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Open enrollment guide: Your real costs
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October 17, 2001: 4:45 p.m. ET
Don't just look at premiums when comparing policy costs.
By Jeanne Lee
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NEW YORK (CNNmoney) - It's hard to say, even when looking at two plans side by side, which would be more expensive to use. You can't total up the premiums alone. Here are the factors to look at.
Deductibles
If you're considering a plan with low premiums but a high deductible, try to guesstimate how much you would have paid in cash last year. If you've never spent much time at the doctor's office, chances are good that such a plan would save you money. "What most young, healthy people really need is coverage for catastrophic illness or accidents," says the National Coalition's Schoeni. "Their odds of getting sick are not so great. And if they do go to the hospital, they can pick up the first $500." In my case, all plans have the same premium and deductible.
Co-payments and discounts
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 WHAT YOU'LL REALLY PAY
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To compare the true costs of health plans, add obvious expenses -- like premiums -- to others, such as co-payments, that are harder to track. Add up:
1. Total premiums for the year
2. Estimated co-payments or co-insurance (based on how often you went to doctors last year)
3. Cost of services that are partially covered. Include payouts to meet the deductible and subtract any reimbursements.
4. Cost of services that aren't covered, such as acupuncture or infertility treatments (if needed)
5. Annual co-pay for prescriptions you take regularly
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Six of my seven HMO options charge a $10 co-payment and one charges $15, as do all three POS plans. That $5 difference can add up: If I had three kids who went to the doctor monthly -- say, for allergy shots -- the higher co-pay would cost me $180 extra for the year. But since it's just me, and I've already ruled out the HMOs, once again I can't eliminate anything. Zipping over to the POS websites, though, I notice that some give big discounts on complementary and alternative medicine, which I like. Aetna and Oxford offer reduced rates for selected acupuncturists; I can't find acupuncture on United's site. I don't eliminate United, but I take this into consideration.
Infertility
This is a special case. If you are encountering difficulties starting a family, infertility coverage should be a make-or-break issue, because treatment costs can quickly run to the tens of thousands of dollars. Although no federal law mandates coverage, 13 states require insurers to offer coverage of infertility diagnosis and assisted-reproductive technologies. Your employer, however, is not always required to buy the coverage. Infertility is not a concern for me, but I do notice stark differences between plans: Among my POS providers, Oxford covers only one cycle of treatment and caps payment at $10,000; the others cover three attempts at artificial insemination plus three cycles of in vitro fertilization.
Three of the HMOs in my plan book cover infertility diagnosis but not treatment. One pays for three attempts at artificial insemination. But I'm surprised to find a great deal from Aetna U.S. Healthcare's HMO -- 100 percent coverage for three attempts each at artificial insemination and in vitro. Plans will vary widely, depending on your geographical area and the deals negotiated by your employer.
Drug coverage
Prescription-drug prices rose 15.5 percent last year, making that the fastest-rising element of health-care costs. Insurers are passing those price hikes along to you by boosting co-payments for brand-name drugs and tightening up formularies (lists of drugs that your plan will cover fully). For example, Empire Blue Cross Blue Shield of Downstate New York, an HMO, now has three co-payments for prescriptions: $5 for generics, $15 for preferred brand-name medications and $25 for other brands. With that policy, if I had to take a brand-name drug daily -- say, Zocor -- that wasn't on my plan's formulary, I'd pay an extra $240 a year.
It's important to talk to your doctor before switching to a less expensive version of your prescription. "There are drugs that have what is called a narrow therapeutic index, which means the amount that causes a good effect is not much different from that causing a toxic effect," says Dr. Paul Gitman, an internist at Long Island Jewish Medical Center in New Hyde Park, N.Y. If your body absorbs the new formulation differently, you could risk developing side effects. Many employers offer drug coverage as a separate plan. That's the case for me -- all three POS plans contract with PCS Health Systems. But if you do have a choice, check the restrictions within each plan -- and be warned that formularies do change. "Prescriptions are the biggest area of consumer dissatisfaction," says Watson Wyatt consultant Richter. 
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