Open-enrollment Season

The Impact: How three households confront health coverage decisions

October 17, 2004

The Impact: How three households confront health coverage decisions

They hope options include dentist

For Bryan Butler, the financial reward of his job is not the paycheck as much as the health care benefits.

"It's not like we make great salaries, and we work kind of long hours. The benefits have always been important and they are pretty good," says the 42-year-old educator with the Maryland Cooperative Extension in Carroll County.

He pays about $212 a month for health insurance for himself, his wife, Karen, and their four children, ages 9 through 13. It would cost three times that much if he had to buy insurance on his own, Butler figures.

A state employee for 11 years, Butler worries about Gov. Robert L. Ehrlich Jr.'s plan to make workers pay more for health insurance next year, which would override an effort by lawmakers to freeze rates and benefits. If premiums eventually get too high, other job opportunities might appear more appealing, he said.

Still, the Butlers are eager for open enrollment this month.

They are satisfied with their coverage from a preferred provider organization but want to switch dental plans.

Their dentist quit participating in their insurance plan about six months ago, and they don't like the other available choices, whom Butler describes as "industrial dentists."

The couple found a dentist outside their plan and pay for his services out of pocket while continuing to pay for dental insurance. "It's a real kick in the gut to pay for it twice that way," says Karen Butler.

But now, with two children needing braces, they hope this year's dental options include a dentist they like.

Cancer survivor tied to her plan

Each year during open enrollment, Kathleen Pieper has the same concern: Are her doctors still in her insurance plan's network?

Pieper is a breast cancer survivor. She has a surgeon, internist, medical oncologist, radiation oncologist and obstetrician-gynecologist. "Being married to these doctors for seven years, I don't want to have to develop a new relationship," said the 54-year- old senior vice president with Sandy Spring Bank in Columbia.

So far, that hasn't been a problem. Her employer typically offers two or three health plans, and Pieper has been able to remain with her doctors by sticking with a preferred provider organization.

Pieper's husband, Burke, who owns his own watch repair shop in Baltimore, is also covered under her plan. She pays about $200 a month for the two of them. It costs another $88 a month for dental coverage for both spouses and life and long-term disability insurance for her.

Pieper says she always appreciated employer health benefits, but never more so than during her illness.

While Pieper was undergoing chemotherapy, there was an insurance bill mix-up. Rather than deal with the paperwork problem at that time, Pieper figured she would just pay the bills herself. That is, until she found out that each of her treatments would cost $5,000, for a total of $40,000.

"If I were to ever contemplate leaving this organization, I would have to get another job that has health care benefits," she says. "You can't survive without them."

Health coverage critical issue to young worker

Sometimes the toughest health insurance choice is having no choices.

Dustin Jackson, a 21-year-old from Brooklyn Park, was working at packaging pharmaceuticals, and was ineligible for health coverage because he was employed by a temporary agency.

He didn't shop for insurance in the individual market because, "I just knew it would be astronomical." While he was uninsured, he hurt his collarbone in a pickup football game. He was examined at a hospital, but worries that he might not have gotten the treatment he should.

Just this month, he started a new job as a security guard. Once he has worked 90 days, he'll be eligible to get insurance, contributing $70 a month and having his employer, Wackenhut Corp., pay the rest.

He's sure he'll sign up, and plans to elect dental insurance as well.

His experience, he said, colors his view of the presidential election. "Health care is what's important - not tax breaks," he said.

Voluntary benefits

Besides choosing health insurance, workers during open enrollment are offered the chance to sign up for extra benefits, such as life insurance or legal advice. Typically, employers donM-Ft kick in any money for these extras, but use their negotiating power to secure lower premiums or fees for workers.

This enrollment season, employees may see more voluntary benefits than usual as employers try to soften the blow of rising premiums or reduced benefits on basic health coverage, benefit experts said.

Here are some extras you may encounter and factors to consider:

Supplemental life

This is above any life insurance an employer already provides.

Do you need extra insurance? Is anyone dependent on your paycheck, so that your demise causes a financial crisis for those left behind? If the answer is yes, still shop around. You might find less expensive life insurance elsewhere.

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