It's Open Enrollment Time

We got hit hard last year with medical costs when I had to have an emergency surgery at the end-of-the-year (Dec. 21to be exact), and ended up with a four day hospital stay.  Prior to last year, we had a local HMO insurance plan.  Had we still had our HMO plan, I would have owed very little (if anything) for this, but since we changed insurances to a PPO plan for 2011, I paid more than $3,500.00 (for myself) and at least another $1,000.00 + for my husband and daughter's bills in 2011.  Again, if we would have stayed with the HMO, we would have owed very little, if anything! 

Here's the back story.  In 2011 we decided to go with the PPO to save money on our premium expenses.  The HMO was much cheaper, but we had fewer choices and always had to play the game to get referrals, authorizations, etc for our medical care.  Seeing how we never used the HMO for much, and didn't have much in the way of medical expenses, we decided to save the "Premium Money" and go to a PPO. We would have much more flexibility with the PPO and just take our chance that we stayed healthy and didn't have any major problems.  To make a long story short, WRONG ANSWER.  As you can probably guess, we didn't save any money switching plans, and ended up paying more in the long run. If only I had that magic crystal ball, not only would I have stayed with the HMO, but I also would have chosen the winning lottery numbers

This brings me to my topic of Open Enrollment. Now is the time where most companies offer you the chance to change your insurance plan.  If you work for a big organization (such as a state entity), you probably have more than one plan to choose from. If you work for a small company, you may not be able to choose and have to go with the plan they offer.  I can't advise you on what to choose.  That is a personal decision you must make after weighing all the factors. I can give you a list of questions to ask yourself to help you make an informed decision.


      *Do you need insurance for just yourself or your family?

    * Do you need to make adjustments to your current plan?

    *Do you want to be able to have access to a large number of providers     that you can see without getting permission from your insurance company?

     *How much will it cost me?

      * How affordable are the different plans?

     *Do you want to have a high deductible so that you’re monthly premiums will be lower?

     *How do I pick a health plan?

     *Do I need to pick a primary care physician?

      *Am I able to see my current doctor on the plan?

      *What do the plans cover?

      *Are there any limits on how much I will have to pay in case of a major illness?

      *Does it cover hospitalizations for elective services?

     *Does is cover pre-existing conditions, chronic illnesses and preventative care?

      *Do I need referrals to see specialists?

     *What will my insurance company cover if I need attention for an emergency of when I’m out of town?

      *Are there any wellness incentives?

      *Will it coordinate benefits with my spouses insurance?

You may have noticed I have blogged about this in the past, but I felt it was an important topic to revisit at this time.