March 20, 2023

Bucks Blog: The Annual Health Benefits Gamble

It’s soon to be open enrollment season for many workplace health plans, when employees choose their coverage for the coming year. And while this may be an annual ritual, many workers, according to a recent survey, have trouble determining which plan is right for them.

Choosing annual benefits is often a gamble, even if, like my family, you’re fortunate enough to be in good health and have pretty good insurance options. None of us has a serious chronic condition, and we use few prescription medications. So last year, after weighing our choices, we opted to keep our monthly premiums low by going with what we considered to be a substantial ($5,000 plus) family deductible. Everyone was reasonably healthy, we reasoned. Our children are well out of the phase when they catch every bug going around school, and we had enough emergency savings in case something pricey cropped up.

Essentially, we considered the odds and wagered that the coming year would be like the last year. And we pretty much lost that bet.

Illness happens, even to generally healthy people. For various reasons, our family ended up having unusually frequent visits to the doctor (not to mention the dentist, but that’s another issue). So we quickly exhausted the upfront health “credit” that our plan provides, to cover costs before the deductible must be met. We probably won’t top our deductible, but we’re still (ouch) a couple of thousand dollars out of pocket. Our overall bill at the end of the year would probably be lower if we had gone with a higher premium and a lower deductible.

So it’s no surprise to me that a survey from the health insurer Aetna found that consumers think health care benefits decisions are confusing, second only to retirement savings in complexity.

The Aetna Empowered Health Index Survey was conducted over the phone, including both land line and cellphones, by KRC Research in late July among 1,500 adults. The margin of sampling error was plus or minus 3 percent.

A quarter of Americans who have health insurance told the pollsters that they found it difficult to make the right health decisions. They said the available information was confusing and complicated (88 percent), there was conflicting information (84 percent), and it was difficult to know which plan is right for them (83 percent).

Also, 81 percent said they found it difficult to make decisions because they didn’t know the cost of various medical procedures.

It all sounds dishearteningly familiar, as we prepare to evaluate our choices again.

On the plus side, health plans this fall are required by the Affordable Care Act to provide a simple-language “Summary of Benefits and Coverage” form, to help consumers compare health plan options. Consumers Union, which helped test the format of the disclosure form before it was adopted by the federal government, offers a sample form online. It also includes a coverage example of how much certain events, like having a baby, would cost under the plan. You also can give your opinion on the form you receive online. The forms are available to people insured through employers, as well as those shopping for insurance on their own. If you don’t get such a form, you should contact your insurer or your employer, Consumers Union advises.

How do you make decisions about health benefits coverage? Does your plan offer helpful tools for making the choice?

Article source: