Smart Money Podcast: Choosing a Healthcare Plan via Open Enrollment (HMO, PPO, FSA, HSA, HDHP and More)

Tina Orem
Kate Ashford, CSA®
Liz Weston, CFP®
Sean Pyles
By Sean Pyles,  Liz Weston, CFP®,  Kate Ashford, CSA® and  Tina Orem 
Published
Edited by Kevin Berry

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Welcome to NerdWallet’s Smart Money podcast, where we answer your real-world money questions. In this episode:

Expert Nerds talk through the complexities of open enrollment, starting with ways to assess healthcare plans and costs.

This episode takes a deep dive into specific terminology and scenarios relevant to choosing health insurance coverage. Hosts Sean Pyles and Liz Weston start with an overview of open enrollment period timelines for November and December 2023 before welcoming guest Nerd Kate Ashford to explain deductibles, premiums, HMOs, PPOs and HDHPs.

Then, NerdWallet’s Tina Orem joins the show to discuss the pros and cons of high deductible plans and the intricacies of Health Savings Accounts (HSAs) and both Medical and Dependent Care Flexible Spending Accounts (FSAs). In the second half of this episode, she zeroes in on selecting optimal health insurance for individual needs, discussing the merits and disadvantages of different health plans, budgeting for healthcare, and how to compare the benefits of an FSA and an HSA

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Have a money question? Text or call us at 901-730-6373. Or you can email us at [email protected]. To hear previous episodes, go to the podcast homepage.

Episode transcript

This transcript was created based on the podcast audio by an AI tool.

Sean Pyles:

Decisions. Decisions. Sometimes it's hard to make them. And that goes double when you're trying to figure out which health plan to choose during open enrollment.

Kate Ashford:

How much healthcare do you use? How often do you see the doctor? Do you have any major surgeries or procedures coming up? Are you planning to try for a baby? Do you have small children? All of these things can affect what kind of plan makes sense for you.

Sean Pyles:

Welcome to NerdWallet's Smart Money Podcast. I'm Sean Pyles.

Liz Weston:

And I'm Liz Weston.

Sean Pyles:

This episode kicks off our Nerdy deep dive into open enrollment. Yay. Liz? Liz?

Liz Weston:

Sean, did you just, yay open enrollment?

Sean Pyles:

Sarcastically.

Liz Weston:

Oh, okay. Well then yes, yay. And I'm confident in predicting that nobody actually says that at this time of year.

Sean Pyles:

Yeah. It's not my idea of fun to sit down and try to figure out if I want a high deductible plan, what my premiums will be, what prescriptions are covered or not. If I should use an HSA or FSA. How to decide on life insurance, and disability.

Liz Weston:

Sean. Sean, you're spinning out, as we all want to do during open enrollment. And for those who aren't following along too closely, open enrollment is that time of year, typically anywhere from October to mid-December, when people in employer-sponsored health plans, and public and private health plans, including through Affordable Care Act exchanges, get to choose their individual and family plans for the coming year.

Sean Pyles:

Right. And we are smack in the middle of that right now.

Liz Weston:

It's kind of like tax time in April, and sometimes just as confusing.

Sean Pyles:

And fraught, because if you make a mistake, you're stuck with it for a year.

Liz Weston:

Exactly right. And we as a populace are not too good at making the right choices. In one study, more than 80% of the employees at a Fortune 100 company picked the wrong health insurance plans. They went with low deductible options that ultimately cost them more. Another study found that inertia, sticking with the same plan, rather than evaluating the options each year and choosing a better one, cost workers an average $2,032 annually.

Sean Pyles:

Sheesh. And Liz, health insurance is often just one of the decisions we have to make during open enrollment. Should we get our company's life insurance, or buy our own? Use a flexible spending plan, or health savings account? Do we really need disability insurance? And what about some of the newer benefits employers are adding, like pet insurance or adoption assistance? How much of this is must-have? How much is nice to have? And how am I going to afford all of it?

Liz Weston:

That last question is really the crux of all this, isn't it?

Sean Pyles:

It is. And remind us what kind of deadlines we're all under.

