The annual open enrollment window challenges all families to make complex choices, and we know many ask: Isn’t the cheaper monthly plan always better? Frequently, cheaper is not better for your overall financial health. To make a smart choice, we encourage you to decide first what kind of medical needs your family typically has throughout the year.

The Financial Risk of High Deductibles

The deductible is the first part of the financial conversation, and this amount must be paid out-of-pocket before your insurance covers any portion of your bills. If you select a high-deductible plan, you will have to pay the full amount, perhaps $5,000 or more, before the insurance pays a penny on any bill. Remember that you are already paying a monthly rate to the insurance, plus all of your medical bills up to the deductible. This structure can present a significant financial risk in a high-sickness year.

Aligning Plan Choice with Family Health

If you have a quiet year medically, the high-deductible plan with a high out-of-pocket max may feel like the right fit for your budget. However, if you have a year where you or your loved ones have a lot of visits, surgeries, or ongoing medical costs, you should seriously consider high monthly rates with lower deductibles and lower out-of-pocket maximums. We advise families to weigh the known cost of a higher premium against the unknown, and potentially large, cost of a high deductible.

Critical Checks for Network and Coverage

There are still more things to consider! The biggest question for us is: Are your preferred doctors, like your trusted newborn pediatrician in Alpharetta, GA, currently in-network? If your providers are not in-network, you will end up with much higher out-of-pocket rates for co-pays and co-insurance, or you may not get covered at all. We strongly urge you to check with your doctors and your insurance prior to signing up to ensure coverage and avoid unexpected bills.

Choosing the right insurance is a balance between your monthly budget and your family’s predicted health needs.

Remember: The above is just a very basic overview with many variations and additional details missing when selecting a plan. Somewhere between 900–1,200 insurance companies exist, with each having a multitude of plans. You must understand your plan’s coverages prior to purchasing, or you may be stuck with large, unexpected out-of-pocket expenses. At The World of Pediatrics, we are here to support you in securing the best healthcare for your child.