Open enrollment thoughts

Open enrollment season is coming up really soon. I just got the e-mail from Duke HR that outlined the choices I’ll need to wrestle with. Medicare’s open enrollment starts on October 15th. Covered California opens up their enrollment period on the 15th as well for the individual market. Healthcare.gov will run their open enrollment starting on November 1st. January 1 is the most common start date for employer sponsored insurance so corporate open enrollments are going into high gear now.

There are a lot of questions that someone going into open enrollment needs to ask as they make their decisions:

  • What are the choices being offered?
  • Am I or my family member(s)  guaranteed to run up a certain level of costs or am I only worried about getting hit by a surprise?
  • How important is our current set of doctors/hospitals?
  • If something bad happens do I have a preference for certain docs and places?
  • How much is the trade-off between monthly premiums and out of pocket costs

Duke has a very small, curated set of choices.  There are four health insurance choices with three networks and fairly low variation in benefit configurations.  There are three dental plans and a vision plan.  This is an easy set of choices.  I am fairly certain that I am going to be perplexed at some point though.

Some counties on the ACA have a single insurer offering sixteen different Silver plans in 2018.  Other counties have over one hundred plans from half a dozen insurers.  Medicare Advantage has dozens of options in some counties from multiple insurers.  Medicare Part D drug plans are frequently numerous.

Choosing insurance is hard.  The best advice that I can give to you is to ask for help and take your time.  Lay out your objectives and constraints.  Lay out what trade-offs you are comfortable making and then knock out the easy failures and then think about the plans that are meeting your minimal standards.  When I buy insurance, I acknowledge to myself that I probably won’t choose an optimal choice but I should be able to choose a satisficing choice.

Picking an insurance plan is tough so accept that fact and don’t be scared of that fact.






18 replies
  1. 1
    Yutsano says:

    Just as a data point: the FEBHP plans are going up only 1.3% on average this year.

  2. 2
    Brachiator says:

    And of course,

    …The Trump administration is planning hours-long downtimes for maintenance on healthcare.gov during the coming ObamaCare sign-up period.

    The administration drew criticism for a similar move last year from advocates who said the downtime would hinder efforts to sign people up for coverage, but the administration counters that maintenance downtime happens every year and is designed to occur during the slowest periods on the site.

    The maintenance schedule is the same as last year, the federal Centers for Medicare and Medicaid Services said Tuesday, meaning healthcare.gov is scheduled to be offline for maintenance from 12 a.m. to 12 p.m. each Sunday during the sign-up period, except for the final Sunday, for a total of 60 hours of downtime.

  3. 3
    Amir Khalid says:

    @Brachiator:
    Overt wickedness is the one area in which the Trump administration has set a high bar.

  4. 4
    FlyingToaster says:

    I’ll put a big tick by your third bullet point: If you have a set of doctors you like/trust/want to keep, make sure they’re in your plan.

    When HerrDoktor last changed jobs, he asked me what was our criterion for a health plan, and I sent him a list of every doctor we’d seen since 2002. And a note that every regular doctor is affiliated with [redacted Harvard teaching hospital] and referrals outside of the hospital have been to satellite facilities of Partner’s or Children’s. His company hired a specialist to handle all of the inputs from the incoming employees (it was a startup). We ended up with an HMO plan that included all of our doctors and the entire practices of our (mine and his) doctors’ and WarriorGirl’s pediatric&adolescent group. Dental and vision are included.

    This past summer there was a plan change; we could stay with the previous plan for a signficant bump, or take “Hospital Choice” for a price reduction. “Hospital Choice” means to avoid (or pay a higher co-pay for) the two flagship hospitals for Partner’s (Mass General, Brigham & Women’s), and Children’s; their satellite campuses and other Partner’s hospitals are unaffected.

    Our home hospital was unaffected. The emergency hospitals for his work and her music school were unaffected. He had their outside specialist make sure that this was true. So we took the price cut.

    It’s still incredibly important to make sure that the plans, as they morph, still cover what you’re actually using and likely to use.

  5. 5
    Yutsano says:

    @FlyingToaster: I need to find it later, but there was a good article in NYMag about how even employer sponsored insurance is getting so prohibitively expensive that it’s costing raises and promotions.

  6. 6
    MazeDancer says:

    Of course every state is different, but having bought insurance in 3 states, it always seemed like, if you had a claim that year, you were going to pay the same amount to the insurance company.

    Deductibles could be higher, payments lower, but if you made a claim, the deductible plus payments were going to catch up.

    The reason to go with the higher deductible, lower payments was a roll of the dice. Maybe you would have no claim that year, then you’d be ahead.

  7. 7
    geg6 says:

    I don’t really have a choice when it comes to health insurance, but I am wondering about how or if the CVS/Aetna merger is going to affect mine, especially if it means lower costs or better benefits. We have Aetna for insurance and CVS for prescription coverage, so it may just be a wash?

