Open Enrollment: The Cheapest Health Plan Isn't Always the Cheapest
When choosing a health plan during open enrollment, the lowest premium is not always the cheapest option overall. Out-of-network benefits and reimbursement can make a pricier plan cost less across a full year of care, especially for ongoing therapy or specialist visits.
A friend recently told me she was worried about what to do for health insurance this year. Her daughter needs therapy. The more affordable option available through their church wasn’t working well, but private-pay therapy felt impossible to sustain. When she looked at plans with out-of-network benefits, the premiums seemed much more expensive.
So we did the math differently. Instead of asking, “Which plan has the lowest monthly premium?” we asked, “What will this actually cost if her daughter gets the therapy she needs all year?”
We looked for a plan with out-of-network benefits and a deductible that wasn’t impossibly high. Then we estimated how many therapy sessions it would take to meet that deductible and what reimbursement could look like afterward. The therapy still wasn’t suddenly cheap. Maybe a $250 session doesn’t become a $50 visit. But if insurance eventually brings the effective cost closer to $100 after just eight sessions, that can completely change whether weekly therapy feels sustainable. She realized that paying a little more each month for insurance didn’t look quite so expensive after all. More importantly, it could give her daughter a better chance of getting the care that actually works for her.
That’s why open enrollment is worth looking at carefully if anyone in your family regularly sees an out-of-network therapist, psychiatrist, specialist, OT, SLP, or other private-pay provider. Don’t compare premiums alone. Look at the whole year: the premium, out-of-network deductible, coinsurance, reimbursement rules AND the care you already know your family needs.
Sometimes the more expensive plan has math that works better for you.
MySuperbills is not a healthcare provider, insurance company, or legal advisor. We are a claim preparation and submission service. This article is general information, not medical or insurance advice.