Latest / Bill of Health / Stop Letting Open Enrollment Choose for You — You Have More Options Than You Think (Bill of Health Ep.3)

Transcript

Stop Letting Open Enrollment Choose for You — You Have More Options Than You Think (Bill of Health Ep.3) · Bill of Health

• 0:00
  Starting in a few weeks, if not already, employees all across the country will
• 0:05
  be getting an email reminding them that open enrollment is coming soon.
• 0:09
  Open enrollment, it's a big time.
• 0:12
  It's the time when you pick and choose what benefits you wanna use for the
• 0:15
  coming year, and most importantly, how much of your paycheck you're
• 0:18
  going to give away for those benefits.
• 0:21
  And when the time comes, undoubtedly, employees all across the country
• 0:25
  are gonna get a 70-page PDF with all of the details included.
• 0:30
  Now, don't ask your HR team any questions.
• 0:33
  It's in the PDF.
• 0:35
  Have a question about the health insurance?
• 0:36
  It's in the PDF.
• 0:37
  You wanna know about dental?
• 0:38
  It's in the PDF.
• 0:40
  You're, you're on your own, right?
• 0:42
  And it's soon after employees receive another email with a
• 0:46
  link for them to self-enroll.
• 0:48
  You click it, and you start the process of enrolling.
• 0:51
  Is it complicated?
• 0:53
  Yes.
• 0:54
  Do you have questions?
• 0:55
  Also yes.
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  And is it impactful on your take-home pay?
• 0:58
  Of course it is.
• 1:00
  Well, best of luck to you.
• 1:01
  Does that sound familiar?
• 1:04
  Well, it should be.
• 1:05
  According to the Kaiser Foundation, the Bureau of Labor Statistics, a bunch of
• 1:08
  other sources, about 155 to 165 million Americans get their health insurance
• 1:15
  and their benefits from their employer, and oftentimes they go about making
• 1:21
  very impactful decisions on their own.
• 1:23
  But you don't have to do this alone, and you're not always
• 1:27
  trapped by the options given to you.
• 1:30
  Before you click submit, before you sign away your paycheck for 2027, you owe
• 1:37
  it to yourself to be a smart shopper
• 1:49
  Hi, friends.
• 1:49
  Welcome back to The Bill of Health.
• 1:50
  I'm your host, Bill Feigh, the health insurance guy, and today we're gonna
• 1:53
  talk about employee benefits and how to be a smarter healthcare consumer.
• 1:59
  We're gonna cover just a few tips and tricks to help you maximize your
• 2:02
  benefits and protect your take-home pay.
• 2:05
  Open enrollment, we just talked about it.
• 2:07
  It's a big time of year.
• 2:08
  Now, not everybody does their enrollment this time of year, but it is by far and
• 2:11
  away the biggest time for open enrollment.
• 2:14
  You'll start getting information soon, and then the hot and heavy
• 2:16
  period will be October and November.
• 2:18
  And then remember, the benefits that you're signing up for will kick
• 2:22
  in at the start of the new year.
• 2:25
  Now, I've got a lot of experience with this.
• 2:27
  Number one, I've worked in organizations that have used open enrollment periods.
• 2:32
  I've received that 70-page PDF.
• 2:36
  Also, when I was helping with financial literacy, oftentimes I'd be dealing
• 2:41
  with people who wanted to talk about investments, but then they also had
• 2:44
  questions about insurance, and so we spent quite a bit of time talking about
• 2:47
  health insurance just off the cuff.
• 2:49
  Not something we were supposed to, but something we always
• 2:51
  kind of matriculated into.
• 2:53
  And the biggest thing, I've had the pleasure of being a
• 2:56
  benefits enrollment counselor.
• 2:58
  Not for everybody, but for some businesses, they're fortunate enough
• 3:01
  to bring on an enrollment counselor who'll sit across the table from an
• 3:04
  employee and talk about their benefits.
