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 pay
- Why you should not automatically accept the benefits presented by your employer
- How to think about open enrollment like a buffet instead of an all-or-nothing package
- Why couples can “divide and conquer” by comparing benefits from both employers
- How mixing medical, dental, vision and other benefits may save money
- Why the health plan offered to you may not match the way you actually use healthcare
- The difference between needing a “Mercedes” health plan and being comfortable with something simpler
- How direct primary care (DPC) works
- Why direct primary care can offer more access to a doctor or nurse practitioner
- How health sharing organizations work alongside direct primary care
- Why direct primary care and health sharing may be worth exploring for relatively healthy families
- The difference between an HMO and PPO
- How networks, referrals and out-of-network coverage differ between HMOs and PPOs
- Why 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 Organization, generally requires you to receive care within a defined network and typically uses a primary care physician to coordinate your care and provide referrals to specialists.
A PPO, or Preferred Provider Organization, generally provides more flexibility. You can typically see specialists without a referral and may have access to out-of-network providers, although you will usually pay more for that care.
HMOs often have lower monthly premiums because care is more tightly managed within the network. PPOs typically cost more but provide greater flexibility.
Understanding how you use healthcare, which doctors you want to see and how important network flexibility is to you can help you decide which type of plan makes more sense.
Learn More
To learn more about individual health insurance options, Medicare planning and healthcare consumer strategies—or to schedule a consultation—visit: www.core360benefitsgroup.com
For more practical healthcare tips, price-comparison strategies and consumer advocacy insights
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Disclaimer
This podcast is provided for educational purposes only and should not be considered legal, tax, investment or insurance advice. Individual circumstances vary, and listeners should consult qualified professionals regarding their specific healthcare and financial situations. Opinions expressed by the host and guests do not necessarily reflect the views of any insurance carrier or affiliated organization.
Chapters
00:00 Open Enrollment Is Coming — Are You Ready?
01:49 How to Protect Your Take-Home Pay
03:42 The Open Enrollment Mistake Bill Sees Over and Over
04:37 Open Enrollment is Like a Buffet
05:25 What Being a Smarter Healthcare Consumer Really Means
06:17 Divide and Conquer Your Family Benefits
09:20 Your Employer’s Health Plan Isn’t Your Only Option
09:55 Direct Primary Care + Health Sharing Explained
10:16 How Direct Primary Care Works
12:10 How Health Sharing Organizations Work
13:23 Rethinking Your Open Enrollment Choices
14:05 Jargon Jar: HMO vs. PPO
16:53 Open Enrollment Takeaways
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