Open Season and Choosing a Plan

When it’s open season I’ve had several friends come and ask me which insurance plan they should choose. Obviously everyone’s health situation is different, but I’m going to briefly explain the process I use when I choose my insurance carriers. I am not going to include the pros and cons of high deductible health care plans (HDHPs) in this analysis for simplicity. So I am going to assume that this is for more risk averse individuals, or individuals who know HDHPs are not for them.

These are the points I will cover:

  1. Access to Healthcare
  2. Premiums
  3. Copays & Coinsurance
  4. Deductibles
  5. Reward Programs
  6. Medication Costs
  7. Out of Pocket Maximum
  8. Hospital Stays & Surgeries
  9. In-Network & Out-of-Network Benefits

1. Access to Healthcare

First and foremost when  considering any health insurance plan consider how much access is necessary to healthcare. I live in the DC metro area. Some plans I choose from are national, while others are regional, only allowing access to doctors in DC, Maryland and Virginia. Be sure to consider if you will experience:

  • Extended periods of time out of state. If your child or spouse has extended periods of time out of state
  • Second opinions outside of your region (Mayo Clinic, Cleveland Clinic, John Hopkins etc.)
  • Regularly seeing a doctor out of your region

 

2. Premium

The premium is pretty straight forward. It’s how much you pay for insurance every pay period.  For a single person in my area, some range from as low as $50 to as high as $150.  Multiply this by the number of pay periods in a year to get the annual cost. I have noticed a lot of people ONLY consider the premiums when determining their health insurance carrier. This is the biggest mistake! 

3. Copays

Copays is a fixed amount of money you pay for an office visit or procedure. Coinsurance is the percentage you pay for an office visit or procedure. A good rule of thumb is to:

  • Estimate number of visits to primary doctor and times it by the copay/coinsurance
    • 3 visits x $20 = $60
  • Estimate number of specialty care visits and multiply by the copay/coinsurance
    • 3 visits x $30 = $90
  • Consider testing you need. X-rays, MRIs, blood work, etc.

4. Deductible

A deductible is generally the amount of money you must pay before the insurance company will start paying your medical bills.  One thing I have learned is sometimes not everything applies towards the deductible! This is a good thing! I have a $500 deductible, but it only applies if I end up in the hospital. So other than the copay, my insurance will fully cover doctor visits, testing etc. on the very first day of coverage. This year I hit my out-of-pocket maximum without reaching my deductible.

5. Rewards Program

Some insurance programs reward you for being healthy. I get a $500 reward card if I am not overweight, diabetic or hypertensive. I can use this to pay my copays or deductible.

6. Medication Costs

Don’t forget to compare this as well!

7. Out of Pocket Maximum

This is the most you will pay out of pocket. This is important to consider, because if one plan is slightly cheaper in every way but has an out of pocket maximum that is significantly higher then it might not be the plan for you.

8. Hospital Stays & Surgeries

If you know you have a hospital stay or a surgery coming up, or that you are likely to end up needing either or. Compare these benefits. Some insurance plans bill hospitals stays each day. Others are per stay. Then there are the coinsurance plans.

9. Network Benefits

If you want to see an out of network doctor be sure to check the out of network benefits your plan has to offer. Remember if the doctor bills beyond what the insurance company is willing to pay you will owe them the copay/coinsurance plus the unpaid amount.

Simplified Example

Below is a simplified example of two health care plans. It is similar to a decision I had to make when I was choosing health care plans this open season:

Plan A Plan B Conclusions
Premium 50 85 Plan A costs $1300/year

Plan B costs $2210/year

Copays/Coinsurance 20% copay for appts

20% coinsurance for all other services

$10 copay for Primary

$30 copay for specialist

$50 Urgent Care

… various fixed copays for all other services

Plan A – 3 appts = $210

Plan B – 3 appts = $160

Deductible 0 $500
Rewards Program None $500 Reward
Medications $10 copay $5 copay Plan A – 5 meds/month = $600

Plan B – 5 meds/month = $300

Out of Pocket Maximum 3000 3000

Conclusions

The estimated costs for each plan is as follows

  • Plan A = 1300 + 210 + 600 = 2110
  • Plan B  = 2210 +160 + 300 – 460 = 2210

The most I would pay with Plan A is 1300 * (0.70) + 3000 =  3900
The most I would pay with Plan B is 2210 * (0.70) + 3000 – 500 (reward) = 4047

Where 0.70 is a multiplication factor to convert pre-tax dollars (my health care isn’t taxed by my employer) to after tax dollars.

In every way Plan A is estimated to be cheaper, but  personally I went with Plan B because I’d be able to smooth my spending. The fact that plan A has coinsurance rather than fixed copays suggests that I may be paying a large sum of money very early on in the year and hit my out of pocket maximum quickly. $147 is not enough for me to pick Plan A over Plan B unless I had a very solid emergency fund to fork over $3,000 all at once and then some in the case of a catastrophic health situation.

Recap: 2016

This year marks the beginning of my personal finance journey, which began one month after completing my PhD.  Thanks to a financially savvy friend, who was well on their way to financial independence, I quickly became motivated to do better. I also realized it would be a good idea to prepare for the unfortunate but likely scenario of disability retirement.

