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Should You Stick to Your Current Health Care Plan? Maybe

The most confusing part of getting my first job out of college wasn't getting used to the structured days, it was deciphering the health care plan options that were offered in my benefits package. Years later, the choices make a little more sense but they still aren't 100 percent clear, and one thing is for sure: health care is more expensive. Hewitt Associates estimates that total health care spending will cost eight percent more than it was last year, and not paying attention to whether or not your plan is best for you could mean you are spending more than necessary. CNN Money broke down how to evaluate the situation so you can make changes to your plan for 2009 if needed.

  1. Separate the apples from the oranges. More companies are offering the option of high-deductible plans with an HSA. This type of plan will likely save you money while you're healthy, but could end up costing you more when you are sick. Make sure you can afford the deductible before opting for this plan.
  2. Narrow the oranges. Are your doctors in-network? And would you ever want to go out of network? If you want to keep your current provider, call your doctors to see if they'll accept the plans you're considering. Note that HMO and POS plans usually require a recommendation to see a specialist, so if you're too busy to fit in an extra appointment just to get the referral, a PPO might be a better choice.

Don't miss steps three and four, just

.

  1. Zero in on key costs. Make a chart comparing the following costs: Premium, deductible, co-pays and co-insurance, prescription coverage (confirm that the plan covers your current meds), and out-of-pocket maximums.
  2. Pick your final answer. Don't miss the sign-up deadline. According to Watson Wyatt, more companies are defaulting workers into high-deductible plans instead of their past year's choice. You want a plan that you'll be able to afford no matter your health status.

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ilanac13 ilanac13 7 years
i totally remember the FIRST time i had to sit through a benefits meeting and i had no idea what they were saying and what plan was right for me. i felt soo dumb for asking certain questions and ended up not asking and praying that i made the right choices. now i've learned the things to look out for and these tips here are great. i think that for myself - i've learned that i've never had a year that i was 100% healthy and that those types of plans aren't the best for me. i've always managed to break bones, get some random rare illness that needs specialized treatment, or just needed to get some type of care that was outside of the basic plan that i typically opt for the higher level. i think that now in the era of walk-in clinics, it's something to consider so that you don't have to necessarily raise your premium if you just need meds for strep throat or something just as minor.
Hoaxerz Hoaxerz 7 years
I made the mistake mentioned in #1 - went with the deductible plan because it was cheaper. Then, I fractured my rib but couldn't pay for treatment.
Deidre Deidre 7 years
For anyone who needs help just understanding the basics of how benefits work, try the Plan for Your Health website. If you have no idea what deductible or coinsurance means, it's a good source to check out the basics. It also does a pretty decent breakdown of HMO vs. PPO and how HSAs work. And yes,as LV stated, you should always talk to your HR team if you have questions. They've heard it all, and it's their job to be able to explain the basics of coverage.
melizzle melizzle 7 years
I count myself lucky for having a company that offers several excellent health care options, including ones that have premiums fully paid for by my employer. It's nice to have a choice rather than being forced into a plan that may not be appropriate for your needs.
LVBelleAme LVBelleAme 7 years
POS plans don't require a referral in and of themselves, POS plans are plans that usually have a 3 tier system where you have an HMO option, a PPO option, and an Indemnity option - you can go from one to tier to another as you need to. Obviously the HMO will always cost you less out of pocket, the PPO slightly more and the Indemnity will cost you the most out of pocket. An HMO will always require a referral, and you can only see doctors that are participating in their particular HMO service unless a particular PPO physician is contracted with them as a referral doctor, that would be the only way to see your PPO physician with the HMO rate. I realize that this article is trying to simplify things for the average Joe/Jane, but you should really encourage people with questions on their medical benefits to speak with their benefit department and if they aren't getting the answers they need then they need to speak to whoever their company medical broker is. Making the wrong choice with a medical plan is one of the most expensive mistakes one can make.
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