Navigating Open Enrollment: Choosing the Best Health Insurance and Other Benefits in 2024
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Hello, and welcome to another episode of All The Hacks, a show about upgrading your life, money, and travel. Now, with open enrollment coming around the corner for so many people, and for some of you, maybe it's already started, I really wanted to do an episode to help you go through that decision-making process because I've tried to optimize it many, many times in my life, and I felt like that's something worth sharing. And then on top of that, I did a ton of research to help you go through that decision-making process.

as I always do to try to help you guys out. So the majority of this episode is going to focus on health insurance and we'll go really deep there and we'll share some hacks to save money and optimize, but I'll also make sure to touch on dental and vision and some other open enrollment options like HSAs, FSAs, and employer life insurance. And then at the end, just because I'm recording this from Hawaii, I'll share a few tips from our experience on the Big Island and

Not too much, but just a few things that we've done that we thought were really fun. So lots to cover. Let's jump in right after this.

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Okay, so I want to start this episode giving an overview of some of the really common terms you need to understand to make sense of all this. So first, I'm going to just talk about the plan types. There's HMOs, PPOs, and EPOs. And for total context, there might be other types. This isn't meant to be a fully comprehensive guide to everything you might ever cover, but I went pretty deep, so hopefully this covers a lot.

The main distinction here is with a PPO, you can see a specialist without needing help. With an HMO, you need to have a primary doctor on file to refer you to be able to go see a specialist. So if you wanted to see a dermatologist, you need to talk to your primary care physician and get them to refer you. In my personal stance, that's frustrating for me. So I've always gone with a PPO. Although recently we switched to what's called an EPO, which is kind

Kind of like a hybrid of the two. It's really more like a PPO in that you can see anyone, but you can only go in network. So if your doctor's out of network with a PPO, usually you can do that with a higher deductible or a higher out-of-pocket maximum or less coverage, higher copay, or maybe there's no copay. But with an EPO, you cannot go out of network.

So a lot of HMOs are similar, at least with Kaiser. One kind of big caveat if you live in a state with Kaiser is that when you're on a Kaiser plan, it's usually an HMO plan or a PPO plan, but you can only go in Kaiser. You can't see a doctor outside of the Kaiser network. In general, the most flexibility you can get comes with a PPO plan and the HMOs and EPOs are usually a little bit less expensive.

Next is the deductible, which is usually the amount you have to spend before your health insurance kicks in. That said, there are a handful of expenses that usually are covered before the deductible. Stuff like preventative care, telehealth, pregnancy, and some basic labs.

One interesting thing that I actually learned in this process, a lot of plans list individual and family deductibles. I'd always assumed that if you had a plan that covered multiple people, your deductible was the family deductible and it was just you, yours was the individual. But in reading the plan details, I actually read, if you have other family members on the plan, each family member must meet their own individual deductible until the total amount of deductible expenses paid by all family members meets the overall family deductible.

So there are cases where for a family that might work to your benefit, if one person needs a lot of medical care, they're not actually going to need to hit that entire family deductible first. They're actually going to only need to hit that individual deductible. I actually think that could have changed the calculus on some of the things that we've decided in the past, but the past is the past.

Next is coinsurance. And so sometimes you'll see a coinsurance listed as 20% or 10%, and that's the percentage you are required to cover, and your insurance will cover the rest. So in fact, if you look at the plans, a lot of the tiers, usually you'll see bronze, silver, gold, and platinum, and those tiers usually correlate to the coinsurance amounts. So at bronze, you're responsible for 40%, silver, 30%, gold, 20%, and platinum, 10%. Now, usually those kick in after your deductible is met.

Then you have your co-pay, where for some types of services, there's co-insurance. And then for others, usually like a primary care visit or a specialist visit, there's a co-pay. Usually somewhere between 10 and as high as $95. Usually you have to meet your deductible before, but depending on the plan, sometimes those co-pays actually work even for a specialist visit before your deductible is met. So that's definitely one thing that when I looked through all these plans, I couldn't actually get perfect clarity on. So I would definitely read into that.

Next, there's out-of-pocket maximum. And that's the total amount you'll be liable for before insurance will cover everything. So once you hit your out-of-pocket maximum, that's the max you're going to have to spend on health coverage. And similar to the deductible, if you have other family members on your plan, they each have to meet their own out-of-pocket limits until the overall family out-of-pocket limit has been met. So again, this is not

what I expected, which is actually quite beneficial. If you happen to be in a family where one person might have really high medical expenses and the rest of the family doesn't, you wouldn't actually be subject to that higher out-of-pocket maximum either. Many times that out-of-pocket maximum and that deductible, your co-payments don't apply towards that, but usually those are pretty small. So I don't think that is going to be a big factor.

