Monthly Premiums & Annual Deductibles: Planning for the Year Ahead

So many great things are associated with the months of November and December — snowmen, pie, reindeer, candles, trees, gifts. Not on anyone’s list of favorites but occurring at the same time for many families is open enrollment for a new year of insurance coverage. (Yay!)

If your family’s plan rolls over with the beginning of a new calendar year, you should soon or perhaps have already received notice of open enrollment season from the health plan or your employer group. Be sure to note when a decision is required. Enrollment windows can be short and there is a lot of information to sift through.

Open enrollment is the one chance you get every year to think through your plan choices in terms of cost and coverage and consider the ways in which you did or did not use your benefits during the previous year. So make time to dive in and read up. Cocoa and marshmallows or mulled wine optional!

Have premiums risen for the new plan year? Has the deductible increased even if premiums have remained constant? Compare the last calendar year's benefits and coverage with what is on tap for the new year.

Have benefits shrunken or disappeared for such services as acupuncture and chiropractic care, and the big four for our kids: OT, PT, speech, and ABA? Has your share of cost increased? Is your 90% coverage now at 70%?

Here are some points to compare as you mull through the choices.

If your deductible had been just a little lower, would you have met it and seen some (or more) reimbursement for in- and out-of-network benefits on your PPO? If so, you might want to increase your premiums to reduce your deductible.

Should you consider changing from a PPO to an HMO or visa versa? An HMO will offer fewer options for providers and no options out-of-network, as well as additional wait time for approval of services, but at less or no cost to use and less cost to purchase.

Is there an option for a health saving account (HSA) in which the deductible is high but your employer and you can contribute pre-tax funds toward medical costs?

It’s not often that health plans give more than they cost, but be alert to coverage or discounts for weight-loss and fitness programs and alternative medicine.

Whatever is highest on your list — affordability, coverage, convenience, ease of access, choice of providers — open enrollment is the time to look back at the year that’s ending to plan for care and cost for the year ahead.