Edit Content

Specializing in consulting services to help providers with payer management to increase revenue, reduce waste, and streamline their operations.

Get in touch

Annual Enrollment

Annual Enrollment – What you need to know


It’s that time of year again! The fall season is also the start of the 6 week rush to elect new benefits for Employer-Sponsored Plans for the annual enrollment. Companies send emails to employees asking them to select a new plan and/or confirm enrollment for the coming year. There are usually a few options, but how do you pick the best one? Comparing the plans is essential; however the language is confusing, calculating your health needs is difficult, and being confident in your choice is impossible. I’d like to provide some clarity. Let’s break it down.

Step 1 – Choosing a plan type

The biggest difference in the choices for employee-sponsored health plans is whether to select a Preferred Provider Network (PPO) or Health Maintenance Organization (HMO). The names are deceptive, but the differences are simple. At least, I’m going to make it simple. If you don’t want to be bothered with getting a referral, select a PPO plan. PPO plans have flexible options for referrals; in addition, there is a better selection for choosing doctors. Now you will pay more for a PPO. If you do not mind having to obtain a referral or a cheap option is more cost effective, choose an HMO. Just make sure your doctor is part of the HMO, before you sign up. Either plan will offer similar benefits, which we will discuss tomorrow.

Step 2 – Comparing Plans

Now you have selected an HMO or PPO, how do you know which HMO or PPO is best. If you are lucky, your company offers multiple choices. If not, you can still use the guide below to compare the plans.

To compare similar plan types look at the language for out of pocket costs, basically your costs each year. This is the part that may take some time to calculate. Let’s start with these comparisons tomorrow, it will be time consuming. No need to worry, I’ll be there with you the whole way.

Share Post:

Continue reading

We Have the Connections

How to Find the Right Consultant

The Importance of Network Development

Never Over Pay!

Medical Bills No More