Chapter 1: Why are health insurance premiums increasing this year?
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Chapter 2: What factors contribute to rising healthcare costs?
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I'm wondering if having healthcare coverage is worth it from a financial perspective.
It feels pretty bad to be in healthcare in America. It makes me want to move.
I just stick with the millennial health care plan, which is don't get hurt, don't get sick.
You guys, it's time. We got to choose our health insurance again. Gonna be honest, I've been off my parents' insurance for almost a decade now, and I still call my mom to try to figure out which plan is best for me. Because somehow, it keeps getting more complicated.
Hey, JQ. This is Natalie.
When I signed up for my benefits, I was given a big book. And I was told, read the book and pick your benefits. And I kept asking, what do these policies mean? Can someone help me understand all this information in this book?
And I was told, no. The benefit specialist kept telling me, I cannot pick your benefits for you.
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Chapter 3: How do different health insurance plans compare in costs?
So if the HR specialist isn't helpful, who else are we supposed to ask on what these policies mean for us? Well, Natalie, we got you. I'm Jonquan Hill, and today on Explain It to Me from Vox, we're going to make sense of open enrollment together. What all those acronyms mean, why we're paying so much more this year, and whether there's an alternative that actually works.
First up, I talked to Lisa Jarvis. She writes about healthcare for Bloomberg, and she says that like with any major decision, the key to choosing insurance is to start by looking within. I would say the first thing to think about is how you use your healthcare. Are you going to the doctor regularly?
Do you have a standing appointment with a healthcare provider that you want to make sure you can keep seeing that same provider? You know, do you have prescriptions that you take regularly? And then you want to look at what your options are. There's a few different kinds of plans that might be offered to you.
There's an HMO, there's a PPO, and then there's some other things that are kind of in between. So an HMO, You're going to have to pick a primary care provider. That person is sort of determining how many other specialists you can see. You have to ask for permission. A PPO, you have a lot more flexibility. That one, you can go see a specialist usually without a referral.
You can also see out-of-network people with a PPO plan. So I would be looking at... how you're using your health insurance, what you think your healthcare needs might be going forward. For example, are you turning to an age where you suddenly need a little more visits to the doctor? Are you thinking that you might be growing your family in the next year?
And just sort of weighing what you think you're going to need in the next year and then looking closely at the fine print of your plans. Okay, when it comes to price, how do these plans shake out? So you'll notice that the HMO is probably going to be cheaper than the PPO. And that's because you've got this limited network of providers. You're not allowed to go out of network, right?
And you have to kind of ask for permission to see specialists.
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Chapter 4: What does open enrollment mean for consumers?
The PPO is going to give you a lot more flexibility. And so it probably is going to be more expensive and you'll feel that. Okay, so we got HMOs, we got PPOs. There's more jargon that shows up in open enrollment, and I'm hoping you can remind us what it means. The words I'm thinking of are premium, copay, and deductible. So there's a premium. That's what comes out of your paycheck.
There's the deductible. That's how much money you need to pay before your health insurance kicks in for certain services. And then there's the copay. So every time you visit your doctor, it might be $25, it might be $40. That's how much money you pay and your insurance pays the rest of it. So there's another plan that I've heard about, and that's the high deductible plan.
What is that and how does that fit into these options? Yeah, so I think you want to think about how you're using healthcare. If you're someone who is not using a lot of healthcare, a high deductible plan might be good for you. What that means is you're paying very little in premiums. So the premium is the part that comes out of your paycheck, right?
You see that number and it can feel really good, right? to have it be a low number. But the tradeoff could be a high deductible, meaning that you first are going to be paying a lot of money upfront before your health insurance starts to kick in and pay for your coverage.
You can also pair that with some other things like a health savings account, which can allow you to put some pre-tax dollars aside to help pay for that deductible. So There is it's a it's complicated, but you want to think about how much you think you're going to be using your health care.
And, you know, sometimes a high deductible plan might be an affordable choice for you and make a lot of sense. Yeah, you talked about that health spending account. There's also a flexible spending account. What's the difference between those two? There are other ways that you can try to save some money on your health care expenditures for the year.
There's an HSA, which basically is a way of taking pre-tax money out.
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Chapter 5: How can consumers navigate their health insurance options?
You have to have a high deductible plan. That's the key to know. in order to have an HSA. And then you can decide how much money you want to put aside. That money can roll over for year to year, and it can also grow. So it can be invested. If you don't spend it, you can use it the next year. An FSA is a little different. That's through your employer.
And there's a limit similarly to an HSA and you're putting money aside and you have to spend it all in that calendar year. So you got to be careful about thinking about what you want to put aside.
Usually there's either a little bit of wiggle room around like tipping over that spending into the next year, or it could be that some employers could choose to let you carry a little of the money over a certain percentage of it for the full year. But you can use that for lots of things. The copay, the deductible. You can use it for what you buy at CVS.
