Earlier this summer, I found myself completing a 3-day stint in my local hospital's Intensive Care Unit for a suspected heart issue. Although I proved during the visit that my ticker is, in fact, quite healthy, the $62,000 bill I got made me infinitely glad for my insurance. It was a staggering reminder of how just one medical event potentially can devastate an individual or family financially, and of how critical it is to get a plan that's truly effective.

What you're up against

Yosselyn Dupuis, Director of HR, PHR for telemedicine company Doctor On Demand, says there are three big hurdles that people have to overcome to get a plan that actually works.

  • "Plans themselves have generally not kept up with the change in demographics of today's workers. That includes the need to understand your ability to access while traveling, change in companies, if you decide to stop being a formal employee and instead be a contract worker.
  • The current political climate has also increased confusion on what is and is not covered and what may change after an employee signs up for the next year.
  • Current employees want 24/7 access, through electronic means such as email, messenger and video. It's very important for employees to know and understand if this access is covered in the plan they choose."

Making matters even more difficult is a lack of transparency common among providers. Dupuis asserts that physician and clinic performance scores are difficult to find online. Websites aren't always clear about telecommunication options, either. And Dupuis claims the practice of separating physical and mental care holds people back, too.

"Traditional healthcare systems have neglected the interaction between physical and mental wellbeing for too long," Dupuis says. "It is now widely recognized that patients with what have traditionally been thought of as physical ailments, such as heart disease, stroke, HIV, diabetes and cancer often have an overlapping mental health impact. It is critical for medical providers to engage their patients psychosocial needs as well as biomedical needs. Failure to do so results in higher costs of care, reduced workplace productivity and increased missed days of work. This is why Doctor On Demand has cross-trained our medical providers to screen and treat mental health conditions alongside the physical conditions that trouble our patients."

What to pay more attention to when comparing plans

Dupuis says that most workers look at what their coverage will cost them each month and what the paycheck deduction ultimately will be. This makes total sense given the need to see if a plan works with an overall budget. They also try to figure out why they need the coverage, if the features fit their needs and what the overall value is. But they often neglect to get the details on

  • Copays
  • Deductibles
  • Out-of-pocket expenses
  • Which items aren't covered

They also need to know and ask about

  • The difference between FSA and HSA or other options.
  • Covering one person versus covering an entire family.
  • How the plan accommodates care across many geographical areas, such as you might need if you travel a lot for work (telemedicine can help).

A good starting point is to look at your Summary of Benefits and Coverage. All health plans have to provide this, and you typically can view yours by logging into your online account. But creating a simple chart is handy when comparing and analyzing plan choices, too.

"The chart [should] list the most important concerns and features needed across the top and the health plan choices across the side," Dupuis explains. "It's important to research using the material provided to you, the website info and the customer support numbers to fill in the grid. Is it offered, is it not offered, ability to access, cost, etc.? Then review the side by side and determine your priorities versus the costs."

What business leaders can do

Employers can share some of the responsibility for workers getting good coverage. Doctor On Demand's Open Enrollment Guide recommends that business leaders

  • Create a single-page information sheet that contains definitions of key terms, contact numbers, website URLs and a list of data workers need to fill out forms.
  • Put notices on online or hard-copy paycheck stubs.
  • Make videos available on office or cafeteria screens, as well as Youtube, Facebook and other platforms. Aim some of these at significant others/spouses, who might be the primary healthcare decision makers for the family.
  • Set up informational tents where workers can get information at their leisure.
  • Create a dedicated page on the company's Intranet.

Even though finding and obtaining a sufficient plan takes work, Dupuis is optimistic about the future. Dupuis notes that an increasing number of states are recognizing the opportunity for digital health solutions. Dupuis also points to HIS Market, which estimates professionals could complete 45.6 million virtual doctor visits in the U.S. by 2020. With reduced cost, increased effectiveness and improved ease all emerging from these types of technologies, that's something people on both sides of the political aisle can celebrate.