In addition to a lot of those criteria of HMO and PPO, there's also what's called a high deductible health plan. And usually that is a plan that you would get for more catastrophic situations. Many, but not all high deductible health plans are eligible for an HSA. And I'll get to that in a minute. And the idea is you wouldn't get a lot of coverage for your basic visits, though, again, preventative visits are usually always covered.

But going to see a specialist, you're going to pay completely out of pocket for that until you hit this very high deductible, which depending on your plan could be as low as $1,600, could be as high as $7,000 or more. And so if you have a high deductible health plan...

that meets certain requirements, you are also eligible for an HSA. And an HSA is a special savings account called a health savings account that you can put money into pre-tax. You can actually, while that money's there, invest that money. Many providers will let you open up effectively like a brokerage account for the HSA and invest it. All the gains on that account are tax-free. And then when you take the money out, which you must do to pay for eligible health expenses, you do not pay taxes there either. So it's got this triple tax advantage. It's

one of the most amazing investment accounts out there, but you are only eligible for it if you have a HSA eligible high deductible health plan. I'll get to a couple tricks with the HSA later, but that's just another little overview. Next on plans, you'll usually see two lists of coverages, one for in-network and one for out-of-network.

And so the way that works is every carrier has a network, but it's not just for the carrier. In fact, it's for the plan specifically. So you might have had Anthem or Blue Cross Blue Shield at one employer on one plan and go to another employer on another plan. And you might find that that network is not actually the same. So definitely need to make sure that your doctors that you want covered are

in the network, even if you think they might be. And that's a really important thing because some plans have no out-of-network coverage. Some plans have out-of-network coverage, but it's at a much, much higher deductible, out-of-pocket maximum, coinsurance, et cetera. So definitely, whenever I'm looking at any plans, if there are doctors that you're really tied to, you can go in there and search for whether those doctors are part of the network or not.

And then last, where you even get these plans. So if you work at a company that provides health insurance, then it's pretty straightforward. You usually get the insurance from your employer. It's usually a much better deal to do that than any other place. And so that is an easy option. However, if your employer doesn't offer health insurance or you don't have employment, there are a few options. So one is from the exchange.

So as part of the Affordable Care Act, there are healthcare exchanges in every state and you can go and enroll in insurance. You can go on COBRA. If you've left your previous employer, you can stay on their health coverage as long as you cover it fully at the full cost for up to 18 months. Or if you own a business, you can actually shop for plans for your business.

Or if you're over 65, you're eligible for Medicare. This episode is not going to go deep on Medicare since I'm not very familiar with it. But I will say that in addition to Medicare, you can get supplemental policies to go above and beyond what Medicare offers. And we're going to go back to things that are kind of broadly applicable to everyone. But just for the people looking on exchanges or trying to figure out what to do, there are also brokers who are there to help you find those plans, either as an employer looking for plans or just someone looking for a plan on the exchange. Typically, you're not paying them and you're

health insurance costs aren't going to be higher. So there's not necessarily a downside to working with a broker. But having talked to three or four brokers going through this process for us this year, because we both left our employment and we were both looking for health insurance for the whole family, I couldn't find a broker that had access

to any plans that I couldn't easily get access to myself. As an employer, you can usually go on a lot of these websites. So for all the hacks, we went on to these small business plans and looked at them. Some of the HR platforms, we use Gusto is a broker and can give you access to plans. So maybe as an employer, the brokers might be able to give you plans, but I don't think it's really worth shopping around to lots of brokers because at the end of the day, I didn't find anything unique from any of them.

And on the individual side, I didn't find anything I couldn't have found on my own on the carrier websites or the exchanges. A couple notes, if you are looking at starting a business or getting insurance for your business, a lot of the carriers have a requirement. You need to have at least one business

non-spouse, non-owner employee. Now, in some plans, Kaiser and Blue Shield in California, you need a non-owner, but they can be a spouse employee. So you need a minimum of two employees. So it could be you and your spouse if they're not an owner in the business. And by owner, I don't mean through California joint property kind of law. I mean, owner on the LLC. If you're both owners, usually you need a third employee to be eligible for a lot of these plans who is not an owner.