Liquid Assets Jan-16 Dec-16 $ Change
Cash & Savings $3,946 $2,357  ($1,589)
FSA $1,625 $0  ($1,625)
Other $0 $290 +$290
Retirement Jan-16 Dec-16 $ Change
Roth IRA $3,620 $11,749  +$8,129
401K $4,069 $11,339  +$7,270
Liabilities Oct-16 Dec-16 $ Change
Credit Cards $773 $0 +$773
Medical $0 $175 ($175)
Piano $2,893 $0 +$2,893
Net Worth $9,594 $25,749 +$16,165
% Change +286.5%

In the aspect of personal finances, 2016 went by smoothly.  My net worth almost tripled, and I surpassed  a $25,000 net worth!

Typically a bad health year is seen as a catastrophic event, but for me every year tends to not be so hot for my health. While I didn’t mention or record all of my medical expenses, they were high.  I ended up reaching my out of pocket maximum. This happened last year as well. Thankfully, my FSA cushioned a lot of the blow and I am do well at cost minimization when shopping for a health insurance plan.

Overall  I’m pleased with where I ended up.  The only thing that disappoints me is the lack of liquid assets. When I skim through my entries I can see that $2,000 in catch up IRA contributions and a $2,900 loan repayment were big contributing factors to this. With that in mind, my Cash & Savings did increase otherwise. Still this is one thing I really need to work on.

Half way through 2016 I changed the software I use to track my spending. I started off using both mint and personal capital, but after further consideration, I no longer feel comfortable having a third-party know my login/banking information. I now manually enter my transactions into Quicken, That being said,  below is my spending for the year.

spending-2017

According to Quicken, I spent $35,233.48 in 2016. There is a “Bill & Utility” payment for $2,375 to my company for over-reimbursment for my relocation. Therefore, I really only spent $32.858.48.  For reference, in 2015 I spent $37,389. A lot of this had to do with a $4,000 piano purchase, moving expenses (such as paying double rent) etc. When I lived exclusively in the midwest, I spent $22,569 in 2014, $19,409 in 2013, and $22,623 in 2012.

Net Worth Update – December 2016

There is no more spending to be had in December so it’s time for the update. December was difficult due to the holidays but my net worth still managed to increase by more than 7 percent. I’ve also officially separated out and started working on my emergency fund!

Liquid Assets Nov-16 Dec-16 $ Change
Cash & Savings $2,102 $832  ($1,220)
Emergency Fund $1,500  +$1,500
Other $240 $290 +$50
Retirement Nov-16 Dec-16 $ Change
Roth IRA $11,309 $11,756  +$447
401K $10,657 $11,521  +$864
Liabilities Oct-16 Dec-16 $ Change
Credit Cards $228 $0 +$288
Medical $75 $175 ($100)
Net Worth $24,005 $25,749 +$1,719
% Change +7.2%

Liquid Assets: Obviously the decrease in Cash & Savings is due to its transfer into the Emergency Fund.  I have a solid $1,500 emergency fund which is almost one month’s worth of living expenses. The “Other” category shows that people still owe me money and I am owed $50 more than last month.

Retirement: My retirement accounts increased nicely. I continue to make regular contributions and it appears that the markets performed well. I have not been paying attention to the markets to be honest.

Liabilities: I decided not to carry over any credit card debt this month and I would like to get into that habit. I still have medical bills to pay though.

Budget

I was pretty certain I wouldn’t meet my budget in December. I was correct, however I actually didn’t do too bad. I ate out a lot more this month than I usually do but should be able to save quite a bit next month since I now have groceries stock piled.  I live in DC and I go to restaurants semi-freely but still manage to keep my food expenditures low. For reference my food spending includes eating out at restaurants three times ($82) and eating fast food two times ($14). The rest of the money includes grocery store purchases. The Quicken software I use to track my spending doesnt properly categorize some of my spending if I buy groceries on amazon, for instance, so that explains some of why my food expenditures are low. But mostly I don’t eat much meat or buy more than 2-3 days worth of food at a time because that’s all I can carry without a car. In other words, I don’t waste much. I’m not terribly pressed on categorization as long as I don’t go over the total budget for the month.

Category Budgeted Actual Remaining
Rent $1,650 $1,650 $0 left
Fixed Expenses $100 $93 $7 left
Food $200 $263 $63 over
Health $175
Gifts $250 $250 $0 left
Everything Else $300 $293 $7 left
Total  $2,549  $2,500  $49 over

Net Worth Update – November 2016

November was a another high spend month, making for two high-spend months in a row. I did anticipate November being this way due to a vacation. Thankfully, things still seem to be moving along. As you can see in my net worth outline below, the only category that decreased was the “Pending” category, meaning I received payments for money owed to me.

Assets Oct-16 Nov-16 $ Change
Cash & Savings $1,901 $2,102 +$201
Roth IRA $10,372 $11,309 +$937
401K $9,799 $10,657 +$858
Pending $400 $240 -$160
Liabilities Oct-16 Nov-16 $ Change
Credit Cards $361 $228 +$133
Medical $75 -$75
Net Worth $22,111 $24,005 +$1,894
% Change +8.6%

Below was my budget for November vs my actual spending. I went $52 over my totaled budget, mostly because I bought a new tablet, sorry not sorry. I don’t budget for health expenses, but do like to keep them on record.

While the tablet wasn’t planned, I was so far under my vacation budget, that I purchased it anyways, plus I needed to. My current tablet is 4 years old and has been acting funny for the last few months, it should be arriving tomorrow!

Category Budgeted Actual Remaining
Rent $1,650 $1,650 $0 left
Fixed Expenses $100 $91 $9 left
Food $200 $208 $8 over
Health $190
Vacation $630 $470 $160 left
Everything Else $300 $513 $213 over
Total  $2,880  $2,932  $52 over