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every week. It's my goal to share financial information that helps you in both your life and financial vineyard. We hope it takes you from your roots to the journey of your minds and the influences in the air that have helped craft your delicious lives like wine. Life and finances have different palettes that should be celebrated and not judged. Welcome to this edition of Wine and dine with Amy Irvine. This week we are talking specifically about employee benefits and health insurance. We want to make sure you're getting the most from your employee benefits and solving some of life's financial problems. But before we discuss that, we want to get into my wine recommendation of the week and that's from domain lesser and their cab franc. As I mentioned last week, I am on a cab from kick again. I think it's because it's october and I love the fall. Um, I used to not like the ball because I knew what it was leading up to, but now that my husband and I spend the winters in sunny florida, I actually enjoy that season and I embraced some of the darker reds and full flavor wines that are more fruit forward in the sense of dry grapes instead of that fruity dry grape.

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Anyway, check out domain the sore located off from Keuka Lake, they are a French one. As you can tell by the name. Their winemakers are actually from France and we very much enjoyed our tastings of their wine and we think you'll enjoy their cab drunk as well. So diving into this week's podcast, I did some research and pulled out of the archives various stories that I thought might help drive the point home about medical expenses. We all know uncovered medical bills can basically wreck lives. We see appeals on the tv and through crowdfunding for help in covering expenses, their stories of family losing their homes. As a result, even with coverage bills can mount up a friend of ours that used to run fiscal fitness clubs, carol Craigie. She probably had the most powerful story to share. Now Carol was into financial education.

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Um, and prior to that she was actually um, psychology. But carol tells the story and I just wanted to share this with you because I think it's so powerful as we lead into open enrollment season to really take time to look through your benefit options and possibly project out some of the costs that you may be hit with and plan for those worst case scenarios and hope they don't happen right plan for the worst and hope for the best. So let me tell you carol story, Carol began her career not really understanding health insurance. She didn't spend any time at all and chose the cheapest medical plan for premiums. When her husband spent six months in the hospital, she said yes to anything, the doctors asked for, what was her husband, she was going to do anything. She didn't understand the pre approval process at all or honestly didn't even think about money. Well she ended up owing $40,000 at 21% interest because she claims that she wasn't a savvy consumer.

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She relates how she could have gotten all that great treatment with a lot less bills. But since then she has learned to look carefully carefully at policies and engage doctors, hospitals and systems to answer questions to make sure to get the best coverage and to get the insurance cover and company to cover. And that's a point that I want to really raise Corey approval process or reaching out to the insurance company before, especially elective procedures is pretty important in the case of an emergency. Remember that read file I told you guys to keep back when we talked about estate planning, have your emergency contact, call the companies, the insurance companies and explain to them what's going on and make sure that no pre approval is required a few years back. My step father had a stroke and when he was going to be transported from one hospital to another, I happen to think, hey, that ambulance ride might need pre approval and I called the insurance company and indeed it did.

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And if we hadn't known to do that, we would have been on the hook for that transportation. It's super important not only to select the company or the policy that best supports your family, but to know the provision of those policies as well. So thinking about protecting yourself against medical bills. During this open enrollment process, there's a few key things that we want to take into consideration who needs the coverage. Is it just you and your spouse? How about the Children or young adults or are you hoping um, to have a baby? That might be a decision in the selection of your plan. If your child is under the age of 26 and out of the house, it's easy to think that they're on their own. But if you would co sign to get them treatments to save their life, Then it's important to know did they have the coverage that's actually needed? I use 26 because Children can remain on parents coverage until that age.

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Yeah. Another thing to think about is anybody going to transition off medical coverage or moving on to your plan this year. This is especially important to note and maybe even consult about because you'll be especially careful in the choice is during enrollment. Right? So it's a spouse maybe going to be retiring and will either of them lose their coverage because of that. If you can enroll in one person's plan because of that, then you, you would start the deductible at the beginning of the year on the right plan instead of having to need to deductibles specifically. So it's important because there's always the option when there's a change in life that you can sign up for one of the other insurances, if you know if somebody's insurance goes away. But again, we want to take into consideration other things like deductibles and those sort of things. So if a spouse is retiring and either will lose their coverage in a specific plan, then you may want to elect to go onto the other spouse's plan or if there's retiree health benefits, we want to look at the benefits between the two plans.

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Right? So we had a teacher who was on her husband's plan because it was better. But in the year retirement it was so critical that she signed up her own coverage so that the district would then provide a $400 a month benefit towards healthcare coverage after retirement for the rest of her life. Now that's something that's really important if you missed out on that sort of thing. So knowing those kinds of things is important during open enrollment because that's when you can make those changes, you wouldn't want to miss that. Of course. And another thought is, if you're moving, you want to make sure the coverage is going to be portable with you. If it's an H. M. O. And you're moving to a bigger area, that's a big deal. So we want to look at the different plans that are available. If you're thinking about relocation. So if you know or suspect suspect a change may be occurring. It's important to really dig into those questions and the next question, uh, that you might want to ask yourself is what did you spend last year and what are you anticipating to spend this year?

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Of course, that may honestly change and there might be some things that you have to discuss. But one is your overall health and that of your family members. And a great source for answering that question comes from a health assessment that general Mills actually put out together for their employees and you can google that to find the information. It's been widely copied and used to help people evaluate their own health. Honestly, we incorporate, we incorporate comments and components of this and use the assessments and the healthcare evaluator to help you understand what health plans are appropriate for you. And again, you can just google that if you're interested and you'll find it. Another item to consider is is if there is a chronic condition that will require consistent treatment and ongoing medications. So those are the and the medications, the plans that you might be eligible for are the medications covered after the deductible or prior to the deductible.