So definitely something to look into there. And one important thing to consider, when we were looking at all these plans, we were actually really surprised that certain doctors were just not in network anywhere. And so I have a few doctors at Stanford Medical, and I was trying to figure out which plans they would be under. And I went through over a dozen plans on the Covered California Healthcare Exchange site, and I couldn't find anyone that had our doctors in coverage. And so I called and I

ask them, what insurance do you guys take? Because I'm so confused. And Stanford actually said they don't accept non-group policies, meaning they don't accept health insurance that is not through an employer. So none of the covered California exchange plans would work at Stanford. So if you're getting a little confused, it might be that maybe the doctor or the hospital or the

medical provider you work with, maybe they don't take non-group plans. And that's definitely something to consider. In fact, for us, it put a strong, strong advantage to the COBRA plans and the small business plans because we wanted to be able to continue seeing the doctors that we were already looking at. And then last, all of that, there are a few other options, things like medical sharing plans. I'll

come back to that later because I guess the idea here was to give an overview of just the terms and the things you're going to run into. But medical sharing plans are an alternative to health insurance that is eligible for the requirements that you have coverage from the Affordable Care Act, but they're very different and I'll get to them.

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So when I go through this process, there's kind of two axes. There's the carrier and the plan. And so you might be looking at, especially if you're on the exchange, there's two or three carriers that all offer a bronze PPO. So you need to decide which carrier do I want and then which type of plan do I want?

If you're employed by a company, you might not have a lot of choices. You know, in California, I've typically had companies where there is a Kaiser option and then an other option, whether that's Cigna or United Healthcare or Blue Cross or Blue Shield, but there's usually not a carrier choice other than Kaiser and non-Kaiser. So you don't really have to think about the carriers, but if you're on the exchange or you're picking as an employer, it can be tricky to decide which carrier makes sense. In fact, if you look at the ratings in California, only Kaiser

has more than three stars. Every other carrier on the exchanges in California is a two or three star carrier by whatever system Covered California uses for stars. There's not an obvious way to decide which carrier makes sense. It kind of feels a little bit like airlines.

Some people have their favorites and then other people have had terrible experiences with what could be someone else's favorites. And so for every person that's probably said, oh, UnitedHealthcare was great. They covered everything. There's certainly going to be a person who said, well, they wouldn't cover anything. And it was so frustrating to deal with them. So at the end of the day, I'm really focusing on just the plans that are there and picking a carrier that seems reputable. But it's a little bit for me, a crapshoot as to which carrier is the best. And I kind of wish that it was a situation where I worked at a company and I didn't get to

pick because honestly, I don't think there's an easy way to know which one is going to be the best for your circumstance in advance. So ultimately, what it really comes down to is picking a plan. So first, you've got that question of EPO, PPO, or HMO. And I think that if you have a primary care doctor and you're okay having them be the point person, you can save some money going to an HMO.

But if you really prefer to be able to have the flexibility to go see a specialist and not need anything, then a PPO could be great. And then when it comes to EPOs, I think the really important thing is that you do an exhaustive search to see if every doctor or provider you might want to go to is covered.

And so what we did was we went in and searched for all the doctors we've seen. But then we also went to like the 20 best medical facilities all around the country in case some crazy extreme thing happened. What if we got a rare form of cancer and we wanted to go to Johns Hopkins or Mayo Clinic or some other very specialized center? But we looked.

And all those doctors were covered. And so we felt really good about the EPO we were going to. And in a lot of cases, the EPO plans are really great. Ours has no deductible, no co-insurance, basically co-pays only for everything. So ER visit is $150, hospital, surgery, that kind of stuff, $0 co-pay, zero co-insurance. You have no expenses. Most doctor's visits are $20, $30, but you can only go in network. So it's a huge issue if the network wasn't good.

And then the question is, do you want the high deductible health plan or not? I used to think a high deductible health plan only made sense if you weren't going to be spending that much on coverage. But actually, now that I did the math, having to pay for these plans on our own, the increased premiums, and I guess I never defined premium, but premium is the amount you pay each month for your plan. The increased premiums on plans with much lower deductibles often are so high that it

makes up entirely for the cost savings on the deductibles, meaning you're almost cost shifting. So if you had a lot of healthcare expenses in January with a really expensive plan, you're paying a high premium every month throughout the year, but you're not having to pay a ton of money up front in January. Whereas if you paid a much lower premium, but needed a lot of care in the beginning of the year, you'd have really high bills. So I thought maybe I would just try to give you an example of two plans that are

uncovered California for us that we considered. It's the bronze and the platinum PPO from Blue Shield. A lot of these plans aren't going to make sense if you don't live in the state in the same exchange, but I think the overall comparison is helpful no matter where you are. So the premiums for us as a family of four were $2,000 a month and $4,000 a month. So significantly

