What's different this year?
Most employers have changed their plans this year due to the
economy, say Rubin, and you'll have to foot a much larger
portion of the bill. Health care costs have soared, and in flush
times, employers have absorbed those increases. But when companies
are choosing between layoffs or passing health care costs to
employees, they often pick the latter (or both).
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What's the difference between an EPO and PPO and
HMO?
It's worth nothing that all plans are different and depend on
what benefits your employer has packaged together for you, but
here's an overview: HMOs are typically the
lowest overall cost option because the care is tightly managed and
there are no out-of-network benefits, says Rubin. So if
you have an HMO, but your doctor's not on the plan, you're
stuck footing the entire bill. (Sometimes you will pay a little
more out of your paycheck for an HMO than for a PPO because HMOs
typically have lower copays, no deductibles or other savings.) An
EPO is basically like an HMO, but it is
open-referral, meaning you don't have to see your primary care
doctor for a referral to, say, a podiatrist or other specialist if
you need one. PPOs let you have some
out-of-network care, so you can keep seeing any doctor--although it
can still be expensive to do so. And some companies also offer
high-deductible plans, which typically have very
low premiums. If you're generally healthy, and paying a $5,000
or $10,000 deductible won't break you in an emergency, then
these types of plans may be an option, say Rubin, "But if you
can get into an HMO or PPO, I'd recommend it. High-deductible
plans are risky, and you have to be able to stomach that. It's
like going to Vegas--some people are comfortable in Vegas, and some
aren't."
Shouldn't I just choose the cheapest
one?
In a word, no, says Rubin. "Many employees only look
at the rate sheets when choosing health insurance--and that's a
mistake." You need to look over your last year's medical
costs (ideally the last three years) to determine what is really
the cheapest option for you. How many times did you go to the
doctor? "If you utilize healthcare frequently, it is usually
cheaper to select an 'enhanced' plan. Your premiums out of
your paycheck are higher, but the out-of-pocket amounts you pay at
the doctor are typically lower, so you save in the end," says
Rubin. If you're a generally healthy, get-one-checkup-a-year
kind of gal, you may want to go for a basic plan with a cheaper
premium, and then just pay the extra copays or fees for that one
visit. "Just remember, this is insurance, and you are
protecting yourself from the risk of something bad happening--there
are no guarantees. But this rule of thumb usually works," says
Rubin.
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What is coinsurance, anyway?
For some people, this may be a new part of your benefits.
"Coinsurance essentially says that you as an individual are
responsible for a portion of the bill," says Rubin. Whereas in
the past, you may have had to just fork over a copay and the rest
of the visit was covered, if you now have a plan with coinsurance,
you'll be required to pay for the copay plus a
percentage of the rest of the cost. Those costs can really add
up--especially if you go out-of-network.
Have more questions?
Check out rubinhealth.com. And remember,
although benefit sheets can be intimidating, it's crucial to
take the time to dive into the details. "You'll find
it's not that complicated," says Rubin. "Just look at
the plan with pen and paper, and figure out what you're
utilization of services are. It could be the most important hour or
two you'll spend all year."
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