Author Topic: Choosing a new health insurance plan... is my math right??  (Read 1445 times)

Dollar Slice

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Choosing a new health insurance plan... is my math right??
« on: February 08, 2017, 11:21:28 AM »
I was recently hired (sort of - company acquisition) by a newer, fancier, bigger company, and for the first time in my life I actually have a choice of health insurance plans instead of being told "this is what we've got, take it or don't."

I'm looking at the options and trying to figure out what is the best, mathematically.

Annual premium cost to me will be (pretax/after tax):
Base plan: $1209/$701
Buy-up #1: $1806/$1047
Buy-up #2: $2994/$1736
HDHP: $1197/$694

Caveat: I tend to get sick a lot, I take medications for chronic conditions, and there is a fairly high chance I will be needing one or two out-patient surgeries in the next year or two. So I'm not considering either the base plan or the HDHP. Even without surgery, I'd be sprinting through the deductibles with specialist visits for the issue that may need surgery.

It seems like buy-up #1 is my best choice if I don't end up having surgery, but buy-up #2 would be significantly better if I did have surgery (because there is almost no way to run up costs with that one). I'm leaning towards #2 because I think I'm likely to max out the deductible every year on #1, which would mean at best I'd only be saving a couple hundred bucks a year while risking $2000 OOP if I end up having surgery or some other medical event.

Please tell me if I am missing something!
« Last Edit: February 08, 2017, 11:24:01 AM by Dollar Slice »

Morning Glory

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Re: Choosing a new health insurance plan... is my math right??
« Reply #1 on: February 08, 2017, 11:43:37 AM »
It looks like buyup #1 is still your best choice if you have surgery. Premium + OOP max is 3547 for buyup #1, vs 3736 for buyup#2.
You will most likely meet your OOP max if you have any type of surgery or hospital stay, even if there is supposedly no copay. This is because unless you go to a large medical group where the doctors are employees (think Mayo or Kaiser Permanente), the doctors are private contractors. Even if your hospital and surgeon are in network, your anesthesiologist or radiologist may not be. Pharmacy charges and other tests and procedures may also not be considered part of the hospital stay for insurance purposes.
« Last Edit: February 08, 2017, 11:53:15 AM by MrsWolfeRN »

Dollar Slice

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Re: Choosing a new health insurance plan... is my math right??
« Reply #2 on: February 08, 2017, 11:47:13 AM »
It looks like buyup #1 is still your best choice if you have surgery. Premium + OOP max is 3547 for buyup #1, vs 3736 for buyup#2. You will meet your OOP max if you have any type of surgery or hospital stay.

That was my initial thought, but buy-up #2 has a $0 co-pay and no coinsurance for outpatient surgery and durable medical devices, so presumably I wouldn't be out of pocket for surgery under that plan. Are there other charges from surgery that are not covered by those categories?