extra cost. The deductibles were $0 on the expensive plan, but they were about $6,000 for an individual and almost $13,000 for a family on the bronze PPO. So really high deductible that you're going to have to hit. However, if we have to spend an extra $2,000 a month for that platinum PPO plan, that's going to cost us $24,000 a year. By the way, yes, health insurance in California for two people that are 39 years old and two kids is really,

really, really, really expensive. So that $24,000 of extra premium could more than cover the deductible. In fact, the out-of-pocket maximum was $8,000 and $16,000 for individual and family, which we could absolutely completely cover with the total cost of the premiums for the Platinum Plan also. And so while the Platinum Plan had no deductible and a $4,500 or $9,000 out-of-pocket maximum, it just didn't seem to make any sense. And that was after really digging. At the

the beginning, I thought, well, yeah, let's pay upfront a lot so that we don't have all these ongoing expenses. But when I actually dug in to do the math, I was totally surprised that the increased premium cost just negated all the benefits. Now, if you work at a company where your employer is giving you both options and you don't have to pay any extra,

then sure, I would much rather have the platinum plan because all my ongoing expenses are going to be much lower. For these two plans, they had the same network. And while the PPO had 10% coinsurance and the bronze had 40, it was a bit strange because the bronze 40 doesn't actually kick in until you hit the deductible. So it didn't really matter that much. But on the PPO, it definitely kicked in. As an example,

The bronze plan to go to the ER was a 40% coinsurance after you hit your deductible and the platinum PPO was $150. So again, if you don't factor in the cost of the premiums, then the platinum PPO feels like a much better deal. Copays were 15 and $30 instead of 65 and $95. So very, very different. The one cool thing that I learned

that I'd never seen before until I dug in was that the Bronze PPO actually had a feature called first dollar coverage. And I'd never seen this before, but basically they cover the first three visits, whether they're primary care, specialist, urgent care, before you need to meet your deductible. So that's definitely something to look into if you're considering one of these higher deductible plans, because you might not realize that something else is covered.

That bronze PPO was actually, despite the high deductible, not actually eligible for an HSA. There was a bronze high deductible health plan that was eligible for an HSA, slightly higher deductibles, but surprisingly lower out-of-pocket maximum. That said, there was no coinsurance, no copays, no first dollar coverage for visits. Other than preventative care, you were on your own for absolutely everything.

That said, you're also eligible for an HSA. The HSA contribution limits for a family this year are $8,300. For an individual, it's $4,150. And by this year, I mean for 2024. So depending on your tax bracket, let's say you're at the 35% tax bracket, putting that money in that HSA is actually probably going to save you about $3,000. And on top of that, it's going to grow over time. You're not going to pay tax on that. And when you withdraw it. And honestly, one of the hack

that I've heard so many people use for an HSA, instead of just using it to meet the deductibles and the costs in the year that you're contributing to it, if you have the cash flow, use your savings, use your salary to pay your medical expenses, and just let that account grow as long as it can tax-free until maybe you're in retirement and need that money for other medical expenses. And you've built up a massive, massive amount because it could compound for 30 plus years. And by the way, if you want to create a Dropbox or Google Drive folder and

put all your medical receipts and expenses there. Just in case you don't have medical expenses like you think in the future, or maybe healthcare changes, you can actually reimburse yourself. There's not actually a limit to how long expenses are eligible to be reimbursed. You could save those receipts from 2024, but reimburse yourself for them 30 years from now, assuming nothing else changes, of course. And so the HSA is great. I wish I could contribute to it. Ultimately for us, we actually ended up going with the COBRA plan. I'd

always in my mind assumed Cobra was the most expensive thing. For whatever reason, people kind of had just made me feel like Cobra is so expensive. But for us, we could get a plan that was as good or better than the top $4,000 a month plan on the exchange. And the Cobra pricing was about $2,200. So way, way, way more cost effective for us. It was an EPO, which we love because we don't have to think about the expense. I think that's the other challenge when you pick a high deductible health plan

that you have to really process is, is there a psychological effect that's going to change how you get care? So for example, if you know that going to the pediatrician when your child is sick is gonna cost $400, do you go or do you kind of hold it out four or five days

because you don't want to spend that cost. At the beginning of the year, of course, you said, well, it's way cheaper even if we go to the doctor every single time than to pay these higher premiums. But in the moment, are you going to do it? So for example, I had this crazy pain in my upper abdomen

abdomen area. And I had no idea what it was. And it was so incredibly painful. I ended up on a Saturday just going to the emergency room. And because my health insurance plan covered everything other than $100 deductible, I thought, I just need to get this solved. It's Saturday. I don't want to wait until the morning. And so I just went. And the bill for that ER visit, when I actually looked at the

bill. Obviously, I didn't have to pay it. But when I looked at what the insurance company paid, it was over $10,000, which could be a whole nother conversation about how ridiculously expensive that was. I saw a doctor did one test. I have no idea how that's justified, but I didn't have to pay it. And so I didn't really need to fight back. But knowing that cost, if I had a high deductible health plan, I definitely wouldn't have gone and

And maybe you could argue that's better. Maybe I didn't need to go. Maybe I could have held out. But I think there are a lot of circumstances where because we don't have to pay so much for each visit, we're a little bit more liberal with how much care we get. And I know that even sometimes Amy and I have caught ourselves saying, do we want to run to this doctor's visit? And all we had was a $35 copay. And we were like, is it even worth it? Which...