Liz Weston:

Okay, so if you're getting health insurance through the ACA, the Affordable Care Act, it's November 1st through December 15th. For Medicare, it's October 15th to December 7th. If you're a federal employee, it's November 13th to December 11th. And if you get your plan through a private employer, it varies. It's usually two to four weeks, somewhere in October through November.

Sean Pyles:

Well, we are coming to the rescue for those of you who haven't made those decisions yet. And if you already have, good for you. We hope you chose well. But if you're still in the morass of plan evaluation, we are going to walk you through a lot of the process over the next three weeks of this series.

Liz Weston:

So get a cup of coffee, and get out your plan options, and we'll see if we can help you sort it all out. Today, it's Healthcare. Episode 2, we're covering all kinds of other insurance including disability. And episode 3, we're talking about vision, dental, pet care, and more. I mean, how bad can it be? We're talking about benefits.

Sean Pyles:

Bennies for one and for all. All right, well we want to hear your stories about open enrollment, the good, the bad, and the ugly. Have you timed how long it takes you? Are you cool with your options? What else do you think should be covered by insurance? Leave us a voicemail, or text the Nerd hotline at 901-730-6373. That's 901-730-N-E-R-D. Or send a voice memo to [email protected]. So Liz, where do we start today?

Liz Weston:

Well, we're going to lead off with health insurance, because that is the biggest challenge for most people in terms of the breadth of options to choose from, and the math they have to do to figure out what's best for them and their families. And for this we're going to talk with our fellow nerd, Kate Ashford. She's written about health insurance for years, and she's a certified senior advisor who covers Medicare and retirement topics for NerdWallet.

Kate, so glad you could join us on Smart Money.

Kate Ashford:

It's so fun to be here. I appreciate you having me.

Liz Weston:

So when you hear the words open enrollment, what happens in your brain?

Kate Ashford:

Well, I'm a health insurance Nerd, but even to me open enrollment, it feels like homework. You've got to wade through the fine print, and you've got to do some math. And it all feels a little tedious. Actually, it really feels a lot tedious.

Liz Weston:

Yeah. For me it's basically a trigger to run away to Europe for a month or two, to avoid the whole thing. But all jokes aside, this is serious business and incredibly complex. So let's start with some of the real basics. We hear these terms all the time, but it doesn't mean that we really understand them. So Kate, how about explaining premiums and deductibles for us?

Kate Ashford:

Sure. The premium is what you pay each month for your health insurance. If you're getting insurance through work, this is probably taken right out of your paycheck. And the deductible is the amount you pay out-of-pocket before your health insurance starts to cover things. So if your plan has a deductible of $500, you'll pay for the first $500 of medical costs before your insurance starts to cover things.

Liz Weston:

And this is really like a seesaw, right? In that most plans either have higher premiums that you pay monthly, or high deductibles that mean you're paying a potentially higher bill if you end up using a lot of your insurance. So how do individuals and families go about deciding which part of the seesaw they should be on?

Kate Ashford:

It's really about anticipating how much healthcare you typically need or use each year. If you see the doctor a lot, if you have a chronic condition or you have small children, you are pregnant, you might want to plan with higher premiums but lower copays. Or maybe a cheaper plan, like an HMO. If you're healthy, you're not doing a lot other than your annual physical and flu vaccine. Maybe you've got a sore throat here and there. You might go for the higher deductible plan with low premiums, and just pay out-of-pocket for the care you need. The high deductible plan can feel like a scary choice, but if you've got the money to cover your upfront costs, it can be cheaper overall.

Liz Weston:

This always feels like such a hard thing to figure out, because you're almost being asked to predict what's going to happen to your health in a given year. If you feel like you're healthy, you might take the higher deductible thing thinking you'll never have to pay it. But then you have some sort of a health crisis, or an accident, and suddenly you're on the hook for all of it before the insurance kicks in. Is that a fair assessment?

Kate Ashford:

Oh yeah, that can definitely happen. That said, you really have to run the numbers to see which plan is better for you. You might find that even if you anticipate a lot of health needs, a high deductible plan isn't the worst-case scenario, because the lower premiums balance out the higher care costs. I think people forget about the amount they're paying in premiums for a traditional plan, because it comes right out of your paycheck. You never see it. But it's a cost, and you have to factor it in. The other thing about a high deductible plan is that some companies kick in a contribution to your health savings account, which you can use to pay for care pre-tax, so that lowers the cost also. You just have to make sure you have the money to handle that higher deductible upfront. And if you don't have the cash on hand if a health emergency strikes, a high deductible plan is not a great idea for you.