• 3:06
  Can't help them make a decision, but I can answer any questions they might
• 3:09
  have and then help them get enrolled, and I've been fortunate enough to
• 3:13
  do this in a lot of places: Georgia, Tennessee, Texas, Oklahoma, Arkansas,
• 3:16
  Missouri, and Kansas, for example.
• 3:18
  And honestly, that experience is what helped, radicalize is not the right
• 3:23
  word, but it certainly helped galvanize me into the notion that people really
• 3:28
  need help when it comes to this.
• 3:29
  This is where people, they don't make mistakes, but they don't maximize their
• 3:33
  benefits, and they don't protect their paycheck, and it is really what got
• 3:37
  me into this podcast business and the insurance business in the first place.
• 3:42
  Personal story here.
• 3:43
  I can't tell you how many times I've sat across from a young man
• 3:46
  or a young woman or even somebody further along in their career.
• 3:50
  They're making decisions about their benefits, and when we start talking
• 3:54
  about health insurance and inevitably how much that health insurance is gonna
• 3:58
  cost, there's always this resigned shoulder shrug And they'll say, "Well,
• 4:04
  I gotta have it." That shoulder shrug is honestly what causes me to get up
• 4:10
  every morning and renew the commitment again and again and again and again.
• 4:15
  I want to avoid people all over the country with that resigned shoulder shrug.
• 4:19
  You have options.
• 4:22
  Ask yourself a simple question: Have I looked at other options?
• 4:26
  Or more importantly, are there other options that need
• 4:29
  exploring or can be explored?
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  And the answer is a resounding yes.
• 4:34
  We're gonna talk about a couple of those things today.
• 4:36
  Friends, I want you to think about open enrollment as a buffet.
• 4:39
  You choose what you wanna eat on the buffet, and you leave what you don't.
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  And if you don't see anything you like on the buffet or anything that you can
• 4:47
  afford, you simply don't eat there.
• 4:50
  You've got other restaurant options.
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  Number two, it's never, never, never, never, say it with me, never
• 4:57
  all or nothing Choose the benefits that you and your family need.
• 5:03
  Take advantage of the add-on benefits that appeal to you, of course.
• 5:07
  But don't blindly choose a medical insurance option simply because that's
• 5:11
  all you see on the buffet or that's all you see online as an option.
• 5:16
  You can mix and match.
• 5:21
  That's absolutely critical, and you should know that.
• 5:24
  So how?
• 5:25
  How can I be a smarter healthcare consumer during open enrollment?
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  First of all, I want to mention something real quick here, just as an aside.
• 5:33
  We're gonna continue to talk about healthcare consumerism and being
• 5:36
  a smarter healthcare consumer.
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  I want to put that into perspective.
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  I'm not asking you to have a PhD in billing codes at the
• 5:44
  hospital and doctor's office.
• 5:46
  I'm not asking you to be an expert on diagnostics.
• 5:49
  I'm not asking you to be an expert on procedures.
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  I'm not telling you that every single day of your life you're gonna be
• 5:54
  knee-deep in medical jargon and working with hospitals and doctor's offices
• 5:59
  trying to maximize and drive benefits.
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  That's not what smarter healthcare consumer is.
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  You don't have to be an expert.
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  You just have to ask yourself, "Are there options here? Can we do something else,
• 6:09
  and can it save money?" That's all being a smarter healthcare consumer really means.
• 6:15
  So let's get to it.
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  What are a couple of strategies we can try?
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  A lot of couples do this already, a lot of families do this already, but
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  the first one is divide and conquer.
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  What do I mean by that?
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  I work for a company that has employee benefits.
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  My spouse works for a company that has employee benefits.
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  Let's shop.
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  Is the healthcare better on that side?
• 6:35
  Is the healthcare better on my side?
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  Is the dental and vision benefits cheaper on her side, or is it cheaper on his side?
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  We don't have to have everybody enrolled into the same plan.
• 6:45
  Matter of fact, it happens a lot.
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  For example, a long time ago, just personally, I was insured by myself,
• 6:51
  my wife was insured by herself, and just to split up the budget, I
• 6:55
  had the dental, she had the vision.