Yes, $35 should never get in the way of health. For frugal people, sometimes I know it will. But if it was $400 or $500, I feel like it would get in the way every time. And so in a way, getting on a plan that doesn't have that high deductible kind of forces us to do that. I wish I just had the mental ability to not get caught up there and that psychological pressure didn't affect me. It would be much easier. But for me, that was really tricky. So that's just something to consider. It's a big impact on all of this. That said...

financially, the platinum plan seems to almost never make sense in almost any scenario. So I started doing some research. Does the platinum plan ever make sense? And there are tons of articles that point out the math that no, it doesn't really make sense. The only arguments would be if that is the only way to get in-network doctors that you want, or if your employer is covering the cost of it, that's great. Or if you really need that spread out cash flow. If having a $10,000 expense in the

really be a problem, but paying an extra $1,000 or $2,000 a month over the course of the year wouldn't, then maybe that makes sense. And one thing I should point out, if you are paying for this as a business, the cost of health insurance is often deductible. So this is not an episode on tax advice. I am not a CPA, but that's definitely something to consider as you factor in how much you're going to be spending on medical coverage, how much of it's tax deductible, maybe the plans are

but the medical expenses aren't. And that might change the calculus there a little bit. And then the psychological thing is real. I was actually looking into this and now I'm like, hmm, I started thinking platinum made sense. Now I'm thinking gold. Fortunately, because we're on Cobra for 18 months, we have about 14 more months before we have to think about any of this. But in 14 months, I honestly can't tell you what I think we're going to do. I would have told you something completely different two weeks ago. And instead of trying to figure it out, I thought,

Let's just wait until then and share everything I've learned. But if one thing is for sure, it's that going into it, I thought the platinum plan was for sure it. And now I'm not sure I agree.

I love helping you answer all the toughest questions about life, money, and so much more. But sometimes it's helpful to talk to other people in your situation, which actually gets harder as you build your wealth. So I want to introduce you to today's sponsor, Long Angle. Long Angle is a community of high net worth individuals with backgrounds in everything from technology, finance, medicine, to real estate, law, manufacturing, and more.

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Money can be stressful, but if you want to find some inner peace from actually knowing how much you're spending and on what, so you can be more intentional about your financial decisions, you have to check out Copilot, which is one of my all-time favorite apps. I check it almost every day, and I'm so excited to finally be partnering with them on this episode after being such a huge fan. Copilot makes it seamless and easy to track your spending and, in my case, boost your savings.

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So please consider supporting those who support us. I also want to talk about some hacks. So that's a lot about how to think about this, how to make decisions. But there are a few things if you're looking at this and say, wow, it's really expensive. How do I bring costs down? How do I do things a little differently? And there are a few really interesting things

tactics I've heard. So one is enrolling in college. And this might seem a little crazy, but there are a lot of universities that offer really, really, really compelling health insurance plans for students, even some community colleges. So definitely take a look in your area, or maybe there's an online university where you can enroll and take a few credits, learn something, and in return, save way more on the

health insurance that you might need. And some of those do include family plans. So I saw someone posting in a long thread on Reddit about how they ended up spending like $500 a semester or something for college, but in return saved $10,000 a year on health insurance. So that's one. Another one, which may or may not be something you're interested in, but there are really great health plans at

much, much less cost to you if you are part of the military reserves. So if you wanted to join the Army Reserves, Marine Corps, any of the military reserve programs, great healthcare there. If you have the kinds of expertise that you could be a part-time teacher or professor at a university, again, you could get some similar coverage there.

or even a part-time employee. If there's a company that might employ you, give you health insurance as a part-time person, that's interesting. So those are some hacks on getting plans. Now we'll talk a little bit about medical sharing plans. So this is a really interesting one and it's quite controversial. There's a John Oliver last week tonight, entire episode devoted to this. I'm not going to try to re-summarize all of that, but...

