Why Picking a Health Plan Is So Confusing

Even health and policy experts struggle to choose health care each year. Here’s what to know.

Michael Millenson
Elemental
Published in
6 min readNov 14, 2018

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Credit: Irina_Strelnikova/iStock/Getty Images Plus

David Johnson and Terri Brady met at Harvard while both were working on master’s degrees in public policy. He became an investment banker, specializing in complex financial instruments like derivatives and options. She added a law degree from Columbia.

When the couple moved to Chicago and needed to figure out which health insurance plan to select from Brady’s employer, it felt natural for the duo to set up a spreadsheet. They’d simply calculate tradeoffs among the different plans, such as annual premiums and deductibles. After hours of frustration, however, the couple came to a realization.

“It was impossible to know for sure which approach would cost the most money,” recalled Johnson, now a health policy consultant. “It actually ended up being pretty complicated math.”

Welcome to open enrollment season. In contrast to general end-of-the-year cheer, selecting a health insurance plan typically conjures feelings of confusion and inadequacy. There’s a nagging worry that you’re wasting money, picking a plan with in-network doctors who will give you inadequate care — or both.

The bad news is that you could be right. But the good news, though it’s small consolation, is that you shouldn’t blame yourself. Your unease is ubiquitous, secretly shared by many health experts when they make their own choices, possibly because they’re even more attuned to the possible pitfalls.

“It was impossible to know for sure which approach would cost the most money.”

“Even if you understand all the terms, I think it can be very confusing,” says Paul Fronstin, a veteran economist for the Employee Benefit Research Institute (EBRI).

The 2018 Kaiser Family Foundation survey found that six in 10 workers whose workplace offers health coverage have more than one plan option. But while choice may signal a market sensitive to individual needs, having too many choices can overwhelm our brains and stress us out.

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Michael Millenson
Elemental

As author, researcher and consultant, I focus professionally on safe, high-quality and patient-centered health care. I also write on more personal concerns.