Deciphering your options for insurance

This open-enrollment season, many employees will have to decipher a confusing alphabet soup of options.

I’ll start with the increasingly common CDHPs, or consumer-driven health plans, which are anything but driven by consumers because if they were, they’d be much easier to understand. Let’s not kid ourselves: These plans are being driven by employers desperate to reduce their health care contributions.

A CDHP allows you to choose your own health care providers, although out-of-network services may cost more.

Within a CDHP you can have a high-deductible health plan or HDHP, which is really a catastrophic insurance plan. The premiums are inexpensive, but you have to pay in some cases several thousand dollars of your health care expenses before your health plan pays any benefits.

An HDHP can be coupled with a health savings account, or HSA, which is a tax-advantaged account that allows you to set aside pre-tax money to help with medical expenses.

In a health reimbursement arrangement, or HRA, an employer agrees to cover health care costs up to a set amount.

Once the allotted money is spent, you cover costs at 100 percent until you reach your deductible. Once the deductible has been met, another level of co-payments kicks in.

As many of you know, a health maintenance organization, or HMO, requires you to select a primary care physician, or PCP, from a network of physicians. Your PCP has to refer you to a specialist, should you need one. An HMO is typically the cheapest, but you are limited to the physicians and specialists in the plan.

A preferred provider organization, or PPO, allows you to choose any provider. You get higher benefits for using preferred or in-network physicians and hospitals. PPOs generally have slightly higher premiums for comparable benefits or require that you pay slightly more out of pocket than HMO plans.

A point-of-service plan, or POS, is a hybrid of an HMO and PPO. Like an HMO, you choose an in-network doctor to be you primary care physician, and like a PPO, you can go outside of the network for services. If you choose an out-of-network provider, you’ll get a lower benefit.

Selecting among the plans hinges on your ability to predict the likelihood that you or a covered family member will get sick. If you can afford high deductibles and expenses not covered, it may be worth the money you save in lower premiums.

Before you choose, take some time to figure out your annual health care expenses. Try the expense calculator at www.planforyourhealth.com.

In past years, I might have elected a consumer-driven plan. But then a few years ago my daughter, Olivia, was diagnosed with juvenile rheumatoid arthritis. She developed a rare complication and was hospitalized for several months. She ended up needing chemotherapy and expensive, experimental drugs to save her life.

One month we had a healthy 7-year-old, the next month she was near death and racking up a hospital bill that topped six figures. Had we been covered by a consumer-driven plan, we would have had to pay several thousand dollars plus any premiums paid. We would have blown through any money saved in a HSA within a week or two.

That’s life, of course. You can’t predict what will happen.