I will make it clear that these are not health insurance. So the way these plans work are that members contribute money to a organization and that organization has rules about how they will contribute to members who need expenses paid for medical services. They don't guarantee the payment and they certainly aren't held to the same standards and consumer protections as health insurance plans.

For example, the Affordable Care Act requires insurance companies to spend at least 80 to 85% of their premium dollars on medical care. No rules like that here. Most of these companies are private, so seeing how their operations work is almost impossible. But there have been a few court cases that resulted in some learnings. And at least one of these medical sharing companies, it turns out they spent something less than 20% of the premiums they collected on

medical care. So really a weird space. I have some friends that have been on these and have had great experiences, but again, very different sets of rules. They're not required to cover any pre-existing conditions. They can place lifetime or annual caps on things. A really catastrophic health event could easily exceed your sharing plan limits. And also many of them are very tied into a religion. And so if that's not something that is part of your lifestyle, it can be

a bit strained. So if that's not something that's part of your lifestyle, it might not be a good fit for you. I know there are some medical sharing plans that, for example, if you have a child out of wedlock, not covered by insurance, things like that. And so definitely, definitely worth reading into them. I do think that if you're earlier in your life and there's really low costs, maybe it could be a way to save money. But for me, I don't want something that might have some limit, might require me to jump through hoops, or just might require me to spend a lot of money because I didn't get covered.

or even have to go through a lot of hassle. Many of these plans require you to pay on your own and request reimbursement. Not all of them. The general idea of these plans is interesting. The idea that we would basically group self-insure is definitely interesting, but the more that I read into them, the more I think that it's something that...

I'm not personally interested in. That said, if anyone listening has experiences, would love to hear about them because I don't feel like I have enough firsthand experience. But from what I've read, it's not something that we're considering at all. When it comes to saving, two other big areas that I thought I'd focus on. One is if you're on a plan with high deductibles and you want to cut the

cost down of your medical care, there are two things. So one is direct primary care. There are a lot of doctor's offices and doctors around the country that have started creating a direct relationship with their patients. So someone wrote in that they use partner MD in the Northern Virginia, DC area, where you pay a usually a monthly or annual fee.

And that covers your ability to get primary care visits or message your doctor if you're sick and get a prescription or any of the kind of basic things you'd see your primary care doctor for without having to pay out of pocket each time. It's not quite concierge medicine in that they're not focused on crazy testing and longevity and coming to your house, but they

are creating kind of a fixed cost to cover all of your primary care needs. In the past, I've also talked on the pediatric side about two companies that we've tried out. One's called Summer Health and one's called Blueberry Pediatrics. And they're effectively direct primary care for pediatrics. So you pay a fixed cost of $20 a month and they will...

be on call through mostly text message, but also you can schedule calls with Blueberry to be able to talk to a doctor to help with situations related to your kids. Obviously, if you need to go into the office and do a test, they can't do that, but it really would cut down on that cost. So if you have a high deductible health plan, definitely something to look into to lower the cost of your health insurance so you don't have to hit those deductibles.

On the more expensive side, there are concierge medical practices where you'd spend anywhere from thousands to tens of thousands of dollars a year and have access to doctors. And that would cover all of your visits, usually cover all of your testing as well. But that I will save for another episode outside of the scope of open enrollment. And then finally, if you are paying for a lot of your own medical expenses because you have a high deductible health plan,

Definitely worth negotiating. Definitely worth asking for cash rates. I know that some hospitals and facilities even publish... If you're paying cash, we'll give you a discount. I did a whole episode with Marshall Allen. Episode 34 of All The Hacks. He wrote an amazing book called Never Pay The First Bill. It's all about fighting back and pushing back against healthcare costs. And so if you are paying on your own...

You should always be negotiating with your providers and with any facilities and asking for cash rates. If you're paying for your own prescriptions, there are sites like GoodRx or RxSaver that you can use to get discounts on prescriptions as well, or at least shop around and find the best prices. That is definitely something worth doing if you are paying on your own.

So I think that mostly covered everything I've learned on the health insurance side. I'm sure more will come up. If you have other things to share, let me know. We're going to probably do an episode like this every few years so we can cover whatever's changed. But I also want to talk about some of the other things that you're going to be doing for open enrollment. So when it comes to dental and vision insurance, there are a lot of mixed opinions because dental insurance, for example, often doesn't cover that much and has a cap.

And so really, it's kind of 50-50 whether it makes financial sense. If your employer covers it completely, then it seems like a no-brainer. If you are someone who's regularly going to get your checkups, sometimes it can just be a break even there. If you have a filling every now and then or something like that, it seems to make sense. And then vision insurance...