You'll look at the very end of your receipt at CVS and there'll be a line that says FSA eligible or HSA. That can be deducted. You can get that money back. Yeah, I did discover that I could buy my fancy sunscreen with an FSA. That was exciting. I mean, I nerdily save all my CVS receipts.
And at the end of the year, when I realize I am running out of time to spend my FSA money, I go through them all and I find all sorts of things I never would have expected are covered by an FSA. This whole process seems like it can be so confusing. Do you find it confusing? I mean, you cover this. I find it very confusing. My mother-in-law was trying to pick a plan through the ACA.
I found it very hard to help her. Luckily, the ACA has navigators, so you can go to one of those people and they'll help you find your plan. When it comes to employer-sponsored insurance, you just really have to think about all the different ways that you might be paying or not paying, right?
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Chapter 6: What are the pros and cons of high deductible health plans?
So you just have to think about how you're using your health care and how your insurance is covering what you might use. It's complicated. It can be a really, it's like trigonometry and algebra and geometry combined. I don't know, trying to calculate all the right factors and come up with the right choice.
But I think ultimately trying to understand what your family can afford and what they use, you know, is also going to help you as you try to do the calculation of what makes the most sense for you. This year, when you open that email from your HR and look at what the premiums are, you open up the Obamacare to find out what your plan will cost next year.
You might experience a little sticker shock. Healthcare costs are going up and employers are trying to balance absorbing some of those costs or managing some of them with premiums. passing them on because they can't afford it all either. And so, you know, look at the fine print.
It might be that your premium doesn't change, but it might be that there's more costs on the back end that you should be aware of. So I just think really paying extra close attention. This is the year to not just accept the plan that you've had every year and just weigh your options carefully. You heard right. Premiums are about to go up. A lot. Coming up, we'll explain why.
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Chapter 7: What alternatives exist to traditional health insurance?
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This is Explain It To Me. I'm JQ. And today we're explaining all things health insurance, including why it's so expensive this year. No matter where you get your insurance, whether it's through your job, the Affordable Care Act marketplace, or Medicare, the price is going up. To find out why, I went to D.C. 's number one go-to for health care reporting. I am Julie Rovner.
I'm chief Washington correspondent for KFF Health News, and I'm host of What the Health, brought to you by KFF Health News and WAMU 88.5 FM. Julie has covered the health care system for nearly 40 years, and she says that while the costs always go up... This time is different. Well, we are talking premiums going up pretty much across the board for every kind of health insurance right now.
You know, we've had bigger inflationary spikes, particularly in the early 2000s. But for the last 15 years or so, health care costs have been rising, but not terribly fast. They seem to be accelerating again now. Why now?
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Chapter 8: How can we address the healthcare system's affordability issues?
Well, there's a bunch of reasons, but they come down to sort of two things, price and utilization. Utilization is how many health care services people use. And obviously the more services people use, the more the nation's health care bill goes up. So there's a lot of things that are driving expanded use right now. One of them is aging the baby boomers. I am one of them.
As we get older, we suddenly get and need more health care. And to some extent, we're still catching up from health care that people didn't get during the pandemic when nobody was leaving their houses and when you basically didn't go to the doctor unless you absolutely had to.
So we're still seeing people not only getting care that they didn't get then, but people who didn't get care then and should have, who are sicker than they might have been if they'd gotten preventive care or care early in the pandemic. So that's sort of driving up use. And then of course, there's just new things that we can do.
Everybody knows about the GLP-1 weight loss drugs that are so popular and so highly used right now. We have lots more new drugs. I mean, some of these are sort of amazing advances. It used to be you didn't want to do things and, you know, it was always cost-benefit, whether the benefit was worth the cost.
And the cost was not just monetary, the cost was in how long you would be laid up if you had a joint replaced or had some kind of surgery. Now we have much easier surgeries. So it makes it much easier to do these things, so we're doing more of them. So that's just the usage side. Then there's the price side. And the price side, basically, you know, I can sum up in one sentence.
We have the highest prices in the world because people who provide health care here can. The government doesn't regulate it nearly as much as they do in other countries. Most other countries do have hybrid systems. They do use some private insurance and some government subsidies. But they also, most of them that don't have spending out of control, have much more serious regulation of prices.
than the United States has. It's really wild because we should be going to the doctor. We should be taking care of ourselves. But it feels like when it comes to the price of things and the price of insurance, we kind of get punished for it. Yeah, we do. And, you know, one thing that I didn't mention is that because we now spend so much on health care that it's
like 18% of our GDP, lots of people who would like to earn money are going into healthcare. So we have people sort of encouraging possibly unneeded healthcare to make a profit. So there's that piece of it also, in addition to the things that we should do and that end up costing us money.
Is there a difference in, you know, the rise in costs we're seeing for those of us who get employer-sponsored insurance versus those of us who get our insurance through the ACA marketplace? There is. And, you know, one of the reasons that in 2026 ACA premiums are rising is because of these additional subsidies that made it easier for people.
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