You Might Be Paying More for the ‘Better’ Health Plan

Changing leaves, college football, PSL, and the dreaded Open Enrollment window. An annual tradition. I can remember being a corporate employee and having NO IDEA what I was doing trying to figure this out. The funniest part of the conversation was the time I asked an HR person to clarify things for me and they were just as confused as me.

It’s no surprise then that every year during open enrollment, one of the most common questions I get from clients is:

“Can you help me figure out which health plan makes the most sense for my family?”

You’re staring at deductibles, out-of-pocket maximums, copays, and now (for many people) much higher premiums than in years past, so having someone to sense check your ideas (or just give you an idea of what the heck is going on) can be valuable.

For a lot of families, increasing healthcare costs mean premiums have quietly become one of the biggest monthly expenses they face, often larger than utilities, and sometimes even bigger than car payments.

A Real Example from a Client

This week, a client had two plans to choose from through work:
the Plus Plan and the Basic Plan.

The Plus Plan has a $4,375 deductible and a $9,700 out-of-pocket maximum, while the Basic Plan has a $7,375 deductible and a $12,750 out-of-pocket maximum.

Deductible and Out-of-Pocket Maximum Comparison

Why Premiums Change the Story

At first glance, most people pick the Plus Plan. It feels safer. Lower deductible, lower maximum out-of-pocket, more predictable.

But here’s what most people miss: Premiums are money you pay no matter what. Even if you don’t visit a doctor all year, that cost still comes out of your paycheck.

Premium + Deductible Costs

Even if you hit your detuctible for the Basic plan, it is still less money out of pocket when you factor in premiums.

“What if We Have a Lot of Health Expenses?”

Suppose you add everything together (premium, deductible, and out-of-pocket maximum). In that case, your maximum potential spending tells a different story.

Premium + OOPM

In this case, the Basic Plan could actually cost $1,600+ less in a worst-case year, even though it looks more “risky” at first glance.

How to Compare Plans the Right Way

When you’re reviewing options during open enrollment, here’s a good process to follow:

1. List the total annual premium.
   This is your baseline — money you’ll pay regardless of how healthy or sick you are.

2. Add your out-of-pocket maximum.
   That’s the most you could pay in a worst-case year.

3. Consider your usual healthcare usage.
   If you rarely hit the deductible, lower premiums might save you money overall.

4. Check for employer HSA contributions.
   If one plan offers HSA matching or employer deposits, include that value in your comparison.

The Bottom Line

It’s easy to focus on deductibles or out-of-pocket maximums because those numbers feel tangible. But premiums are real money, leaving your paycheck every month, even if you never use the coverage.

Before you make your open enrollment selections this year, take a few minutes to add everything up. You might be surprised which plan actually costs less.

If you’d like help reviewing your open enrollment options and want to see how your benefits fit into your bigger financial picture, you can schedule an Intro Call to get started.