• 6:57
  Absolutely fine.
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  Her benefits package was a little bit wider, more options.
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  She had legal services available to her.
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  She had discounted gym memberships, a couple of other things like that.
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  Take advantage of those.
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  Mix and match, shop, compare.
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  Just divide and conquer.
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  It not always a requirement that you go to the same doctor or the same network,
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  and so don't be afraid to chip away at your needs by using one plan or the other.
• 7:29
  Divide and conquer.
• 7:31
  I know many of you are probably doing something similar to that, okay?
• 7:35
  But it's a really important strategy, and it can really save you big time.
• 7:39
  There's something a mentor once said to me that sticks with me all the time,
• 7:43
  and this is particular when it comes to shopping for your health insurance
• 7:45
  or your medical insurance options and your plan Medical insurance options
• 7:50
  that you have oftentimes are a Mercedes when you don't want a Mercedes.
• 7:56
  You're happy driving a Camry.
• 7:59
  You like your old beat-up pickup truck.
• 8:02
  Sometimes the options that are available to you don't reflect your personal
• 8:07
  experience with how you use healthcare.
• 8:09
  What the heck do I mean by that?
• 8:11
  Maybe you're someone that goes to the doctor once a year for
• 8:13
  your physical, and that's it.
• 8:16
  Maybe you're someone that goes to the doctor to have your physical and your PSA
• 8:20
  checked, or maybe you'll go once a year because you've got some mystery bug that
• 8:23
  you want some medicine for, and that's it.
• 8:26
  Knock on wood, throw salt over your shoulder, you haven't had a critical
• 8:29
  illness, you haven't had a major accident.
• 8:31
  And so a lot of times these plans with high deductibles and low costs,
• 8:35
  even though the costs are low, they're still incredibly expensive, and they
• 8:39
  don't reflect who you are and how you consume healthcare On the other
• 8:43
  hand, maybe you need that Mercedes.
• 8:46
  Maybe you or your spouse has a chronic condition, let's say an autoimmune
• 8:50
  condition like lupus or something like diabetes type 1 that requires insulin
• 8:55
  treatment, and maybe you need an array of specialists, and you need an array of
• 8:59
  doctors, and you need close, coordinated care, so you do need the Mercedes.
• 9:05
  But a lot of times you're stuck in between, and you don't truly have an
• 9:09
  option that reflects what it is that you need, that you want, that you can explore.
• 9:17
  And so this is what I wanna mention to you today.
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  It's not all or nothing.
• 9:21
  We've said that before.
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  If you have health insurance that doesn't reflect who you are and
• 9:26
  what you wanna spend, you have options, and here's the biggest one.
• 9:31
  This topic is so important to me that I'm gonna devote probably a
• 9:35
  couple of different episodes as standalone just to this topic alone.
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  But when it comes to your medical insurance and your health insurance,
• 9:42
  if you are relatively healthy, if your family is relatively healthy, if you
• 9:46
  do not have any chronic conditions, and if you've been fortunate enough so
• 9:49
  far not to have any critical illnesses or major accidents, then there's
• 9:53
  something you should know about.
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  It's called a direct primary care relationship bundled with
• 10:00
  a health sharing organization.
• 10:02
  I'm not gonna go into a lot of details here, but I'm just gonna
• 10:04
  briefly outline what this is.
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  Direct primary care is a big, big, big trend.
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  I see it happening over and over and over again.
• 10:12
  It's something that my wife and I and my son personally have taken advantage of.
• 10:16
  A direct primary care relationship is a subscription-based service where you
• 10:20
  pay a monthly fee to have a relationship with a doctor or a nurse practitioner.
• 10:25
  Now, that monthly subscription allows you unfettered access, more than you would
• 10:29
  ever get with a traditional relationship with a primary care physician.
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  You can text.
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  You can email.
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  You can call.
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  Same-day appointments are almost always available, next day for certain.
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  It is a concierge-level healthcare service.
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  And I wanna say this, and I truly mean this.
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  It's almost as if the uber wealthy and the ultra rich have been doing this forever.