I actually have not ever used my vision insurance, but it's usually only cost somewhere on the order of one to $2 per pay period at whatever company I've worked with. So I just kept it on there. I haven't looked a lot into private vision insurance, so I don't have a lot there. So I'm sorry to leave you guys hanging if that's something that's really important to you. That's one where I'm going to

lean on someone that maybe knows more about doing private vision insurance if you're on your own or from an exchange and whether that makes sense versus from your employer. But I did actually on the dental side. So when I went to the dentist recently, I was talking to my dentist about a lot of the cost of medical care. And he pointed out that he has a membership that is effectively like dental direct primary care. So for $375 a year, you can be a member of their practice. There's no deductibles, no maximums, no waiting periods, no pre-authorization. And that covers two cleanings and

x-rays a year. And then on top of that, you get 25% discount on all treatment. So if you are without dental insurance or you decide that doesn't make sense, but you do want to get cleanings done, it looks like at least one practice in the Bay Area, if not more around the country, have programs that might make it a little bit more predictable and affordable to be able to go in and get the basic care you want without having to rely on

on spending out of pocket every single time you do it at a higher cost. So that's dental and vision. A few other things that you often go through in open enrollment. So one is FSAs. So similar to an HSA, there is an FSA for health, which is a flexible spending account. However, very different is that unlike an HSA where you own the HSA, the FSA is something your employer owns. And so there is a little bit of a hack around this in that

When you contribute to an HSA, if you leave halfway through the year, you actually aren't eligible for the full contribution amount. With an FSA, if you contribute to an FSA, most employers fund that FSA account January 1st, and then you pay for that amount over the course of the year. So if you were going to leave a company halfway

at the end of January, let's say you wanted to quit your job after you got your bonus, as long as your medical expenses happened in that time you were employed, so in January, you could conceivably use the entire limit in January, but have only contributed 1/12 of the amount. So a little bit of a hack there, if you're planning on leaving your job in January or February, fully fund your FSA, use it up, go get LASIK, or go do a full body MRI,

or do some diagnostic testing, whatever you want. And that's a little bit of a hack there. On the flip side, though, because the company owns the plan, many people don't use up all their FSA dollars. And then their employer actually gets to keep all that money. Depending on how you engage with your FSA, it could be beneficial to you, it could be beneficial to the employer, I will say never let your FSA dollars go unused. While you can usually not roll all of them over, there are lots of things that they're eligible for. If you're having children, you can buy

baby monitors. I know the aura ring. I think I just got an email that the aura ring is now an FSA eligible expense. I love my aura ring. So that would definitely be a good way to use it. A lot of the diagnostic testing that you can do, whether it's blood tests or different things, those are often covered. 23andMe genetic testing is often covered.

I'll put a whole list together in a future episode about end of the year stuff and in a newsletter. But there is definitely enough things. And if you have nothing that you want to do, you could always buy things and donate them to local shelter for people who need them. So definitely make sure you use those FSA dollars before the end of the year.

There's also an FSA for dependent care, which if you pay a nanny, au pair, childcare, daycare, anything like that, then definitely worth contributing to the FSA for dependent care. Though I will make one caveat. I would email your HR team or ask someone and

how often the FSA for dependent care gets clawed back. There are some rules around eligibility and if certain types of employees who make more money or are more senior put in more money, but other employees who aren't in that group put in less, then they have to

claw back the contributions. I know when I was at Wealthfront, it seemed like every year we contributed the max to our FSA for dependent care and it got clawed back at the end of the year. So we actually were like loaning money to our employer for the year and getting nothing for it. So I would ask your employer if that's something that happens regularly or not. And if it does, then maybe think twice about whether it makes sense or maybe ask them what they expect might happen next year.

And then HSA. We talked a lot about the HSA before. The only thing that I'll mention is you don't actually have to use the HSA provider your employer offers. If your employer is willing to contribute to your HSA for you, and a lot of employers will put money into your HSA as a perk,

Because usually to be eligible, you chose a high deductible health plan that has a lower monthly premium. And so you're saving your employer money. And so in return, they're willing to give you money in the form of an HSA contribution. Oftentimes, they'll only do that with the HSA provider that they've partnered with.

But you can open an HSA anywhere. So in the past, I've had whatever the HSA, I think it was health equity that came with the company and it was terrible. The investment options had high fees. And so we actually moved it over to a company called Lively. I've also tried a company called Starship. So you don't need to keep your HSA at whatever HSA provider your employer offers, but you might need to leave it there if your employer contributes. A few other things through open enrollment. Pre-tax transit. A lot of employers offer the ability for you to buy

your local transit cards or even sometimes parking at pre-tax rates. So if those are things you're going to spend money on already, definitely worth contributing and saving money on the taxes there. And then the last one is around life and disability. So many employers include some basic amount of life and disability, usually don't get to even opt into it. It's just there. Definitely no harm in just accepting that. But there's also sometimes the option for supplemental life and disability insurance.

