It\u2019s been stressing me out for the past couple of days, and especially today: \u00a0no, not the election. \u00a0Annual enrollment.<\/p>\n
(Note, I\u2019m writing this up and scheduling the post, just to make it a smidge less clear who my employer is, that is, in case a colleague happens by coincidence to read this blog and say, \u201chey, our open enrollment ended today \u2014 is Jane actually . . . ?\u201d)<\/p>\n
It\u2019s a mess.<\/p>\n
It used to be so much easier.<\/p>\n
We started out with an HMO. \u00a0I was perfectly happy to choose a doctor from a list, since we were new in town and had really no idea about anything. \u00a0Sure, we had to drive half an hour to the hospital where my second son was born because the practice group my OB was in, no longer was linked to the hospital half a mile away, but that was fine \u2014 after all, that meant paying a $10 copay, and not a dime more (well, except for the extra cost for the private room charges). \u00a0And when my son needed speech therapy, that was again a matter of a copay, until one day the office said, \u201cMrs. A, we found out you don\u2019t need to pay the copays after all, so here\u2019s your refund.\u201d \u00a0 The best part was, it was actually the cheapest of the options.<\/p>\n
Now, to be sure, there was a brief period where, after my second child was born but before we moved to Germany, where the usual OB\/GYN practice no longer participated in the HMO at all, and I had to find a name of another doctor who did, who I saw for one visit, but that was fine. \u00a0I\u2019m very consumery \u2014 I don\u2019t feel the need to have a deep personal connection to my doctor. \u00a0Then we went to Germany, paradise of cheap healthcare, and paid for everything with a PPO where the pain of coinsurance was mitigated substantially by how stinkin\u2019 cheap everything was.<\/p>\n
And our return to the U.S. pretty much coincided with the advent of the high-deductible plans \u2014 which were from the start priced such that the combination of the premiums and the deductibles for the various plans meant that, even if we met the deductible ever year, we were still better off paying the premiums for the high-deductible plan plus the deductible, too, rather than the much higher premiums for the lower-deductible plan.<\/p>\n
But for the last couple years, there\u2019s a new wrinkle: \u00a0the \u201cprivate exchange.\u201d \u00a0Which is a real mess.<\/p>\n
Sure, the idea is that a consulting company manages healthcare plans for a number of employers, and each employer\u2019s employees go onto a website where they can choose among a number of health insurers, with more choice than they\u2019d otherwise see, and with the employer paying a fixed amount per coverage tier. \u00a0Employers and employees are both supposed to save money.<\/p>\n
But it\u2019s not working. \u00a0Every year, the insurer recalculates its cost, and every year the comparatively cheaper plan you chose the prior year ends up with premiums that are way out of whack, and you have to switch to another plan to have reasonable costs. \u00a0I can only imagine, if it\u2019s that chaotic for the employees, always switching providers, it\u2019d be a real mess for the insurers. \u00a0And it\u2019s not clear to me to what extent the costs are the same for every employer, or whether the insurer calculates the claims experience, and the cost, for each employer separately, so that maybe there\u2019s a giant musical chairs game going on. \u00a0Which shouldn\u2019t be happening \u2014 there ought to be some benefits realized by keeping a stable group of customers, so that you can take active measures to manage their long-term health needs.<\/p>\n
So you look at this set of price tags, and you\u2019re stuck trying to figure out: \u00a0why are the prices so different? \u00a0What are the hidden differences between the plans? \u00a0Sure, you can look up your doctors (though this is tricky, since sometimes they\u2019re listed by practice name, and sometimes only by the names of the individual doctors, and, in one instance, my kids\u2019 pediatrician, I thought it was odd that she wasn\u2019t listed and called the insurer directly to find out she actually was in-network after all), but there\u2019s nothing that really tells you how large the network is, in a quantified sense. \u00a0If I need a doctor and we\u2019re out of town, how difficult a time will we have finding one? \u00a0If we\u2019re in the ER, how likely is the doctor on staff to be in-network?<\/p>\n
Likewise, I can look up existing medications easily enough. \u00a0But what about unanticipated future healthcare needs? \u00a0If I\u2019m prescribed a medicine, is it likely to be on the formulary? \u00a0How large is the formulary, anyway?<\/p>\n
And for all plan types, what do the negotiated discounts look like? \u00a0That\u2019s key, when you\u2019ve got a high deductible since whether 50% or only 40% of the sticker price is eliminated with the negotiated rate makes a huge difference.<\/p>\n
Same with dental \u2014 and today I had the visit with the orthodontist where he said, \u201cyour kid\u2019s ready to start braces now.\u201d \u00a0 Which plan has the best negotiated rates?<\/p>\n