Health plans

Signing up for my first health plans seemed intimidating to me, so I got this expert review on open enrollment.


This is my first time enrolling in healthcare after turning 26 earlier this year. I knew I needed help.

At 8:10 a.m. on a Wednesday in late November, I had been working online for almost an hour to wrap up a few things before I did a race.

A text message from my mother echoed in my head: “You are all registered for Medicare now, aren’t you? “

The day before, my company had launched its annual open enrollment period, a window of time where people can choose new health care plans, and I had yet to have a chance to review the offers.

I decided to reread my choices before going to Trader Joe’s.

By 8:15 am, I had given up.

I had a full day’s work ahead of me and after five minutes of tooling around Fidelity trying to figure out my options, I was intimidated enough to decide to postpone my final healthcare choices a little longer.

But I knew I needed help with the open registration.

This is my first time enrolling in healthcare after turning 26 earlier this year. Prior to that, I was fortunate enough to continue to receive health care from my parents until the end of the calendar year.

As I was clearly a rookie, I spoke with experts to help me navigate the health insurance landscape: I chose Nancy DeRusso, Head of Financial Wellbeing at Goldman Sachs Ayco Personal Financial Management ; and Mya Roberson, assistant professor of health policy in the faculty of medicine at Vanderbilt University, who is also a patient with chronic illness.

Here’s what the experts say about open registration

Question: What advice would you give to someone going through open registration for the first time?

Nancy DeRusso: A good first step is to familiarize yourself with the options in your plan. Keep an open mind, ask questions, and seek financial advice if you have the opportunity, especially if your employer offers a financial wellness benefit. Remember, open enrollment isn’t just limited to healthcare, it’s an opportunity to review benefits like life insurance, long-term disability, and any other offers that may help meet your personal needs.

To choose the right plans, you need to understand the vocabulary involved. Everyone should make sure they understand the meaning of terms like deductible, maximum charge, networked and non-networked. Always check whether the doctors you are currently working with will remain in the network and whether current prescriptions are covered. HMOs generally have a restrictive network.

You shouldn’t be looking at your benefits in a vacuum – also look at your spouse’s or partner’s options to determine how you can best optimize the benefits for your personal situation.

Keep in mind that the quality of care does not change with the plan. It is important to consider your personal circumstances and medical needs when choosing a plan that is right for you.

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When choosing a health care plan, it is important to consider your personal circumstances and medical needs when choosing a plan that is right for you.

Mya Roberson: There is a lot of terminology that can be very confusing and overwhelming at first. I recommend keeping a glossary handy (like the one in Marketplace) for terms you may not be familiar with. Some of the key terms to know are premium, deductible, co-pay, coinsurance, HMO, PPO, network. I think it’s also helpful to honestly ask yourself how much could you afford to spend on a medical emergency right now, as this is something that can certainly be taken into account when choosing a plan. For people who meet certain income thresholds, grants may be available to offset the cost of acquiring health insurance. The Kaiser Family Foundation has a tool to see if you are eligible for a grant and for what amount.

Q: How do I decide which options are best for me?

From Russo: Always review your situation for the current year and previous years. Consider things like what perks did you use? What changes do you anticipate in your situation for the coming year? Are you getting married, have a child or have other family needs? Is there something in your medical history that you need to consider? Consider your benefit options taking these factors into account.

It may be helpful to review the analysis tools offered by your employer. After adding some personal information, these tools can help you gauge which benefits make the most sense.

Always seek to maximize your benefits. Make sure that you consider any incentives your business may offer, such as contributions to an FSA or HSA, bonus discounts for annual exercise or wellness credits.

Roberson: (Know) if you are looking for coverage for yourself or for other members of your family, such as a spouse or children, because the number of insureds on a policy affects the cost. (Know) if there is a particular doctor or hospital that you want to cover under the policy you choose so that you can select a plan that integrates them into the network. Also, (think) about your average health care use in a year: are you just going for routine care? Are you taking prescriptions? Do you have a condition that requires access to (specialists)? These are questions you want to ask yourself when trying to find the right plan. If you are someone who uses medical care more frequently, you may want to consider a more comprehensive plan.

Q: And what are the best options, in general, financially speaking?

From Russo: The best benefits for you will really depend on your personal situation. For some people, a high deductible plan with a lower premium may make more financial sense. For others, a traditional PPO or HMO might make more sense. The plans and benefits that were right for you last year might not be the best next year, too, depending on how your situation evolves. One of the mistakes people often make is to treat open registration as a task and just select what they did last year. Try to understand your benefits and options as much as possible to maximize the value they can bring to your personal situation.

Plus, plan for your anticipated cash flow needs. Plan your expenses in advance by considering the use of tax-efficient savings vehicles – but make sure you understand how these vehicles work before you use them. FSAs (Flexible Spending Accounts) are usually not renewed and the money in them is “use it or lose it”. HSAs (health savings accounts) can be carried forward to future years and can even be used in retirement.

Roberson: Much depends on a person’s financial situation, risk tolerance and health needs. If someone has enough cash on hand for a medical emergency and doesn’t need a lot of medical attention beyond routine visits, then maybe a lower premium plan ( monthly payment), higher deductible (the amount you pay before insurance takes effect) is fine for them. . For me, as someone with a chronic illness, a higher monthly premium for having a lower deductible works better financially. I also recognize that I am in a financial position to support higher premiums, and many are not, especially many young adults.

Choosing health insurance wasn’t as confusing as I thought it would be

Taking into account the advice of DeRusso and Roberson, I followed the steps to choose health insurance, dental insurance and vision insurance on my employer’s platform. Once I sat down and signed up, the health insurance selection process became less daunting and more about personal choice.

And I found out that I didn’t go through the process on my own with a ton of jargon and confusing costs listed. Instead, a bot called “Alex” was there to help.

“Alex” outlined the plans, deductibles, bonuses and what that meant – including co-pay rates, prescription details, and more. – in diagrams and records. Since I tend to be a visual learner, this has been extremely helpful. I looked at all the options and learned how the plans worked.

I am single and have no children, so I chose benefits for myself. I had to choose between different plan levels for each type of coverage, which took me a bit of time to consider.

The first consideration that came to my mind was the bi-weekly cost of each plan and how much I was able to swallow, financially, out of my paycheck.

Then I took a step back. What did I need in terms of health care? It was more important than the cost alone. I chose the highest premium plan with the lowest deductible which will be $ 109.10 biweekly before taxes for health insurance. I will reach my deductible at $ 1,000. I decided it was worth the cost to have the backstop and lower co-payments in the future, taking into account a regular prescription I need and the unpredictability of health needs. .

Along with dental care, I also chose the high premium plan which is $ 17.58 every two weeks before tax. And for the vision, I chose the low package at $ 2.70 every two weeks before taxes. I got my first pair of glasses last year for work and I’m not too worried about the extra costs this year.

I feel good about my selections which provide me with security and comfort. But it’s safe to say that with $ 258.76 in extra spending each month, I’ll be ordering less on DoorDash.

You can follow USA TODAY reporter Morgan Hines on Twitter @MorganEmHines and subscribe to our free Daily Money newsletter here for personal finance tips and business news Monday through Friday mornings.

This article originally appeared on USA TODAY: Open Enrollment Tips For Health Insurance: What You Need To Know