Stop Letting Open Enrollment Choose for You — You Have More Options Than You Think (Bill of Health Ep.3)

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Stop Letting Open Enrollment Choose for You — You Have More Options Than You Think (Bill of Health Ep.3)

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Open enrollment can feel like a take-it-or-leave-it decision: pick one of the health plans your employer gives you, accept the cost and watch more of your paycheck disappear. But it doesn’t always have to work that way. In this episode of the Bill of Health Podcast, presented by Core 360 Benefits Group, I explain why open enrollment should be treated more like a buffet than an all-or-nothing package. You can compare benefits, mix and match coverage between spouses and explore alternatives when the medical plans available through your employer do not fit the way you actually use healthcare. I also explain why the most expensive or comprehensive health plan is not automatically the right plan for you. Some people genuinely need a “Mercedes” level of coverage because of chronic conditions, specialists or ongoing medical needs. Others may be paying for more healthcare coverage than they regularly use. One alternative I introduce is combining direct primary care with a health sharing organization. For relatively healthy individuals and families, this approach may provide another option worth exploring outside of traditional employer-sponsored health insurance. We also open the Jargon Jar to break down one of the most common open enrollment decisions: the difference between an HMO and a PPO. In This Episode of Bill of Health: I discuss: Why open enrollment decisions can have a major impact on your take-home payWhy you should not automatically accept the benefits presented by your employerHow to think about open enrollment like a buffet instead of an all-or-nothing packageWhy couples can “divide and conquer” by comparing benefits from both employersHow mixing medical, dental, vision and other benefits may save moneyWhy the health plan offered to you may not match the way you actually use healthcareThe difference between needing a “Mercedes” health plan and being comfortable with something simplerHow direct primary care (DPC) worksWhy direct primary care can offer more access to a doctor or nurse practitionerHow health sharing organizations work alongside direct primary careWhy direct primary care and health sharing may be worth exploring for relatively healthy familiesThe difference between an HMO and PPOHow networks, referrals and out-of-network coverage differ between HMOs and PPOsWhy getting a second opinion before open enrollment may help protect your paycheck Be a Smarter Open Enrollment Shopper Treat Open Enrollment Like a Buffet You do not necessarily have to choose every benefit your employer offers. Think about open enrollment like a buffet: choose the benefits that make sense for you and your family, and leave behind the ones that do not. If your employer’s medical insurance does not fit your needs or budget, it may also be worth exploring whether other options exist. Divide and Conquer Your Benefits If both you and your spouse have access to employee benefits, compare them. One employer may offer better medical coverage, while the other may have less expensive dental, vision or supplemental benefits. Your entire family does not always have to be enrolled in the same plan. Comparing both benefit packages and mixing and matching where appropriate may help you get more value from the benefits available to you. Choose the Plan That Matches How You Use Healthcare Not everyone uses healthcare the same way. If you rarely visit the doctor and do not have chronic medical conditions, the most comprehensive and expensive plan available may offer more coverage than you regularly use. On the other hand, if you or someone in your family manages a chronic condition, regularly sees specialists or needs coordinated medical care, a more comprehensive health plan may be worth the additional cost. The goal is to understand what you actually need instead of simply selecting a plan because it is the default option. Explore Direct Primary Care and Health Sharing One alternative I introduce in this episode is direct primary care, or DPC. Direct primary care is typically a subscription-based relationship with a physician or nurse practitioner. Instead of relying on traditional insurance for primary care visits, you pay a monthly membership fee and may receive greater access through appointments, calls, emails or text communication. For some relatively healthy individuals and families, pairing direct primary care with a health sharing organization may offer another way to manage everyday healthcare expenses while having support available for larger medical needs. Health sharing organizations are not health insurance companies. They are membership-based organizations in which members contribute toward eligible medical needs according to the organization’s rules and guidelines. This approach is not necessarily right for everyone, but it is an option worth understanding before assuming traditional employer-sponsored medical insurance is your only choice. Understand HMO vs. PPO An HMO, or Health Maintenance ...

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