And I think the one thing to consider when it comes to supplemental life and disability, it's a plan that's tied to your employer. So let's say you have life insurance at your job. You're 40 years old. You work there for 10 years and you have no health problems. So you just get it through your employer. And oftentimes it is a little cheaper. But let's say in that period of 10 years, you have an underlying health condition. You quit your job.

Now you need to go somewhere else. They don't offer supplemental life for disability. And now you need to go get your own term life insurance. And now you're not eligible for the best rates because you have some health issue or because you're 10 years older and it's just more expensive. And so unless you have a job...

that's very, very stable. Maybe you're a government employee and you have no plans to leave for the rest of your life, or maybe you have a pre-existing condition. It makes it so expensive or even impossible for you to get your own life insurance coverage elsewhere. Maybe in those two scenarios, it could make sense. Otherwise, I would make a strong, strong recommendation to look for your life insurance separately and outside of your employer so it's something that can stick with you for as long as you need it and

isn't bound to being stuck in one particular job with one particular employer. So I think that covers everything open enrollment. I hope this was really helpful. Finally, I did say I was going to give a few tips for Hawaii. We're here on the big island for a week. I'm here for a conference, but we decided to make a family trip out of it. I actually don't have a ton of tips because it's only been two days, but I did want to share a couple things. One,

We had a family dinner at the Lava Lava Beach Club, and I would highly recommend it for anyone. I would go back without kids, but I would definitely go back with kids. It was just great. They had live music, good food, very kid-friendly, right on the beach. Definitely a recommendation that I would give anyone. And then last night, we left the kids at home with our au pair, and we went to the canoe house at the Aubergine-Montalani property, which is beautiful. We're staying at a

rented house. So we're not staying at a resort right now, but it was wonderful. The corn ribs and the pork jowl were just incredible. So I would highly recommend those also the maitake mushrooms. So those are two tips. I was hoping to tell you about the amazing snorkel adventure we went on with Ocean Sports. However, they canceled this morning because there's a lot of swell in the water. So we didn't get to go on that. But I did learn something that works really well if you have young kids. So we went over to a place called Snorkel Bob's and they rent these

boogie boards with cutouts and like a clear screen. And that actually has a cylinder that comes up almost like a paint can made of plastic. So your kids can stick their face on it and look underwater. It's like a glass bottom boat built into a little boogie board. So we did rent one of those for Quinn so she could kind of go out and be able to look underwater. We're trying to teach her how to snorkel, but at three, it is a little trickier than you'd expect, or maybe it's equally as tricky as you'd expect. But that was a cool little hack that we found.

And then also one thing we always do is we just go on Target whenever we're going to Hawaii and we pre-order all the groceries that we might want, all the things, some diapers, whatever the stuff you need is. And then we just pick it up at the Target before we go. We did this in Maui. We've done it in Kona. It just makes it so, so much easier. And you just don't have to worry about a lot of hassle. Those are my quick three tips from our trip right now.

And actually one more, we're staying right near the Fairmont Orchid, which I've been to a lot of times because the conference I'm going to is hosted there. And I think most people know this, but just in case you don't, all beaches in Hawaii are public. So you can access the beaches at resorts without having to stay at the resort. And so we've gone over to the Fairmont Beach, we've hung out on the beach, swam out on the water. But all

Also, most hotels, yes, they have overpriced drinks and food, but they also know that and don't care if you're staying there. So we were able to go to the beach, order drinks, order food, hang out, and not have to worry at all about staying at the properties. We could save money staying very nearby, use the beach, but also be able to get drinks at the beach just like you would if you were staying at a resort. So there's a little hack for Hawaii. Probably doesn't work in most other places where beaches are kind of owned and operated maybe by the resort, but in Hawaii, they are all public.

That's all I've got this week. I hope this episode was really helpful for anyone going through open enrollment. I really hope that you guys can figure it out and get the best deal. I really wish that this entire health insurance process in the States wasn't as complicated and confusing as it is, but hopefully this has been helpful and

makes it a little bit easier for you as you go through this period. So if you ever want to get in touch, you can send an email to podcast at allthehacks.com. I will read every single one of those emails. And if you have questions, they will all be considered for a future mailbag episode. I might not be able to respond to your email, but it doesn't mean I'm not reading it. And I don't love hearing from you. So thank you everyone for reaching out. That's all for this week. See you next week.