  8. 8
    Served says:

    Sat through our open enrollment meeting at the office yesterday. I’m young-ish, I’m single, and my current biggest health question is likely to be whether or not to get on PrEP, but sitting through the byzantine explanation of our plan (preferred providers, preferred drugs, preferred prescription partners, varying deductibles) really re-fired me up about how unnecessarily complicated this whole system is.

  9. 9
    Mike S says:

    OT: I’m seeing an edit button for comment 8, which isn’t mine! I haven’t clicked on it to see what happens. It’s tempting though.

    eta: edit works now after I posted this comment.

  10. 10
    Ohio Mom says:

    Knowing you probably won’t make an optimum choice but most likely a satisficing one is just about all of life I think.

    Ohio Dad’s employer no longer gives us any choice so we are spared these calculations. Doesn’t matter if this is a good thing or not, it is the only thing.

    All of our doctors are with the two biggest networks. I’m guessing there is a symbiotic relationship between every big insurer and the local hospital-based networks. At least that is what I am counting on.

  11. 11
    Kelly says:

    @Brachiator: I spent decades as an IT guy for mainframe accounting applications. If I had told my accountants the system would be down for maintenance when they were closing the books it would have been a short career. I read that last year the actual downtime was 21 hours out of the 60 so there’s that. Funny how many computer glitches have happened in voter registration systems lately.

  12. 12
    Aurona says:

    I have worked for insurance companies (Blue Cross So Cal, Blue Shield San Francisco) and now in retirement I audit Medicare Advantage (secret shopper) plans. For this year, I found a Humana plan, $0 doctor visits, $25 specialist and $3600 total out of pocket for the year, all at my same Polyclinic doctors I’ve been going to these last few years. If you are concerned about those yearly totals, almost 75% of the plans have a $6700 total out of pocket, so that was a huge concern to me if anything popped up, so the $3600 was more suited to what I could handle – without putting up a reverse mortgage on my house to pay for medical expenses. Also included; gym membership, $50 OTC medications (aspirin, etc.).
    The catch on this Advantage Humana plan is no drug plan included, so a separate drug plan, which I found for $18 is required. Stil, $18 a month is not bad.

  13. 13
    Droppy says:

    When David Anderson says ” I am fairly certain that I am going to be perplexed at some point though.” I want to hang myself. If he can’t figure something out, what hope do I have? Perhaps getting their pesky customers to hang themselves is part of the plan.

  14. 14

    @Brachiator: This is a constant; it is not new. Analytically, that distinction matters a lot.

  15. 15
    FlyingToaster says:

    @Yutsano: That may vary a lot by state.

    In Massachusetts, we had Romneycare before Obamacare; there’s a lot of state regulation on top of the Federally-gutted ACA.

    On top of that, most of the Boston-area hospitals are teaching hospitals (not Carney, not the various rehab hospitals, but pretty much everybody else). Some of them have exclusive school affiliations, others have clinical fellows on staff. With three medical schools in town (Harvard, Tufts, BU), it leads to a lot of very expensive health care going on.

    However, we also have economies of scale, because there are a fuckton of people (4.6 million‽) inside of I-495. And the vast majority of the salaried workers are either in corporate or small business group plans; before we moved in together I had health insurance through a professional group. Everyone else is on the exchange or Medicare/Medicaid except for Christian Scientists and nutters.

    So the prices have stayed pretty stable, on the exchange or off, with targeted increases for expensive providers (BCBSMA has a “HMO-Partners” tier to cover the Mass General/Brigham’s/Cape Cod affiliates, which was what our previous HMO plan morphed into).

    But that’s Massachusetts, and Greater Boston. It might map well onto states with their own exchanges, but not ones relying on the ACA.

  16. 16
    Ruckus says:

    David
    And I used to think it was tough trying to pick out a plan for my employees. Start with 10-15, getting rid of the first 80% was easy. Then it became a guesstimate of best. Cost effective/decent coverage. And this was 40 yrs ago. I’d bet it’s a bit tougher today.

  17. 17
    Mnemosyne says:

    The Giant Evil Corporation added a new option this year that is a severely limited HMO network that requires you to participate in the workplace wellness program, but is a LOT cheaper than the other options. I’m trying to decide if I’m going to switch to PPO this year or stay with the regular HMO but switch doctors because I hate the HMO my doctor belongs to with the fiery hate of 10,000 suns.

    That’s something that seems to be a little weird with our options — the HMO I belong to is separate from the insurance company, and if I choose a different doctor, I will probably end up in a different HMO.

  18. 18
    Chris Johnson says:

    @Droppy: Yeah, as near as I can see it, we’re at ‘give up, have no health care, hope to be lucky’. There’s no chance I’ll be able to have any health care. It’s just not happening.

    On the bright side I’m seeing a lot of people die of heroin overdose. I’m in recovery and don’t use drugs, so that bullet at least I can dodge. For everything else, I will have to just keep fit and hope to be lucky, or die.

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