Cases

$1.$ Considering Consumer$-$Driven Health Care

It is the annual benefits enrollment period, and your company has given you a new option to consider for your health$-$care plan. Every year during the annual enrollment period, you have the option to either keep your current health$-$care plan or enroll in a different offering. You have participated for several years in the company$$s Health Maintenance Organization $($HMO$)$ plan; however, this year the company introduced a health savings account $($HSA$)$ combined with a high$-$deductible health insurance plan $($HDHP$)$ as an option.

You just attended the company$$s annual benefits meeting where this consumer$-$driven approach to health care was introduced. While you know that the company is offering this new option to try to control overall health$-$care costs, you liked that they discussed the importance of employees making choices about their health care. Under your current HMO plan, you feel like your health$-$care options are limited$.$

You are generally healthy and have appreciated the ability to see a physician with a relatively low co$-$payment requirement, keeping your out$-$of$-$pocket medical expenses low. However, you page $162$have been frustrated by the limitations of the HMO program. A friend suggested a new physician to you, but because the physician is outside of the HMO network, you have not been able to see the new physician. Further, there is a medical specialist that you would like to see related to a knee injury you sustained in college, but because you are not currently experiencing pain, your primary care physician does not agree that you need to see a specialist at this time. You can only see this specialist with a referral from your primary care physician.

The company$$s new option of the HSA and HDHP is interesting to you. It would allow you to set aside pre$-$tax earnings in the HSA to pay your health expenses. The company will also contribute a monthly amount to the HSA. The HDHP does have the high deductible that you need to meet before the plan pays benefits, but then all of your health$-$care expenses are covered once you meet the deductible. Further, you can use the funds from the HSA to pay for all of your health$-$care expenses. You also pay a monthly premium to participate in the program, but it is slightly lower than the premium you pay to participate in the HMO. You think that this new plan offering could give you the choice and control you want in your health care, without exceeding the out$-$of$-$pocket expenses that you currently pay.

As you consider your options, you look at your medical expenses from last year. You think this is good starting point for your decision$-$making, but you remind yourself that health is not always predictable. That is$,$ you could have an injury or illness that would greatly increase your expenses. While it is difficult to project your exact health$-$care expenses, you know that you are young and generally healthy. You decide the best next step is to speak with the Benefits Specialist that the company makes available to help you make your decision.

Overall, what are the pros and cons of the high$-$deductible health insurance plan and health savings account option?

What questions should you ask the Benefits Specialist to help you make your decision?