How to Choose a Medical Plan

How to Choose a Medical Plan

Here's how one woman navigated the choices in Columbia's health plans.

Maria, age 29, is a computer programmer earning $70,000 a year. She’s expecting a baby in June. She sees an in-network obstetrician who has admitting privileges at New York Presbyterian Hospital. After Maria’s in-network obstetrician confirmed the pregnancy, she made appointments to return monthly until Week 36 of her pregnancy, when appointments become weekly. According to her doctor, Maria should expect to have two sonograms at an outpatient testing center and various tests, such as blood and glucose screenings, throughout her pregnancy, plus a 48-hour hospital stay for a vaginal birth, with professional services and tests. She’s already started taking prescribed prenatal vitamins. 

Currently, Maria and her husband are enrolled in the Choice Plus 80 plan. Maria contributes to a Healthcare Flexible Spending Account. She is considering changing to the High Deductible Health Plan (HDHP) during Open Enrollment.

The Choice Plus 80, 90 and 100 plans cover preventive care, primary care physician office visits and preventive prescription drugs at the same level—100% or copays for office visits and prescriptions. The plans differ in coverage of laboratory tests, outpatient radiology (like X-rays), and outpatient or in-patient hospital procedures. Deductibles that vary with each plan apply to each family member, followed by coinsurance in the Choice Plus 80 and 90 plans, and copays in the Choice Plus 100 plan.

Maria’s Costs:

By the time Maria’s baby is expected at the end of June, Maria will have six months of medical contributions at the employee + spouse level, plus six months at the family level.

Annual contributions:

HDHP:                               $1,320

Choice Plus 80 plan:        $3,228

Choice Plus 90 plan:        $4,602

Choice Plus 100 plan:      $12,672

The High Deductible Health Plan applies the $3,000 family deductible to the contracted costs of the non-preventive visits and the non-preventive drugs. After the deductible is met the Plan begins to pay 90% of covered in-network services.

Maria's husband is in excellent health. His costs are expected to be minimal, limited to preventive care. Maria added annual medical plan contributions to expected out-of-network costs of the pregnancy and birth to narrow her choices to the HDHP and the Choice Plus 80 plans. 

Because the expected cost differences were so close, Maria had a difficult time deciding which plan to choose. The relatively-low monthly contributions of the HDHP appealed, as did the possibility of having a Health Savings Account (HSA)--which would allow her to put aside pre-tax dollars to pay for health expenses, and keep the full account balance when the year is over--something possible only under the HDHP. But Maria was a bit concerned that if something unexpected happened early in the year she would have to pay the $3,000 deductible before she'd built up her HSA savings.

Ultimately, Maria decided to enroll in the HDHP and contribute the $7,000 maximum (for 2019) to an HSA. She feels confident she could work out a payment plan with any provider. She plans to review her options again next year.