My husband and I are insured under his work health
insurance, and open enrollment just ended in mid-November. We
decided to keep our PPO plan the same, but we’re adding a small flexible spending account (FSA)
annual contribution. I’ve always reviewed paperwork for open enrollment, but I paid a lot more attention this year.
He works for a large company, so the benefits are really
good. There are three levels of health insurance, select PPO, standard PPO and
HMO. The company also offers dental, vision, and FSAs for medical/dental,
dependent day care and transportation reimbursement.
We’ve carried the more expensive select PPO since he
started, and we’re keeping it. The payroll deduction is the highest, but
since we cut the budget so close every month, and it looks like my
husband’s health care expenses will be higher next year, we don’t
want to open ourselves up to high coinsurance costs.
I didn’t realize this, but chiropractic and
acupuncture services are each covered up to 30 visits per calendar year. We
definitely might look into taking advantage of this coverage of alternative
therapies in 2009, especially the acupuncture.
The copays are the same between the select and standard PPO,
but the main reason we’re not downgrading to the standard PPO is the
coinsurance requirements for hospital care, lab tests, radiology and outpatient
surgery, in addition to coinsurance for out-of-network coverage. Jeremy at Generation X Finance has a great primer on the differences between copay and coinsurance if you're not entirely clear.
For
in-network care, the select PPO has 100% coverage after deductible, while the
standard requires 20% coinsurance. For a $450 lab test my husband had this
month, that would have meant a difference between paying just $150 for our
deductible under select PPO to paying $150 deductible plus $60 coinsurance. For
out-of-network coverage, the coinsurance costs are lower under select (30% v.
40%). All it would take is one hospital visit or outpatient surgery to really
throw our budget for a loop.
We typically only use preventative care, which is
100% covered in-network after the copay, but you never know. I plan on tracking
our health care spending next year so that we can possibly move down to
standard PPO in 2010. If the out-of-pocket max is less than what we can save in
the FSA at that time, and still use the FSA up by the end of the year with other
expenses, the much-lower premium for standard PPO may make sense for us (the
difference is premiums for standard PPO is less than half of what it is for
select). Of course, we’ll have to also consider what this will do to how
much of our income is taxable. Since the HMO has no out-of-network coverage,
it’s not really an option, especially since the payroll deduction is only
a little bit less than the select PPO.
While we are absolutely not planning on
having children, we both have all the working parts, so to speak, and the
maternity coverage for in-network services has a huge difference in coverage.
For the select PPO, the in-network coverage for maternity is 100% after the $15
copay for the initial office visit and the deductible. Standard only offers 80%
coverage in-network after copay and deductible.
The company also offers personal health resources: personal
health support, maternity support, autism advocate and 24/7 Nurseline.
I’ve already put the number for the NurseLine on our fridge, but we may
look into the personal health support (if we qualify) for my husband.
Included in either PPO coverage is prescription drug
coverage, mental health and substance abuse coverage, and vision coverage. I
learned that we can save a significant amount of money by using our
provider’s prescription-by-mail service, so that’s something to
keep in mind in the coming year for the small number of prescriptions that we
get filled. In addition, if you have the same prescription filled more than
three times at a retail pharmacy, the coinsurance increases.
The only real change that we’re making is adding the
flexible spending account. We’re not making a huge annual contribution to
avoid losing any money, but quite a few of our out-of-pocket costs would be
covered if we had already enrolled, so we’re going to start small. I take
allergy medicine March – November, and wear glasses and contacts. My
husband has just been put on Prilosec daily, and he has significant dental
expenses not covered by our dental insurance. In addition, we could apply
copays, coinsurance, deductibles and lab tests that are not covered by the
health plan.
We probably had at least $600 in FSA-eligible expenses this year, and I wouldn't be surprised if it were more than $1,000. While I’m looking forward to reducing our
taxable income, until we’re on steadier ground as far as finances, I
don’t want to reduce my husband’s paycheck by much. They also offer
a debit card linked to the account, so we’re opting to receive that also. Five Cent Nickel posted about FSAs and open enrollment recently, as did Clever Dude.
For dental coverage, well, we’ve been battling them
all year, so I don’t even want to think about it. But the payroll
deduction amount isn’t very high, and we earn that out based on my semi-annual visits alone, so we’re going to keep it. I hate giving them
our money, though.
Consumer Reports also has a handy guide to choosing health benefits (via Lifehacker).