Last week my aunt Jean texted me in a bit of a panic. She needed help choosing a health plan from her employer and was having a tough time choosing from among the “goofy” options.
Goofy, as she called it, was pretty spot-on. Never have I come across so much odd terminology, endless small print, and complex math as I do in the healthcare field. And, if I factor in all of the stories I hear from friends and family about their (mis)adventures in the healthcare system, it’s no wonder so many smart people like my aunt struggle to understand their health benefits – year after year. On second thought, maybe “goofy” is too nice of a word…
But My Aunt Is A Pretty Savvy Healthcare Consumer
When I arrived at Jean’s house the next day, she had her benefits paperwork neatly stacked on the dining room table (next to a giant bowl of Halloween candy). Jean pulled her laptop over and told me the same thing she always says when I’m visiting: “it’s going to take about five minutes for it to boot up, so if you need to go to the restroom, go ahead.” (I love that she still gives me the OK to use the restroom, even though I’m in my 30s.) While we sat there waiting for the laptop, Jean explained to me that she also wanted to put her adult daughter — my 24-year-old cousin Natalie — on her medical insurance plan. Natalie recently lost her job due to employer budget cuts. We dove into the benefits paperwork first.
1+1 Should = 2
Jean’s employer was offering her five different health plans to choose from: one HMO, three PPOs, and one HDHP (high deductible) plan. The plan description paperwork was split between full-time and part-time status, and premium costs were listed based on individual vs. two person vs. family pricing. My aunt gravitated to one of the lower cost PPO plans (different than the PPO plan she has now) because: 1) it had a lower premium price, 2) her new doctor was in-network. In fact, the plan would only cost her about $33 a paycheck. Not bad at all…if she just wanted coverage for herself.
But Jean noted that as a part-time employee, she would actually have to pay more than quadruple that monthly premium cost if she added her daughter. Learning that, I recommended that Jean stick to the group plan for herself (the $33 a paycheck one), and then find Obamacare coverage for my cousin under “Special Enrollment.” Since Natalie had lost her job within the last 60 days she qualified for shopping on the individual market before Open Enrollment started.
Weighing The Options Side-by-Side
The laptop was finally ready, so I logged into ConnectedHealth’s Smart Choices™ Marketplace for individual coverage. We plugged Natalie’s search info into the site, and right off the bat, the Smart Choices platform told me that my cousin was likely to qualify for a tax credit of about $250 a month. Holy cow!
Then we looked at some of the plans Smart Choices suggested. Jean being Jean knew that Natalie should NOT just focus on the premium costs, but should also make sure her doctors and prescriptions were covered by any plan she considered. We did some checking through provider directories listed and found that her primary care doctor was in fact covered by one of the silver plan options, and also found that her prescriptions (at least the generics) were given the thumbs up. If Natalie was confirmed for the tax credit, she would only have to pay about $25 a month for the premium, in addition to a small $5 co-pay per doctor visit if she needed care. We decided to go for it based on the Smart Choices recommendation, and clicked “Apply.” The ConnectedHealth system integrated directly to the FFM to complete the application process. About 10 minutes later we were done and waiting for final approval from the FFM on our plan application. I asked my aunt to keep me posted on emails from the FFM, and then we ordered Thai food.
Later That Week…
When I left my aunt’s house that night, I was thinking how lucky my cousin Natalie is to have such a savvy mom. While Jean, like many healthcare consumers, is often thrown by all the weird lingo and confusing numbers involved with benefits options, she did a great job in narrowing down her decision to the things that really matter when it comes to picking health coverage for herself and her daughter. Yes, premium costs are a critical factor, but they’re not the only thing one should use in making a decision, as my colleague Tracy points out time and time again. My aunt knew this already, but what she needed help with was how to better understand her own options and how to factor her adult daughter into everything.
The next day, my aunt emailed me to tell me that Natalie had been approved for the tax credit and silver plan option we had selected. It’s awesome when goofy things finally make sense.
(The names in this blog post were changed to protect privacy.)
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Blogger: Jeff Hyman, Marketing and Communications Director for ConnectedHealth
