Selecting The Right Plan

We’re getting really close to open enrollment! It is time to think about which plan suits your needs best.

I wanted to review what you should be keeping in mind as open enrollment is fast approaching.

  1. How to ensure coverage:
    1. Is your doctor still in-network?
    2. Does that matter to you?
    3. Are you open to switching doctors?
  2. Do you want a PPO plan?
    1. Yes, on a PPO, you can pick your plan
    2. But, if you go out-of-network, it costs you a lot more
    3. PPO plans are generally only available through employers in Texas.
    4. I usually recommend an EPO instead
  3. Consider HMO’s, or EPO’s:
    1. HMO: You have to stay in network, and you do need a referral to see a specialist
    2. EPO: you do have to stay in network, but you don’t need any referrals.
  4. What about a private PPOS?
    1. They are not major medical coverage.
    2. Works well if you are healthy and if you don’t have high usage of medical care.
    3. It does give you a benefit as a PPO, but is a limited benefit plan.
    4. It can save you tons of money and premiums. But you have to understand what the plan pays.
    5. Generally, you’re a cash patient, and then you get a receipt you file for reimbursement because the plans going to pay the same amount whether you are in or out of network. This can really be a good fit for some people.
  5. There are also short-term plans
    1. A good option to select if, for example, your COBRA is ending, open enrollment is approaching, but you want to wait to see what the plans will be for next year.

It is important that we evaluate all of your personal factors that would make a difference in your plan selection.

There is a lot to think about – insurance goes up every year. I always look at the bottom line.

The bottom line is what you’re going to pay for health care costs, which includes your premium with anything you pay out of pocket. We weigh up together whether higher premium, lower out-of-pocket costs, or lower premium, higher out-of-pocket costs, work best for your situation.

If you have any questions please feel free to reach out to me.

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(512) 827-8117


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Austin, Texas

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