It's open enrollment season. Here's how to make the best decision for you
Life Kit
This episode of Life Kit demystifies health insurance open enrollment by breaking down complex terminology and plan structures to help listeners make informed decisions. Host Marielle Segarra
Key takeaways
- Cindy George explains that HMO plans feature narrow networks and require primary care referrals but typically offer lower premiums and fewer deductibles.
- PPO plans provide greater provider flexibility without PCP referrals, though they usually come with higher monthly costs and deductibles.
Main topics
- Health insurance open enrollment
- Insurance terminology (premiums, deductibles, coinsurance)
Notable quotes
"The deductible is the beginning. The out-of-pocket maximum is the end."
Conclusion
By translating insurance jargon into actionable math and clear compari
Transcript preview
Speaker 1 (0:01) This election season, you can streamline your news intake with Up First. Our team of reporters and editors works overnight, so you can start every morning with three stories you need to know. In short episodes, 12-14 minutes long, to save you time and your sanity. Follow Up First on the NPR app or wherever you get your podcasts. Speaker 6 (0:22) You're listening to Life Kit from NPR. Speaker 6 (0:27) Hey, everybody. It's Marielle. It is open enrollment season, that time every year when many of us have an opportunity to enroll in a new health care plan, whether that's through an employer or on your state's health care exchange. Now, I think a lot of us put this off until the very last minute because it's so complicated. There are all these terms that you may or may not understand. Every health insurance plan has its own wrinkles and caveats, and it's hard to know exactly how much you'll end up spending. There's just a lot going on. Speaker 7 (0:56) So we hopscotch. So we double dutch. We jump around and we stay informed and we look at our personal situation. We look at our options and we figure out what the best choices are to the best of our knowledge. Speaker 6 (1:10) That's Cindy George, the senior personal finance editor at GoodRx. So on this episode of Life Kit, we'll do our best to help. We'll give you some definitions, explain the different types of health care plans, you know, HMO, PPO, that sort of thing. We'll talk about tax savings, and then we will help you put it all together and do the math to compare your options. Speaker 5 (1:34) Before Bernie Sanders or AOC, a man named Michael Harrington tried to market socialism to the American public. Tens of millions of Americans are poor, miserable, Speaker 2 (1:45) in body and in spirit. Speaker 5 (1:47) On NPR's ThruLine, how the founder of the DSA created a modern political movement. Listen to ThruLine in the NPR app or wherever you get your podcasts. This fall, there are a lot of movies and TV shows on tap for you to see. And we're as excited for all of it to arrive as you are. On Pop Culture Happy Hour, we've got a guide to what's worth keeping on your radar. Listen via the NPR app or Speaker 6 (2:12) wherever you get your podcasts. Speaker 6 (2:16) Okay, here we go. First up, some definitions. There are terms you'll see as you're looking at health insurance plans. One is premiums. Speaker 7 (2:24) Your premium is what you pay every month as the cost of having a health plan. So your health insurance costs you something every month, just like your car insurance or other kinds of insurance. There's a monthly payment. That would be your premium. Speaker 6 (2:40) If you have an employer, your premiums will get taken out of your paycheck. Now keep in mind, the plan with the cheapest premiums won't necessarily be the cheapest over the course of a year. Premiums are just the upfront cost, but other costs will get added on as you go to doctors and need services. Another word you'll see is copay. That's a set dollar amount you pay every time you see a specialist, for instance, or get an x-ray. Another term? Deductible. That's how much you pay out of pocket before your health plan starts reimbursing you or paying your doctors directly for your care. Under some plans, there are services that aren't subject to the deductible, so your insurance starts paying for those right away. And the amount of the deductible will depend on your plan. Speaker 7 (3:20) But... Kaiser Family Foundation did a study and found that for individuals in employer-based health plans, about a third of individuals... have a deductible that's $2,000 or more. Speaker 6 (3:34) Now, a deductible is different from an out-of-pocket maximum. The Speaker 7 (3:38) deductible is the beginning. The out-of-pocket maximum is the end. So a deductible is everything you pay up front before cost sharing begins. An out-of-pocket maximum is where you reach the end of the tunnel and then your health plan takes over. Speaker 6 (3:56) That is until the next plan year, usually in January. One other definition we want to go over is coinsurance. Sometimes under your health insurance plan, you don't pay a copay for, let's say, a specialist visit. Instead, you pay a percentage of the bill and the insurer pays the rest. That's the case with Medicare. Speaker 7 (4:13) Traditional Medicare is typically Medicare pays 80 percent. The insured Medicare enrollee pays 20 percent of a covered service after you meet your deductible. So we're always talking about. a percentage when we talk about coinsurance. Speaker 6 (4:31) And this is why open enrollment can be so maddening, because it just feels like we shouldn't have to do this to estimate so specifically what our health care is going to be and also make these guesses like, OK,