Liz Weston:

Yes, and also if you would put off care, because you have to pay for it. That's another reason not to use a high deductible plan.

Kate Ashford:

Absolutely.

Liz Weston:

I know this is a thing. It's just something that psychologically if you could be prone to that, then maybe get the lower deductible plan and make sure you're getting the healthcare that you need.

Kate Ashford:

It can feel scary. I've had a high deductible plan for a number of years now, and those first few checks at the beginning of the year before you hit your deductible, it feels like a lot of money. And you really have to keep the whole year in mind, because over 12 months it's the cheaper thing. But those checks upfront, it really is a scary feeling.

Liz Weston:

Yeah. We'll get to some of the details about health savings accounts in the second half of the show because you mentioned those, but let's talk about the kind of second tier sort of decisions. Which is looking at co-pays, co-insurance and out-of-pocket maximums. All of these have potential to show up in a variety of plans that are offered to most people. So give us a rundown of what they mean. Especially co-pay versus co-insurance.

Kate Ashford:

All the terms. So co-pay is usually a fixed amount you pay every time you see a doctor or specialist. So your plan might have you pay $25 every time you see your primary care doctor, and $50 every time you see a specialist. Co-insurance is what it's called when you pay a percentage of the costs of a covered service, usually after you've met your deductible. This tends to kick in for things like X-rays. So if you've hit your deductible, you would owe 20% of the cost of the X-ray and your insurance covers the rest.

Liz Weston:

And how do you go about evaluating where these fit into your decision making? I mean, high deductible with low co-pays, low deductible with high out-of-pocket. We're doing a lot of math here, aren't we?

Kate Ashford:

Yeah. Unfortunately, you really do have to do the math. You have to look at all the things. How much are the premiums for the full year? If it's a high deductible plan, does your company give you an HSA contribution? Is there a plan deductible? And what is it? What's the out-of-pocket maximum? Which is the most you could spend in covered care in a year. That's important. If you have a big health event, you could hit that. And you probably should estimate based on what's happened in the past, how many times you typically see the doctor, or a specialist. And what kinds of things might pop up. Do you have a kid who plays sports? Maybe figure for at least one X-Ray. Even a ballpark figure here is helpful.

Then you can do some rough math for what that kind of care would cost you under each plan. If you're totally stumped, you can log into your account for your current health coverage and take a look at the claims you've had this past year. My health plan has an app. I can look at my claims there, or log onto their website. I'm not going to sugarcoat it, you do have to get into the weeds on this. You can't do this while you watch Netflix.

Liz Weston:

And I was really looking forward to rewatching Arcane. Anyway, speaking of Arcane, let's move on to the alphabet soup of healthcare options. PPOs, HMOs, HDHPs, C3POs. Let's take them one at a time. What is an HMO? And what are some of the advantages and disadvantages of choosing this?

Kate Ashford:

HMO stands for health maintenance organization and this is a type of health plan that works with a specific network of doctors and hospitals. Usually this is the cheapest kind of plan to choose, but it's also got the least flexibility. You'll have to get referrals from your primary doctor every time you want to see a specialist. And you'll only be covered for doctors in the plan's network, unless it's an emergency. HMOs can be good choices for people who don't see the doctor all that often, or whose doctors are all in the network anyway. And if you're on a tighter budget without a cash cushion, this is typically the most affordable option.

Liz Weston:

Well, that's good to know. Okay, same question for PPOs. What are they? And who might they be right for?

Kate Ashford:

PPO stands for preferred provider organization. These plans tend to cost a little more than HMOs, but you have more choices. You can typically see specialists without a referral. And if you want to see a doctor that's out-of-network, you can do that. It'll just cost you more. If you travel, if you have complex care needs, if you don't want to have to ask your primary care provider every time you want to see a podiatrist or an orthopedist, this can be a good option.

Liz Weston:

Okay. And finally, the HDHP. This might not be quite as familiar to listeners, so what does it stand for? What is it? And what are those advantages and disadvantages?

