How should I choose between my company's health plan options?
- Claire Baker
- Feb 21
- 2 min read
Your fate lies behind these walls of text:
🙆 Option 1: Keep your income, but at random intervals you’ll be mugged by a masked gang wearing white smocks.
🔒 Option 2: Lower your salary, but know that the masked bandits can’t touch your treasure.
💰 Option 3: Sit on a big pile of wealth, but put a target on your back for the masked bandits roaming the land.
This, my friends, is what it’s like to choose your health insurance.
And your choices are hidden in a page that’s black with small print, written in a language you don’t understand, and littered with numbers that frighten you.
So let’s demystify your SBC (summary of benefits and coverage) so you can make good decisions:
✋😮 Deductible
If you had an emergency, could you afford this and still make it to the end of the month?
If you’re living paycheck-to-paycheck, how difficult would it be for you to make this work?
🫰 Copay
You’re going to pay this every time you talk to the doctor.
If it’s affordable, great. But if you see a provider a lot (e.g. a therapist) these will really add up.
🧾 Coinsurance
If the copay is the door charge, this is what you pay at the bar. It pays for the procedures, tools, medicines, and tests you get while you’re at the doctor’s office.
If the doctor doesn’t touch you, look inside of you, or test what comes out of you very much, these will be low. But if your body breaks down, these can get high.
😰💸 Out of Pocket Max
This is your worst case scenario, or when the extortion stops, depending on your medical needs.
Some people only hit this in a really bad year (or a really bad day). Some people hit it every year.
If you’re healthy, think about how you could afford this if you had a life-threatening accident or illness. If you already have an expensive health condition, think about whether you can fit this into your annual finances.
🙂↔️ Out of Network
They pretend like this is insurance, but it isn’t. It’s more like a rebate coupon on self-pay healthcare.
If your doctor isn’t in-network, ask yourself, “Am I willing to change my doctor, or should I find a different plan where they’re in network.”
⚖️ Premium
Based on your risk profile above, balance what your body needs with what your wallet needs.
If money’s tight, it might be worth paying more every month for the security of knowing one bad day won’t leave you eating rice and beans for a year. If you don’t have many of the risks above and/or could absorb a bad day, this might be a good place to save.
Want to create materials that help your team understand their benefits and make better decisions? We can help.
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