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  They always have had concierge-level medical care.
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  Well, this is very similar, and it's subscription-based, and the
• 10:59
  trend line is very, very clear.
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  What's funny is there are legal and contractual constraints that keep doctors
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  attached to regional hospital chains or big facilities, but the growth rate
• 11:12
  of this direct primary care market is so huge that it's really only limited
• 11:17
  by how fast doctors can extricate themselves from those relationships.
• 11:21
  This is a huge trend, and I will give it a personal plug.
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  I don't think I'm ever going back to a traditional relationship with a
• 11:28
  primary care physician Oftentimes, this relationship with a direct primary care
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  provider in your area is very, very, very inexpensive, all things considered.
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  You can have a relationship with a nurse practitioner that is on call
• 11:45
  basically for you for as little as seventy-five, eighty-five, ninety-five
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  dollars a month, discounted rates for even more family exposure.
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  So it's a really practical thing.
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  And let's face it, eighty to ninety percent of your healthcare happens
• 11:59
  right there at that primary care level.
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  It's a very inexpensive, cost-effective way to pay cash for your healthcare,
• 12:08
  and you sacrifice no quality at all.
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  Then when you bundle that with a health share organization, the health
• 12:15
  share organization is there to pick up the slack for the major events, for
• 12:20
  that car accident, for that critical illness, for something unexpected.
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  And these health share organizations aren't insurance companies.
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  The health share organizations are membership-based as well.
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  You pay a monthly fee to belong to this health share community
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  If you incur a need, you submit that need for reimbursement.
• 12:43
  The direct primary care facilities, the health share organizations are also very,
• 12:49
  very, very smart healthcare consumers, and they'll work on your behalf.
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  You don't have to be the expert, I keep saying.
• 12:56
  They'll give you options on where to go for that X-ray or for that
• 13:00
  lab work, and they'll tell you, "I get my lab work done here.
• 13:04
  It's usually the most cost-effective.
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  It's right in your neighborhood." Or they'll say, "You have a couple of
• 13:09
  choices on where to go to get this procedure or this imaging done, this MRI."
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  They are already equipped, well in tuned, to help you maximize your cash savings.
• 13:20
  Let's rewind a little bit.
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  What am I talking about?
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  You've got an option for one, two, or three health insurance
• 13:27
  plans in open enrollment.
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  Most of them, I should say, with a significant deductible and a significant
• 13:32
  maximum out of pocket, and many of them, or all of them, that don't reflect
• 13:37
  how you actually consume healthcare.
• 13:39
  You don't have to choose that.
• 13:41
  If you haven't explored a health share, if you haven't explored a
• 13:44
  direct primary care relationship, this is the takeaway for the day.
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  This is really what I want you to think about.
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  Ask questions, explore it, really look into it, because this is where
• 13:56
  you can save significant dollars.
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  This is not hyperbole, I mean it.
• 14:00
  You can save hundreds of dollars every month.
• 14:05
  All right, now's the time on the program where we open the jargon
• 14:07
  jar . What we're gonna do is we're gonna take a confusing, intentionally
• 14:13
  muddy topic, something to do with the health insurance industry, and we're
• 14:16
  gonna translate it into plain English.
• 14:18
  If you are sitting here in the face of open enrollment, then you
• 14:21
  no doubt have to make a decision between an HMO or a PPO plan.
• 14:27
  Now, many of us don't even know what that is, and we face it every day.
• 14:29
  So let's get into it real quick here.
• 14:31
  HMO or PPO, what the heck is the difference?
• 14:34
  My friends, an HMO is a health maintenance organization.
• 14:38
  That HMO requires you to see doctors within a strict, strict, strict
• 14:43
  local network, and it forces you to have a primary care physician.
• 14:48
  That primary care physician is the quarterback.
• 14:51
  That primary care physician is gonna call the plays and refer you
• 14:55
  to go see specialists if necessary.
• 14:58
  Stay within the HMO network, that's really the only option you have.
• 15:03
  PPO, preferred provider organization.