Kate Ashford:

HDHP stands for high deductible health plan. Officially to be a high deductible plan in 2024, a plan has to have a deductible of at least $1,600 for individual coverage, and $3,200 for family coverage. These plans usually cost less, meaning the monthly premiums are lower, but the deductible is higher than a traditional plan. So you'd have to spend more money of your own before your insurance starts covering things. High deductible plans usually also come with health savings accounts or HSAs, which are a huge tax win. I think you're getting into those later.

High deductible health plans can be a good option for people who don't use much healthcare. Or, weirdly, for people who use a lot of healthcare because you can predict your costs. And they can be lower over the course of a year with this kind of plan. There's also the fact that employers sometimes give you a contribution towards your HSA if you have this kind of plan, and that lowers costs as well. That said, like I mentioned, I've had these kinds of plans for the last several years. And they are cheaper for me in my circumstances, but it can feel scary to write those big checks for medical care at the start of the year. And that huge deductible, like you mentioned, can mean that some people skip getting the medical care they need.

Liz Weston:

Okay, let's run down some of the key factors to consider when you're making these plan decisions. What are the main questions that individuals and families need to ask themselves when they're sorting through all their options?

Kate Ashford:

Generally people need to think about these questions, and it's a lot of questions. How much healthcare do you use? How often do you see the doctor? Do you have any major surgeries or procedures coming up? Are you planning to try for a baby? Do you have small children? All of these things can affect what kind of plan makes sense for you. How financially stable are you? Are you living mostly paycheck to paycheck? Or do you have a financial cushion you could use to pay the upfront costs of a high deductible health plan? How much choice do you want? If you don't care who you see, you might be fine in an HMO with a limited network. But if you want more freedom to see specialists or doctors who might be out-of-network, a PPO offers more flexibility, although your costs will be a little higher.

And you also have to think about your specific doctors and medications. You want to make sure you choose a plan where hopefully your doctors are in-network, and your medications are covered at prices you can afford. If that's not the case, keep shopping. And the keyword there is "shopping". Definitely compare plans every year. Don't just auto-renew, because things change. Networks change, covered drugs change, and so do your health and financial circumstances. So it's worth your time to get in there and look around.

Liz Weston:

And one last question, Kate. One of our producers was talking about, what you might call the overabundance of options when you go through the Affordable Care Act exchanges, those are also known as Obamacare exchanges, and you're trying to choose an individual health plan. She calls it overwhelming abundance, and not in a good way. So there could be a dozen or more options to choose from. Do you have any advice on how to start that process?

Kate Ashford:

No. Oh, your producer isn't kidding. I plugged my zip code into my state's ACA marketplace page and got 48 pages of results. Not 48 results, 48 pages. So overwhelming. You can whittle your options down in a few ways. It's incredibly tedious to check each plan to see if your doctor is in-network. So start with your doctors, call them directly and ask them what marketplace plans they'll be accepting in 2024. Then you can eliminate everybody else from your list. Some state marketplaces allow you to put in your medications and your doctors, and filter that way. That would be helpful. My state's website did not.

You can also use your budget to take another chunk of plans out, what can you afford each month? And then eliminate all plans that cost more than that. You may be able to filter by metal level, which is the plans ranking based on costs and out-of-pocket expenses. Platinum, gold, silver, so forth. It's probably safe to say that the lower price plans, like bronze level, offer more basic coverage. And after that, you're making choices based on what we've talked about already. How much healthcare do you need? What's your financial situation? You're back to that math. It all comes back to math here.

Liz Weston:

And this is why we have to take math in high school. Okay, Kate, thanks so much for helping us out today.

Kate Ashford:

Absolutely. Thanks for having me.

Sean Pyles:

Liz, after that conversation, I'm thinking about the investing adage that past performance is no guarantee of future results. And in the case of choosing your health insurance, your previous year's healthcare coverage may, or may not, be what you'll need next year. But this uncertainty is why doing the work of finding the right healthcare plan for what you think you'll need is so important. With so much out of your control, it's worth it for folks to take the time to crunch the numbers, shop around, and land on the healthcare plan that is hopefully best for their needs.

Liz Weston:

It may help my fellow maximizers to know that there probably isn't one perfect solution. You do the best you can, and if you find out there's a better choice, you can make it next year.

