Which Insurance Do I Choose



Right now, is open season for picking of insurances and I have a lot of clients that are asking me about which insurance plan is the best to pick. It really depends on what your/your family’s healthcare needs are.  Is/are you/your family healthy?  Little to no need to see a provider except for yearly check ups or for preventative services.

High deductible options with Health Savings Accounts where your deductible can be anywhere from $3,000 to $10,000 or more are increasing in popularity. These plans tend to have lower monthly premiums which is appealing, but you must read the fine print. (Preventative services such as flu shots are most likely covered with no out of pocket cost to you).

Consider your prescription needs. Most of these plans (always check with your HR department for clarification and coverage) count your prescription drugs towards the deductible.  If you have health conditions that require a lot, or very high costing medications, then this plan may not be the best for you.  You will have to pay out of pocket for these until your deductible has been met before the insurance plan starts to pay anything.

If your medication needs are few, or very cheap (generics), then paying small amounts monthly towards your deductible maybe ok. You can always check to see if a “mail in pharmacy” option is available.  These are also very popular and a way to keep costs down.  Typically, 90 days of the medications are ordered at a time and delivered to your home.  Some pharmacies are filling 90 days of generics locally for about the same, or slightly more than you would pay for home delivery.

The nice thing about the HSA accounts is the money that you put into the account can be carried over from year to year unlike the accounts where if it is not used by the end of the year, it is forfeited. The carry over is available to help meet the next years deductible.  You also are given an HSA credit card which is linked to your account and can be used at the point of sale so there is no forms to fill out later or waiting for your reimbursement.

If your health care needs are greater than what is described above, then a plan that may be more monthly out of pocket costs may be a better option. You pay more monthly but have a lower deductible.  You can meet your deductible quicker, and have the plan start to pay a percentage of the costs (co-insurance) once the deductible is met.  This is where the 80/20 or 90/10 split comes in.  Insurance pays 80% or 90% of contracted allowable charges, and you pay the other 20%/10%.  Most of these plans have a separate prescription coverage which does not go towards the deductible but may have its own deductible.

In almost every case, copays are due at the time of services. These are separate from deductible and coinsurances.

Every insurance is different, so you must take the time to read what is covered and how it is covered. Just remember to always take your ID and your wallet to any visit that you may have and be prepared to pay, at a minimum, a copay at the time of service and you will most likely receive a bill for any remaining part due at a later date if you have a high deductible or a coinsurance.