• 15:07
  That gives you a little more freedom.
• 15:09
  You can see any doctor without a referral, including out of network providers.
• 15:15
  What the PPO does is it gives you a local provider network that you can use, and
• 15:19
  they'll pay X amount for this service.
• 15:21
  But if you wanted to go out of network, you can.
• 15:24
  They'll simply pay less Now, HMOs generally feature lower monthly
• 15:29
  premiums, meaning the amount of money that comes out of your pocket, okay?
• 15:32
  Because that care is really tightly managed, and you can only see
• 15:35
  the providers in that network.
• 15:38
  PPOs cost a little more per month, but they give you that added flexibility
• 15:43
  so that you can go see someone out of network if you wanted to.
• 15:47
  HMOs will absolutely provide zero, nada, nothing for non-emergency
• 15:54
  care outside of the network.
• 15:56
  You don't wanna go out of network in an HMO.
• 15:59
  PPOs will pay less, but they will pay something for out-of-network care.
• 16:05
  It's a separate deductible.
• 16:06
  We talked about that in the last episode.
• 16:08
  It's basically just higher everything in the PPO for out of
• 16:11
  network, but it's available to you.
• 16:13
  Do you have a chronic health condition?
• 16:15
  Do you have a relationship with specialists that's critical to
• 16:18
  maintain, or do you have a strong preference for a hospital or a clinic?
• 16:22
  Well, if that's the case, then I might suggest staying with an HMO.
• 16:27
  If doctors, clinics, the places where you receive care is not that important,
• 16:31
  a PPO is going to be just fine.
• 16:33
  Maybe you kinda like having the option to go out of network.
• 16:37
  Well, again, the PPO is for you.
• 16:40
  HMO, health maintenance organization, PPO, preferred provider organization,
• 16:44
  two things you're gonna hear a lot, slightly different attacks
• 16:48
  on how you approach healthcare.
• 16:51
  I hope that helps.
• 16:53
  My friends, it is open enrollment season.
• 16:55
  I want you to be a choosy eater at the buffet, and I also want you to shop
• 16:59
  for the car that you most wanna drive.
• 17:02
  Remember what that means.
• 17:04
  Divide and conquer.
• 17:06
  Utilize each other's plans on what's the most cost-effective, and also don't
• 17:11
  be afraid to shop for alternatives.
• 17:15
  All right, my friends, as this show's getting ready to fade out,
• 17:17
  I wanna get you back to your day.
• 17:18
  I want you to know something, and I want you to know it
• 17:20
  from the bottom of my heart.
• 17:21
  This podcast is not meant to be an elaborate sales pitch.
• 17:24
  It's truly, truly, really important for me that this is a place where you
• 17:29
  can learn and take a few things away from you that you can try in your own
• 17:33
  life to help you save some money, and I absolutely do not wanna cloud that up.
• 17:38
  But I am very , very, very passionate about this topic.
• 17:42
  If you're going through open enrollment and you want a second opinion, you want
• 17:45
  to explore direct primary care and health share alternatives like we discussed,
• 17:49
  check out my socials and get in contact.
• 17:52
  Head over to Instagram or TikTok and you can find me at Bill
• 17:54
  Fye, the health insurance guy.
• 17:56
  A quick five-minute discussion of your situation and your options could literally
• 18:00
  mean saving hundreds of dollars per month.
• 18:03
  And heck, even if it's not with me, find somebody that you
• 18:06
  trust and get a second opinion.
• 18:09
  All right, my friends, that's it.
• 18:10
  Thanks for listening to The Bill of Health.
• 18:11
  Be smart, shop smart, protect your wealth, and I'll see you next time
• 18:24
  This podcast is provided for educational purposes only and
• 18:25
  should not be considered legal, tax, investment, or insurance advice.
• 18:27
  Individual circumstances vary, and the listener should consult qualified
• 18:29
  professionals regarding their specific healthcare and financial situation.
• 18:31
  Opinions expressed are those of the host and guests and do not necessarily
• 18:33
  reflect the views of any insurance carrier or affiliated organization