Sean Pyles:

But one thing I'm thinking about now is, how should folks figure out whether they need an FSA or HSA? Or maybe neither?

Liz Weston:

Well, that's what we're covering next, Sean. Pay close attention to our fellow Nerd, Tina Orem, who's here with some specifics on those savings vehicles. Tina used to cover taxes for NerdWallet. She's now an editor, but she agreed to recap what she knows about tax advantage savings accounts for us.

Tina, it's so great to have you back on the show.

Tina Orem:

Thanks Liz. I'm so glad to be back.

Liz Weston:

So we just spent some time with Kate talking about the basics of choosing a health plan. But we wanted to bring you on to talk about a couple of options that are also offered by many employers, and they're essentially savings vehicles. So explain for us the overall purpose of FSAs, which are flexible spending accounts. And HSAs, which are health savings accounts.

Tina Orem:

Yeah. So the overall purpose of flexible spending accounts and health savings accounts is that you save a buck on purchases that you already know you're going to make. So I mean, if you know you're going to have to spend the money, you might as well get a tax break freebie while you're at it.

Liz Weston:

So true. So how do you get these goodies?

Tina Orem:

So for flexible spending accounts, you typically sign up during the open enrollment period at work, which usually happens toward the end of the year. You can usually sign up when you get hired too, if that's not during open enrollment. And then sometimes you can sign up if there's a substantial change in your situation, like if you get married, or divorced, or you have a child. For health savings accounts, it's a little different. Technically, you can open an HSA account anytime of year, but the catch is that in order to be eligible to contribute to an HSA account, you have to be enrolled in a high deductible health plan at work. And that is something you can typically only do during open enrollment.

Liz Weston:

Well, let's take a more detailed look at FSAs first. Those are the flexible spending accounts. What are some of the specific elements of these kinds of savings vehicles?

Tina Orem:

Yeah, so there are three things I want to tell you about FSAs. So the first thing is that, there are two kinds of FSAs. And your employer might not offer both, but there's still two kinds. Medical FSAs, and dependent care FSAs. So with medical FSAs, you can only use the money in the account for medical expenses that your insurance isn't already going to pay for. So you think about the co-pay at the dentist, or the portion of your medical bills after insurance that you have to pay. Or stuff that's just not covered, like maybe braces or something. And it's also for your spouse and your dependents. But also with medical FSAs, you can think about half the stuff that's in CVS. So it covers bandages, saline solution for your contacts. Like pregnancy tests, antacid, acne medication. It goes on and on. There's allergy medicine, cough drops, antihistamines, tampons, teething medications. And even things like toenail fungus treatments, on and on.

Liz Weston:

Okay.

Tina Orem:

This is all stuff people have to pay for anyway, so you might as well save a buck by running the money through an FSA account first, so you don't also have to pay taxes on it. And if you're listening to this and you're like, "Where is she getting this list of items?" You can Google IRS publication 502, there's the list. The second kind, is a dependent care FSA, is for daycare. That's something a lot of us have to pay for anyway. These accounts work for kids up to age 13. And for parents who, for tax purposes, are your dependents, and maybe they need adult care if they can't care for themselves.

So with these accounts there are some complexities regarding who has to live where, particularly in the case of adult care and divorce. So be sure to read your plan documents carefully. But again, you might as well save a buck by not also having to pay taxes on this money that you're going to spend anyway. I said there were three things. So there's two more things Liz. The second cool thing about FSAs, and the reason I said they help you save a buck, is that if you put money from your paycheck directly into the FSA account, the government doesn't tax you on the money. So if you sign up to have a $100 a month put into your FSA, you don't pay income tax on the $100.

Liz Weston:

Always good.

Tina Orem:

Yes, that's always good. And this year you can put up to $3,050, 3 0 5 0, in a medical care FSA. And $5,000 in a dependent care FSA. So if you have those options at work and you max those out, that's like $8,000 you won't pay taxes on.

Liz Weston:

That's a chunk of change.

Tina Orem:

So the third thing about FSAs is that there's this use-it-or-lose-it rule. So that means you have to spend all the money in the account by the end of the year, or it basically disappears. In the real world, many employers will let you carry over up to, I think, it's $610 to the next year. Or they might give you another 10 weeks to spend whatever's left in your account. But the thing is they don't have to do either of those things, and the rules say they can't do both of those things.