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Again, those are important things to be thinking about and what the cost of those medications are because sometimes with brand names, it's much more expensive than the generics of course. And the last two questions that we want you to address when we're reviewing your healthcare coverage would be, are there more efficient ways for paying for bills and we can explore that throughout the, throughout that presentation. But we want to talk about coverage and ways for pain um the bills itself. So to help you get started with this process and help answer all the questions to protect yourself against medical bills. We've put together a worksheet that you'll be able to find as a resource. That can help you calculate all of the estimated costs that you might have and be able to do a comparison. You'll be asked to rate your own health status. Look back at your expenditures for the last year and determine approximately how many doctor visits each person has and may have going into the next year.

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It will help you project several factors moving forward. In addition it allows you to enter the information on different plans that are available to you and put the information in that usable format. The tool serves as a generic form. So if your employer has something specifically, we encouraged to use that if you need help evaluating the options, certainly contact your financial planner or maybe somebody at your company can help you with some of that potentially an HR person although often they don't want you know that responsibility of getting involved but sometimes they're there to help you from that perspective too. This is an area that we want you to spend some time on because it can save you thousands of dollars don't skimp on this evaluation and remember this is a resource that's available to you uh if you want it and it makes it just easier to compare side by side. And here are some additional thoughts to consider when comparing health care products 1st.

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Don't assume that just because the name of the plan is the same name as last year. That the coverage is the same often what what is and isn't covered may change year after year. So be sure to read the plan offerings and see if you're comparing apples to apples and not apples to oranges. Second, don't just look at the price of the plan or the co pays the details such as co pays for physical therapy, emergency visits, percentage of goods cost covered After the deductible and all of the fine print are very important. 3rd if you take specific medications or get specific treatments or use a specialist asked for a written response on how they are covered. This will give you a better idea of the plan minimums and what out of pocket money you might plan for. Need to plan for ahead of time. Fourth think hard about what you are willing to give up in certain doctors and stay in the network?

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For example, if you've had some sort of medical condition in the past and it's possible that it could return. Are you willing to forego going to the best place for treatment? Lastly check to see who is in network and what the restrictions are. If staying in network means not being able to relocate or travel. Does that change your options now when using our benefits evaluator. Workbook that we've provided. You can easily compare and in and out of network offerings by examining plans side by side you can look at the plan types, individual and family deductibles maximize out of pocket expenses. It's important to know if your doctors are in network out of network and neither are right or wrong. It's just you know examining that sort of thing. And if they're not in network then what are the consequences of being out of network? You'll be able to estimate the cost of your usage for anticipated doctor and er visits, copays, brand name drugs, generic drugs, all that sort of stuff as well as other services like alternative medicine which for many is a direction that they're going now you can do this for both in and out of network.

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As I mentioned, copays come up with an estimated projected costs for each year. As far as running the samples. And again this helps plan for both your budget, health care coverage and contributions to things like your flexor your H. S. H. S. A. By adding these expenses in premiums you can easily see which is the least expensive plan overall most of the categories will be pretty easy for you to answer. But if you need any extra help you know just don't be afraid to ask the questions. Don't let confusion stop you from this exercise either. This is very important. You're you're stuck with this plan for a whole year. So we want to make sure that each year we do this analysis. There are two ends of the spectrum to consider when making a health plan decision for some. It makes sense to use the plan or a plan that will require high monthly premiums and lower out of pocket costs versus one with lower monthly premiums with higher out of pocket costs.

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Remember the goal here is to protect yourself against potential high medical bills. For some, it won't be clear cut choice. So it really should be talked through with your coach and your family on the other side. Excuse me. On the left side, you'll see that you may consider using a plan with high premiums that may require low out of pocket costs. When you see a doctor frequently have a history of emergency care, take expensive a brand new medications on a regular basis, are expecting a baby plan to have a baby in the next year or have small Children have a planned surgery coming up, then you definitely probably want the higher monthly premium lower out of pocket. And if you've been diagnosed with a chronic condition prefer us uh certainty and a level out of pocket expense compared to smaller premium outlays. But with the possibility of needing up to $5,000, then that plan also might be right for you. Typically um you hit the high deduct deductibles and maximum year after year then you probably want to go with the higher monthly premium and lower out of pocket.

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Um the right hand side. You'll see the types of reasons why you might want to consider paying lower monthly premium and higher out of pocket. If you're somebody who rarely sees a doctor, you're in good health. You few activities which may result in emergency care, you take a few generic drugs, there's no planned family changes and you don't usually exceed the deductible now make sure to use that H. S. A. Or flex plan when you're using these types of plans. Really, really can't emphasize that enough. The security you can have built up in pretax dollars stashed away in those health savings accounts if you are young and healthy and choosing the lower premium high deductible plan, Do yourself a big favor and fund your essay with at least the difference between your high deductible plan cost and the lower premium cost your future self will certainly thank you. We hope you've enjoyed this podcast. We'd love to hear from you on any topic you'd like to hear about. Please feel free to share this with your friends like us on itunes, visit us on linkedin facebook and instagram also visit us at www dot rooted pg dot com.

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And don't forget we'd love to hear from you. Mhm and that will about do it for today's episode of line and dying. You can contact AMY through the website www dot rooted pg dot com or AMY at rooted pG dot com. You can also follow us on facebook and instagram at rooted PG for the latest news. And if you have any questions, comments for topics you would like to hear about. Feel free to let us know. Don't forget to rate and subscribe the show wherever you get your podcasts and again, thank you for listening and be sure to tune in next time. Mhm.