This study analyzes employees' ability to select health insurance benefits that fit their needs.The study analyzes both the actual choices and the implications of those choices for employees, measured as out-of-pocket costs (OPC). By introducing OPC as a measure of decision quality, this study demonstrates its advantages over measuring only employee choice. Results from a sample of manufacturing employees suggest that most employees made cost-optimizing decisions, out-performing recommendations from a linear model. Employees also were financially better off overall with choice than they would have been had they all been placed into either medical plan option available to them. This study supports the value of choice, but does not support the assertion that employees always make benefits decisions that best fit their needs.