So when you sign up for the FSA during open enrollment, you have to kind of take a few minutes and make your best guess about how much money you're reasonably going to spend on medical care and daycare next year.

Liz Weston:

Let's get into the nitty-gritty of how they actually work. I think most people get something that looks and operates like a prepaid card, don't they? How does the money get on those cards?

Tina Orem:

Yeah, basically an FSA is an account. And yeah, a lot of people are sent a debit card. And your money goes in the account every time you get paid.

Liz Weston:

And sometimes it's through reimbursement though, right?

Tina Orem:

Right. If you don't have a plan that comes with a debit card, you basically pay for the stuff with your regular money. And then you save your receipts, and you submit them to the plan administrator. And then they reimburse you out of your FSA account. And that's a less fun way to do it than the card, but you still win.

Liz Weston:

Okay. And this is the part of our healthcare system that sends people scurrying to drug stores across America in late December, because of that use-it-or-lose-it by the end of the calendar year. Can you give us some tips for avoiding that?

Tina Orem:

Yes, that's exactly right. The use-it-or-lose-it rule means you generally have to spend the money before the year ends. So there's two main tips here. One, take some time during open enrollment and think carefully about how much you want to put in the account from each paycheck, and what that would work out to in a year. The second thing I would say is, once you're rolling, put some sort of recurring note on your calendar, or some kind of reminder, to check your account balance once a month or so to see how you're tracking. And the third one is, if you have a partner on your insurance, remind them to use the FSA card for purchases. This happened a lot in my household where one of us would get to the checkout, and then completely forget to use the FSA card to pay. Because it's just a habit to pay with the other card or whatever. And then you get home and you realize what you did, and then you have to go the reimbursement route. And a lot of people, they're probably not going to bother with that if it's a small purchase.

Liz Weston:

Yeah, you're probably right. Let's move on to HSAs, which are health savings accounts. What can we use these for? And how do they work?

Tina Orem:

So HSAs are also for paying medical expenses, but they are even cooler than FSAs in my opinion. Because for one thing, you could put more of your paycheck into one if you want to. So in 2024, you could put in $4,150. And if you have family coverage you can put in 8,300 bucks. So like FSAs, you don't pay tax on that money that you're going to spend on medical stuff anyway, and you usually get a card to pay with. But even cooler, is that you can invest the money in an HSA account if you want. And all the capital gains in there are tax-free.

Liz Weston:

Nice.

Tina Orem:

So they can theoretically just sit there and compound, and compound, and you don't pay capital gains tax. Plus the withdrawals are tax-free if you use the money for medical expenses. So we call this a triple tax advantage, right? No tax going in. No tax while it’s in. No tax coming out. And in the tax world that is like finding a unicorn.

Liz Weston:

Yes it is. Okay, so what's the catch?

Tina Orem:

So the one catch with an HSA is that you have to be in a high deductible health insurance plan to be eligible to contribute to one. And I will say there's one little area where the FSA is actually cooler than the HSA, and that is for medical care FSAs, not Dependent Care FSAs. You can use the full balance in an FSA account right away. So, let's say you elect to have $3,000 put in the account over the course of the year. With an FSA, the 3,000 is available to you in January, like immediately. Even though you haven't made $3,000 worth of deposits in the account yet. But with an HSA, on the other hand, you can only spend what's in the account that day.

Liz Weston:

And we should say that high deductible health insurance plans are not a good fit for everybody. So no matter how cool the HSA is, it might not be the best choice for you.

Tina Orem:

Right.

Liz Weston:

Okay. So some companies won't just provide the opportunity to have an HSA, they'll actually contribute to it, right?

Tina Orem:

That's right. It's at the employer's discretion, so it's not required. But if your employer is handing out free money, I would take it.

Liz Weston:

Okay. Is there anything you can't use this account for?

Tina Orem:

Yeah, in general, you can't use your HSA money for nonmedical stuff. And I know that phrase nonmedical stuff is very vague. So what I'll say is that the IRS provides a pretty long list in Publication 502, and which you can google that pretty easily.

Liz Weston:

Okay. I wanted to circle back to talking about this as a tax and investment vehicle, on top of being a healthcare option. So how does the tax stuff work here?

