It’s that time of year again—open enrollment is here! We know this can be a frustrating, confusing, and often overwhelming time. Finding the right plan for your family is crucial, especially when it comes to keeping your valued relationships with doctors you love, like your newborn pediatrician in Alpharetta, GA. When choosing an insurance plan, what kinds of things do we, as parents and consumers, truly need to consider beyond the monthly premium? We've broken down some key considerations to help you choose wisely.

Deductibles vs. Out-of-Pocket Maximums

The deductible is the first amount you will need to pay from your own pocket before your insurance pays any portion of your bills. If you have a $5,000 deductible, you will pay every penny of that $5,000 before the insurance contributes anything. You are essentially paying a monthly premium to the insurance, plus all of your medical bills up to this point.

Co-pay vs. Co-insurance: Knowing Your Share

Now that you have met your deductible, your insurance should start to pick up the bill, right? Not necessarily. This is where co-pays and co-insurance come into play. A co-pay is a set amount for each doctor's visit, typically $15 to $50. A co-insurance is a percentage of the bill (like 90%/10% or 80%/20%) that you are responsible for after the deductible is met.

Why the Cheapest Plan Isn't Always the Best

Frequently, the cheapest monthly plan is not actually the better choice for your bottom line. You need to decide what kind of medical needs your family typically has. Do your children only use their insurance a couple of times per year for quick sick visits, or do they have chronic problems that require frequent follow-ups with a specialist? The lower premium often means a higher deductible and a higher out-of-pocket maximum.

Hitting Your Annual Out-of-Pocket Max

After paying your monthly bill, your full deductible, and possibly a co-pay and/or co-insurance, the payments continue coming out of your pocket until you meet your out-of-pocket maximum. This is the hard limit for your responsibilities for the year. Once you hit this maximum, the insurance will cover 100% of your covered care until the new season begins, when the payment loop starts all over again.

In summary, choosing a plan means finding a balance between monthly costs and potential medical needs. If you have a quiet year medically, a high deductible may feel right. However, if you anticipate many visits to your newborn pediatrician in Alpharetta, GA, or specialists, a higher monthly rate with a lower deductible and lower out-of-pocket max will save you money in the long run. We at The World of Pediatrics encourage all families to carefully review their plan's coverage prior to purchasing to avoid unexpected expenses.

Please note: The above is just a very basic overview with many variations and additional details missing when selecting a plan. Somewhere between 900-1200 insurance companies exist with each having a multitude of plans. You must understand your plans coverages prior to purchasing or you maybe stuck with large unexpected out-of-pocket expenses.