Open Enrollment Comparing Options

Open enrollment is in full swing, and many have asked me what’s the best way compare the options that are out there.   For me, open enrollment comparing options started with figuring out where I could find the information to begin my comparison.  I hope what I’ve found over the past 4 weeks will help you as much as it’s helped me.

Open Enrollment

With all the issues and challenges occurring with the Government’s health insurance website, people are having a challenging time trying to figure out what insurance plans are available to them and what their costs for insurance for next year is going to be.  While the rollout of healthcare.gov wasn’t perfect, there are still ways for consumers to compare their options.  I found some ways to work around the glitches to figure out what health insurance is going to cost me for 2014.  So, here’s what I did so I could begin to compare the health insurance options.

Tip #1 you don’t have to have a small business or work for a small business to look at plans on the small business exchanges.

I went out to www.healthcare.gov and looked up what plans are being offered on the small business SHOP Exchange. I used the filter to select Virginia, and then I selected county Fairfax. The VA exchanged run by the federal government has 25 options for health care, with the insurers being: Care First, Blue Cross Blue Shield, Anthem Blue Cross and Blue Shield, and Kaiser Permanente.

Tip #2 check with other health insurance websites for costs.

From there I went out to www.ehealthinsurance.com to actually be able to get a viable quote for any potential insurance and verify I could keep my current doctor, with the plans available. It was easy to determine if my current doctor participated as an in-network provider for some of the insurance offering, and others I received nothing but the spinning rainbow of eternity.  The only plans that allowed me to keep my provider are plans offered by Care First BCBS.  Next I verified the cost of the plans on Care First BCBS website.

Tip #3 Compare the offered plans

I’ve put together a matrix to help me compare the different options each plan has so I could see them side-by-side.  You can download the Comparing Insurance Plan matrix here – so you can compare your options as well.

I used the the matix to compare the plans my company offered last year, with the plans that are being offered out on the exchanges, so I could identify the best health insurance plan for me and my family for 2014.  I looked at following areas:

  • Monthly premiums
  • Annual premium
  • Minimum in-network Deductible
  • Maximum in-network deductible
  • Minimum out-of-network Deductible
  • Maximum out-of-network deductible
  • Co-insurance in-network
  • Co-insurance out-of-network;
  • Health Savings Account Eligibility
  • Flexible Savings Account Eligibility
  • Prescription drug coverage
  • Lab work/x-ray coverage
  • Preventative care coverage
  • Specialist’s coverage
  • Emergency care coverage
  • Chiropractic Coverage

Once I had this laid out I calculated any additional costs that we’ve had for the past year for prescriptions, co-insurance fees, my bio-identical hormones, and speech therapy for Havoc.  These costs can include the out of pocket expenses that are applied to meet our deductible. I knew our current health insurance was expensive, and I’ve been told by my PCP that I don’t have the best coverage – but talk about a real shock what my plan costs for the entire year.

The cost breakdown of my current plan for the year:

Monthly PremiumAnnual PremiumIn Network Minimum ExpenseIn Network Maximum ExpenseOut-of-Network Minimum ExpenseOut-of-Network Maximum ExpensesAdditional Out-of-Pocket Expenses
$223.52$2,682.24$3,000$8,000$6,000$16,000$13,636.38

If we didn’t need medical care our total out of pocket expenses would be just the annual premium. However, since we do need medical care here’s what our actual costs for health insurance for the year looks like, with our additional out-of-pocket  cost and our annual premium factored into the total cost.

Annual PremiumIn Network Minimum ExpensesAdditional Out-of-Pocket ExpensesTotal Minimum In-Network Expenses for 1 year
$2,682.24$3,000$13,636.38$19,381.62
Annual Premium In Network Maximum ExpensesAdditional Out-of-Pocket Expenses Total Maximum In-Network Expense for 1 year
 $2,682.24$8,000$13,636.38$24,318.62 
Annual PremiumOut-of-Network Minimum ExpensesAdditional Out-of-Pocket ExpensesTotal Minimum Out-of-Network Expenses for 1 year
$2,682.24$6,000$13,636.38$22,318.62
Annual PremiumOut-of-Network Maximum ExpensesAdditional Out-of-Pocket ExpensesTotal Maximum Out-of-Network Expenses for 1 year
$2,682.24$16,000$13,636.38$32,318.62

The equation  for the total costs is annual premium + network deductible + additional out-of-pocket expenses = total cost. It should be noted that some but not all of the out-of-pocket expenses may be eligible to be applied to some of our deductibles.  Additionally, these costs don’t account for the fact that my current plan is eligible for tax free H.S.A of $6,5000.  If I use the entire H.S.A, it brings my costs down, however remember that an H.S.A can be leveraged like a 401K for your health care cost, so the idea is I really shouldn’t want to use the entire amount.

Now, if I look at other plans offered on the exchange I discovered there isn’t a plan that exactly matches the coverage of my current plan, with the same co-insurance fees, that are H.S.A eligible and allows me to keep my current doctor.   There are two plans, one is an HMO that does not cover out-of-network expenses and the other is a PPO that covers out-of-network expenses that come closest to my current High Deductible Plan.

