It’s Benefit Enrollment Time – Medical Insurance Part 1 – Evaluating What You’ve Got”

  1. The Struwwelpeter Edition of the Carnival of Personal Finance Says:

    […] Are You Going To Be This Way: BeThisWay evaluates her medical insurance requirements by starting with an analysis of her current plan. […]


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