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Making sense of your health insurance choices

Which plan is best for you?
Posted: 5:00 AM, Oct 28, 2019
Updated: 2019-10-28 10:33:56-04

PHOENIX — It's the time of year a lot of us dread.

Which is the best health insurance plan for the family?

You have limited time to enroll and there are a lot of terms you might not understand.

45 percent of Arizonan's who have insurance, get it from their employers, according to a recent study.

Employer plans are usually cost efficient because employers pay part of the costs.

You're typically offered called either Preferred Provider Organization (PPO) or Health Maintenance Organization (HMO) plans.

Some employers don't offer HMO's but offer several PPO plans. And there are big differences.

One thing to remember, choice is expensive. The fewer choices you have, the less you pay.

That's how Allen Gjersvig sums it up.

His job is to help people decide which plans are best for them, working with the Arizona Alliance for Community Health Centers.

They deal with free insurance through AHCCCS, the Arizona Healthcare Cost Containment System.

And they look at how you could get low cost plans through the Healthcare Marketplace.

Enrollment for these plans begins Friday, November 1. He says decisions involving employer plans are similar.

Gjersvig says typically if you have really low premiums, you are going to pay more when you see a doctor or have a medical need.

But he says it's a mistake to concentrate only on the premium, or amount you pay for insurance each paycheck.

Instead, Gjersvig says you must compare:

-deductibles, how much you pay before insurance kicks in

-co-pays, what you pay for each service and

-out-of-pocket max, what you pay before insurance pays at 100 percent

HMOs will likely cost less.

While you have copays, premiums are lower with low or no deductible.

But for that, you get fewer doctor choices.

And the biggest limitation for some is that you must see your primary doctor before you can see any specialist in your network.

Another issue, HMOs don't cover any out-of-network costs unless it's an emergency.

With PPOs, you can choose from more hospitals and providers. They are typically more expensive. PPOs are more flexible.

You can see a specialist without seeing a primary care doc first. You can use use in network or out of network doctors.

But there are are multiple deductibles to meet, out of pocket limits can be high, premiums cost more.

Make sure to compare deductible amounts against what you'll pay for premiums.

All week on ABC15 at 6 a.m., we will be helping you with your health care decisions.

Tuesday, we look at the questions you need to ask to find the most cost-efficient plan for your family.

Wednesday, it's all about HSA and FSAs- what are they, how do they help and which is right for you?

Thursday, we check how you qualify for free insurance through the state and what plans cost through healthcare.gov

Friday, you'll find where to get help with your insurance decisions.