 Here’s the cost breakdown for a HMO Plan from the exchange:

Monthly PremiumAnnual PremiumIn-Network Minimum ExpensesIn-Network Maximum ExpensesOut-of-Network Minimum ExpensesOut-of-Network Maximum ExpensesAdditional Out-of-Pocket Expenses
 $841.69 $10,100.28 $12,700 $12,700 $12,700 $12,700$13,636.38

If we don’t have a need for medical care for the year, you can see the total cost for the year would be the annual premium. Obviously, since we will be using medical care, here’s what our total expenses will breakout to based upon minimum and maximum deductibles  and our additional out-of-pocket  cost and our annual premium factored into the total cost.

Annual PremiumIn-Network Minimum ExpensesAdditional Out-of-Pocket ExpensesTotal In-Network Minimum Expenses for 1 year
 $10,100.28$12,700$13,636.38 $26,336.66
Annual PremiumIn-Network Maximum ExpensesAdditional Out-of-Pocket ExpensesTotal In-Network Maximum Expenses for 1 year
$10,100.28 $22,800$13,636.38$36,436.66
Annual PremiumOut-of-Network Minimum ExpensesAdditional Out-of-Pocket ExpensesTotal Out-of-Network Minimum Expenses for 1 year
$10,100.28 $22,800$13,636.38$36,436.66
Annual PremiumOut-of-Network Maximum ExpensesAdditional Out-Of Pocket ExpensesTotal Out-of-Network Maximum Expenses for 1 year
$10,100.28 $22,800$13,636.38$36,436.66

Here’s the  cost breakdown from a PPO Plan from the exchange:

Monthly PremiumAnnual Premium In-Network Minimum ExpensesIn-Network Maximum ExpensesOut-of-Network Minimum ExpensesOut-of-Network Maximum ExpenseAdditional Out-of-Pocket Expenses
 $716.76$8,601.12 $7,000 $12,700 $12,700$12,700$13,636.38

Just like my current plan and the HMO plan on the exchange, if I didn’t need healthcare the total cost is the annual premium.  However, due to medical conditions, my family and I will require healthcare for next year, so my total expenses for the PPO plan is based upon minimum and maximum deductibles  and our additional out-of-pocket  cost and our annual premium factored into the total cost..

Annual PremiumIn-Network Minimum Expenses Additional Out-of-Pocket Expenses Total In-Network Minimum Expenses for 1 year
$8,601.12 $7,000$13,636.38$29,237.50
Annual PremiumIn-Network Maximum ExpensesAdditional Out-of-Pocket Expenses Total In-Network Maximum Expenses for 1 year
$8,601.12 $12,700$13,636.38$34,937.50
Annual Premium Out-of-Network Minimum ExpensesAdditional Out-of-Pocket ExpensesTotal Out-of-Network Minimum Expenses for 1 year
 $8,601.12$12,700 $13,636.38$34,937.50
Annual Premium Out-of-Network Maximum ExpensesAdditional Out-of-Pocket Expenses Total Out-of-Network Maximum Expenses for 1 year
 $8,601.12 $12,700$13,636.38$34,937.50

Ouch, that’s a pretty big jump in costs for both options, there are other options on the exchange but they all are more expensive than my current plan. Right now my only option for a cheaper plan is to consider a PPO plan offered by my company, assuming the premiums offered last year remains the same.  This PPO has a 10% co-insurance fee, and is only eligible for a $2,500 F.S.A.

Here’s the cost breakdown of the PPO plan offered through my employer:

Monthly PremiumAnnual Premium In-Network Minimum ExpensesIn-Network Maximum Expenses Out-of-Network Minimum ExpensesOut-of-Network Maximum ExpensesAdditional Out-of-Pocket Expenses
$335.59 $4,315.08 $400 $4,000 $1,000$6,000 $13,636.38

Like the previous plans, if we don’t need health care, our maximum out of pocket expense for the year is the annual premium.   However, I know that we’ll be using the doctor on a regular basis to manage both my migraines and asthma as well as managing Chaos and Havoc’s medical issues.

Annual PremiumIn-Network Minimum ExpensesAdditional Out-of-Pocket Expenses Total In-Network Minimum Expenses for 1 year
$4,315.08$400 $13,636.38$18,351.46
 Annual PremiumIn-Network Maximum Expenses Additional Out-of-Pocket Expenses Total In-Network Maximum Expenses for 1 year
$4,315.08$4,000 $13,636.38$21,951.46
Annual Premium Out-of-Network Minimum ExpensesAdditional Out-of-Pocket ExpensesTotal Out-of-Network Minimum Expenses for 1 year
$4,315.08 $1,000 $13,636.38 $18,951.46
Annual PremiumOut-of-Network Maximum ExpensesAdditional Out-of-Pocket Expenses Total Out-of-Network Maximum Expenses for 1 year
 $4,315.08 $6,000 $13,636.38 $23,951.46

Unfortunately for me, the Affordable Care Act isn’t so affordable. So right now I need to decide between the High Deductible Plan I’m currently on and the PPO offered by my company. For my family these are the two best choices I have. I need to make the decision if the High Deductible Plan with the HSA of $6,500 and Limited FSA for dental of $2,500 is a better health insurance investment over the PPO plan with the FSA of $2,500.

Hopefully, the matrix I’ve put together will help you identify plans that will meet your health insurance needs, at costs you can afford.  Remember when comparing insurance plans, look at your monthly premium, your total premium for the year, your annual deductibles and any additional out of pocket expenses you may have.  As always, if you have any questions – just ask.

Gretchen