Evaluating Health Plan Choices

If you have health insurance through your employer, it may be that time of year where you need to make some hard choices.  This post describes my choices and methodology and is offered in the spirit of helping others navigate similar choices that may be offered through their employer.



This year there are 5 plans that have made it past my filters for consideration.  My primary initial filter is that the health care plan needs to have an adequate panel in the area that I live and work.  It doesn't matter how generous the plan is on paper, if you can't get the most affordable care which is generally by using "participating" providers.  (Participating providers may also be referred to as "in network" providers or "panel" providers).  One noteworthy "got ya" to look out for is that many providers will advertise, "we accept XYZ insurance".  This may or may not mean that they are "in network" for XYZ insurance.  It could mean that they will work with you to submit the claim to XYZ (i.e. they accept your card), but their expectation remains that you pay the balance after they accept whatever payment is made by the insurance company.

My next filter is cost, specifically what the cost is to me, the employee - how much comes out of my check?  There are several plans that offer a "Standard" or "Basic" plan and then a "High" plan. More often than not, I refer to the later as the "Are you high, plan?" because I think either they (or me would need to be seriously "high" (as in on heavy duty drugs) to sign up for the plan.  Before anyone thinks that I dismiss these "High" plans outright, I do skim through their offerings, but I am yet to find one that offers enough "extras" to justify the cost... maybe if they'd throw in a back and foot massage in my home twice a week, I might consider them, but until then, I'll save my money.

After applying my filters, I do a deep dive of the health plan's offering.  In this deep dive, I look for deductibles and co-pays.  I also look for any "perks" such as vision or dental coverage that may be included within the major medical plan.

After applying these filters and my deep dive, I am left with 5 "contenders":

1.  A consumer driven health plan.  This plan will cost me $2553 per year (my share of the policy), but it "gives back" $2400 in the form of a Personal Care Account.  There is a $1200 deductible after the $2400 is used up; after the deductible is met, a traditional health insurance plan will kick in.  Also noteworthy is that the plan permits you to use $800 of the $2400 toward vision and dental expenses.  On paper this is the clear winner.  Unfortunately, the health care company for this plan is United Health Care (UHC).  This is the health plan that I currently have and as was previously related in an earlier post, UHC has been abysmal when it comes to handling claims.

2.  Next is a High Deductible Health Plan (HDHP).  This plan will cost me about $2727 per year and "gives back" $1500 over the course of the year into a Health Savings Account.  In general HDHP plans are great if you are healthy and "so-so" if circumstances turn out otherwise.  The deductible for this plan is.  The health care company for this plan is AETNA which I consider better at claims than UHC, but also a company with plenty of room for improvement.  Another perk for this plan is that they provide a small amount of preventative dental and eye care under the plan.  A big drawback with this plan and any HDHP is that the rules relating to the allowed Health Savings Account (HSA) are extremely complicated and confusing.  You must have funds in your HSA before you can use them which makes the beginning of the year somewhat precarious (unless you are so well off that you can fully fund your HSA quickly).

3.  My third option is a traditional health insurance plan through Blue Cross / Blue Shield (BC/BS). This plan will cost me $3596 per year.  The do not "give back," but they do not have a deductible, although they do have co-pays and do require you to use network providers. I would place BC/BS near (maybe a little below) AETNA when it comes to satisfaction in the way they handle claims, but better than UHC.  This particular BC/BS does have some preventative dental and eye coverage for all family members.

4. and 5.  My 4th and 5th options are both Health Maintenance Organizations (HMO), Capital District Physician's Health Plan (CDPHP) and MVP Health Plan (I believe the "MV" at one time represented "Mohawk Valley").  CDPHP will cost $3569 annually and MVP will cost $4188 annually.  MVP provides some preventative dental for children.  Otherwise, they are very similar - no "give backs," but no deductible and both having similar co-pays.  Noteworthy is that both of these HMOs are generally well regarded by the local provider community, they handle their claims very well and have high satisfaction levels from their subscribers.

If I knew for sure that a hospitalization was inevitable, I would undoubtedly go with one of the HMOs.  Simply stated, their local relationship and handling of claims equals less headache and stress for me and a much more predictable cost of health expenses.  2012 was atypical for me and included a family member experiencing 2 hospitalizations.  I am going to remain optimistic that 2013 will be a better year with no hospital visits.  With that in mind, both the Consumer Driven option and the HDHP option are about $1,000 cheaper from the get go - coupled with the "give backs" that these 2 plans provide, a selection of one of these 2 options is compelling.  My issues with UHC aside, the Consumer Driving option clearly gives you more money back (2400 versus 1500), plus the $2400 is immediately available as opposed to the $1500 which is slowly placed into a Health Savings Account over the course of the year... it looks like it will be the devil I know for 2013... and when I do, I suppose I will begrudgingly remove UHC from my shit list.