Monthly Premiums & Annual Deductibles: Planning for the Year Ahead

So many great things are associated with the months of November and December — snowmen, pie, reindeer, candles, trees, gifts. Not on anyone’s list of favorites but occurring at the same time for many families is open enrollment for a new year of insurance coverage. (Yay!)

A person with fingernails painted red sits typing on a laptop, a stethoscope sitting beside them.
A person with fingernails painted red sits typing on a laptop, a stethoscope sitting beside them.

If your family’s plan rolls over with the beginning of a new calendar year, you should soon or perhaps have already received notice of open enrollment season from the health plan or your employer group. Be sure to note when a decision is required. Enrollment windows can be short and there is a lot of information to sift through.

Open enrollment is the one chance you get every year to think through your plan choices in terms of cost and coverage and consider the ways in which you did or did not use your benefits during the previous year. So make time to dive in and read up. Cocoa and marshmallows or mulled wine optional!


The number-one concern for many:

Have premiums risen for the new plan year? Has the deductible increased even if premiums have remained constant? Compare calendar year 2020 benefits and coverage with what is on tap for the new year.

  • Have benefits shrunken or disappeared for such services as acupuncture and chiropractic care, and the big four for our kids: OT, PT, speech, and ABA?
  • Has your share of cost increased? Is your 90% coverage now at 70%?

Here are some points to compare as you mull through the choices.


Cost to own versus cost to use

If your deductible had been just a little lower, would you have met it and seen some (or more) reimbursement for in- and out-of-network benefits on your PPO? If so, you might want to increase your premiums to reduce your deductible.

Should you consider changing from a PPO to an HMO or visa versa? An HMO will offer fewer options for providers and no options out-of-network, as well as additional wait time for approval of services, but at less or no cost to use and less cost to purchase.

Is there an option for a health saving account (HSA) in which the deductible is high but your employer and you can contribute funds toward medical costs?


Dental and prescription

Don’t overlook plan details that cover the dentist and trips to the pharmacy. Make sure you know what you are opting into and out of for filling teeth and prescriptions.


Life events

Don’t forget to consider life and family events and family choices that may affect your health care needs for the coming year: new job, new marriage, new mortgage, growing your family, or seeing children move into teen years or even their own coverage. With most plans, you cannot make voluntary changes to existing coverage except at this time of year. 


Hidden benefits

It’s not often that health plans give more than they cost, but be alert to coverage or discounts for weight-loss and fitness programs and alternative medicine.

Whatever is highest on your list — affordability, coverage, convenience, ease of access, choice of providers — open enrollment is the time to look back at the year that’s ending to plan for care and cost for the year ahead. 


Leslie Lobel

Director of Health Plan Advocacy, Special X


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