Tina Orem:

Basically the strategy is this. Stuff as much as you can into the HSA, and then don't take out any money for years and years. So the money, however you invest it, grows and grows tax-free. So of course, that only works if you can afford to pay your medical expenses out-of-pocket rather than using the HSA money in the account. And if you can be disciplined about saving the receipts for those expenses. Because the other part of the strategy is that one day, when you're ready to retire, you have this big pile of tax-free HSA money to use to pay for your medical care. And you don't have to incur the medical expenses in the same year that you use the money so long as you have those receipts, the paperwork, to prove your unreimbursed expenses in the past.

Liz Weston:

Okay. So you have to keep good records, but you generally don't have to worry about having a balance in an HSA at the end of the year.

Tina Orem:

That's right. Once it's in the account, it's yours. If the end of the year comes and goes, it's still yours. You quit your job, it's yours. They fire you, it's yours. You retire, it's yours.

Liz Weston:

Okay, good. Tina, thanks again for joining us. We really appreciate it.

Tina Orem:

Anytime.

Liz Weston:

So Sean, are you an HSA, or an FSA kind of person?

Sean Pyles:

For the past couple of years I've been riding the HSA train, and I've been liking it so far. I'm taking the approach of using my healthcare sparingly, although I'm not avoiding the healthcare that I do need. And I'm essentially setting my HSA up as a pot of money to invest, that will hopefully cover some of my healthcare expenses in retirement. So what about you, Liz? Are you team FSA, or team HSA?

Liz Weston:

I've been both. But our family occupies that middle ground where we use a fair amount of healthcare, but really not enough to where the math makes sense for a high deductible plan. I miss being able to stuff money into that triple tax advantaged account, but a lower deductible plan with an FSA really is a better fit for us.

Sean Pyles:

So Liz, you mentioned up top how a lot of people just default into the plan they're already in. What's wrong with that easy method to this madness?

Liz Weston:

Well, first of all, networks and plans change. If you don't review them, you may end up with something different, even though you assumed it would be the same. Covered drugs often change as well. And Sean, most of us don't have exactly the same lives we did a year ago. Our health, our financial circumstances could be completely different. Or even just mildly different, but enough so that our current plans won't do what we need them to do. So take the time, review your options.

Sean Pyles:

And what if you have two sets of options. As in you have options through your workplace and a spouse or partner has options through their workplace. How do you start on those comparisons?

Liz Weston:

Then you get to do twice as much math, at least. Yay. Unfortunately, there's no one-size-fits-all advice here either. Maybe one plan is clearly better, so you sign up for that. Or maybe you put the kids on your plan, and your partner sticks with their own. Or maybe you don't have a lot of choice. If somebody's on Medicare for example, they can't add a spouse or dependent. So the family needs to find other coverage.

Sean Pyles:

All right. Well Liz, tell us what's coming up in episode two of this series.

Liz Weston:

Next time we're going to look at all the different kinds of other insurance you might have on offer during open enrollment. From disability and life insurance, to critical illness coverage.

Ryan Brady:

Most employers in the US offer a limited amount of life insurance for employees as part of workplace benefits. This coverage is usually what's known as basic group life insurance. And it's actually pretty easy to get. To opt in, all you typically have to do is fill out a form, and maybe meet any eligibility requirements that your company has. Such as working a minimum amount of hours per week.

Liz Weston:

And that's all we have for this episode. Do you have a money question of your own? Turn to the Nerds and call or text us your questions at 901-730-6373. That's 901-730-N-E-R-D. You can also email us at [email protected]. Visit nerdwallet.com/podcast for more information on this episode. And remember to follow, rate, and review us wherever you're getting this podcast.

Sean Pyles:

This episode was produced by Tess Vigeland and Liz. I helped with editing. Arielle O'Shea and Lacey Glover helped with fact-checking. Kevin Tidmarsh mixed our audio. And a big thank you to NerdWallet editors for all their help.

Liz Weston:

And here's our brief disclaimer. We are not financial or investment advisors. This Nerdy info is provided for general educational and entertainment purposes, and may not apply to your specific circumstances.

Sean Pyles:

And with that said, until next time, turn to the Nerds.