Breaking down the healthcare benefits and what you need to know before signing up

Posted at 7:09 PM, Nov 08, 2018
and last updated 2018-11-09 09:59:19-05

It’s open enrollment season and that time of year when most people are signing up for their annual health coverage at work. However, making the right choice for coverage is not always easy.

In fact, some people are totally confused about what's best for them as individuals or for their families. If you’re pulling your hair out as you sit down and try to sign up for your healthcare, you’re not alone. 

Melody Khemmoro, 20, is like a lot of people in metro Detroit. She's confused about open enrollment and only needs individual coverage. 

Action News' Carolyn Clifford asked Khemmoro what she was looking for in her plan.

Khemmoro explained that she's looking for what best fits her when it comes to her deductibles and co-pays. 

“So, do you even know your deductible,” Carolyn Clifford asks.

Khemmoro responded: “I know it's very high!”

Scott Eathorne is a family physician with Ascension Providence. He's also the President and CEO of Together Health Network.

“It really starts with what your needs are, whether individual or part of a family,” Eathorne said.

He says to consider three important things when picking your healthcare plan:

  • Are you generally healthy and only go to the doctor for your annual checkup, preventive health services or minor ailments?
  • Do you anticipate a lot of expenses from surgery, or if a family member has been ill? If there are conditions that are chronic conditions, it might lead to more frequent care. You're really going to want to make sure those conditions are covered.
  • Consider your co-pay price. For instance, if your company will pay 80 percent and you pay 20 percent – does that work for your budget?

“Complexity of these plans is so significant and that's why it’s so important to spend the time to really understand what those benefits are," Eathorne said.

Other options to consider are flexible spending verses health savings accounts. The first must be used within a year on qualifying expenses, whereas health savings accounts you can think of as a savings plan. The money rolls over year to year and if you change jobs it goes with you.

If you're lucky, a company expert will walk you through your options. Often, the Human Resources Department for larger organizations will provide some of that information. Sometimes it's information you understand and often you can't make heads or tails of it.

It’s smart either way to have money in the bank to cover healthcare costs, because it’s the leading cause of personal bankruptcies.

Rachel Adams is a 26-year-old child care worker with no company healthcare and worries what kind of healthcare is affordable, but also dependable.

There is a market exchange that may work for Adams. She can go to and create an account. The website will walk you through steps for a variety of plans.

Sign up will end Dec. 15, 2018.

For those who really can't afford health insurance and land in the emergency room repeatedly, help is available. There are services offered by local hospitals or some other health provider in the spirit of a community health fair. Look to your community churches and local organizations for upcoming events.

Finally, be aware there are changes in legislation that allows some insurers to sell products that are very affordable with deep discounts but may cover very little. Though, the lowest cost product isn't necessarily the best and may not provide the coverage you need.

Remember to do your homework and check out all of your options before you choose your healthcare.