Author Topic: Health & health insurance  (Read 2007 times)

rubybeth

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Health & health insurance
« on: November 13, 2017, 09:06:26 AM »
I have some pain issues going on that have yet to be firmly diagnosed. I am hoping I can get more clarity on this issue later this week during a follow-up with my specialist, but this issue is especially irksome to me because it is confounding my usual open enrollment decision-making process in regards to health insurance.

For all intents and purposes, imagine you have these two options, what do you choose?

Preface: undiagnosed health condition may persist into the next year. More diagnostic testing or procedures may be needed. Diagnostic could be x-ray, MRI, etc. and involve either tissues or bones, or both. Treatment could range from physical therapy all the way to surgery. Otherwise relatively healthy, active, mid-30s female. Situation: married, both employers offer coverage but my husband's is much less to cover both of us. For 2017, due to a mid-year job change for my husband, I have been on my own plan via my state exchange. Also, husband's deductible is met/covered every year at no cost to us due to his health condition (prescription support card).

1) Premium of $565/mo. for employee +spouse, premium is pre-tax. Annual premium cost would be $6,780. Deductible and out of pocket max cost to us: $0. Total annual cost to us: $6,780.

2) Premium for DH of $35, pre-tax. Premium for me alone $270, after tax. Annual premium cost would be $3,672. My deductible and out of pocket max would be $6,600. Total annual cost could range from just premiums of $3,672 all the way to $10,272 if I somehow meet my deductible.

Basically, the way I am thinking about this is: if I have more than $3,108 in health expenses in 2018, I am better off being on my husband's plan and paying the higher premium ($3,108 in expenses plus $3,672 in premiums would be equal to just the premium cost for the 1st plan).

But if I have less than $3,108 in health expenses in 2018, I would have saved money by being on my own plan and simply paying my costs with my HSA funds (already have funds in HSAs but would contribute more in 2018 regardless of health situation for the tax benefit).

I haven't even delved into the tax benefit of the employer coverage vs. paying for my coverage after tax. Basically, it's $530 more to cover me per month, and the relative tax savings on that vs. paying after tax $270 for single coverage. Or, another way of putting it is $260 more per month for my coverage.

I know what I am leaning toward, but curious what other mustachians would decide and why.
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Caoineag

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Re: Health & health insurance
« Reply #1 on: November 13, 2017, 03:07:12 PM »
So what you are saying is that your husband's deductible is the same for himself as it is for him +you? Are you sure about that? I mean it's possible but I have never seen that. Just figured I would double check since all employers here have separate family deductibles (usually double) from individual deductibles.

If that is true, I would probably do his for the year if I really thought I had a lot of tests coming up. But usually the family deductibles are 2x the individual so then I would choose my own policy (which I have actually done in the past because of the deductible issue).

Dollar Slice

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Re: Health & health insurance
« Reply #2 on: November 13, 2017, 03:49:13 PM »
I made a similar choice earlier this year (although the dollar amounts were lower and the choices were closer together). I knew I was probably going to need surgery and PT and various other appointments. I ended up opting for the one where the premium is higher but there is a $0 deductible and coverage is much better (no co-insurance, lower co-pays). It has worked out fantastically for me because I had the surgery, multiple specialist appointments, multiple X-rays, etc. and now I'm doing physical therapy and I've only paid maybe $130 OOP for the year so far. I find that it is encouraging me to do lots of PT and make sure I do all my follow-up appointments etc., because it feels like taking full advantage of my expensive insurance is "getting my money's worth" (and we all know how Mustachians feel about that).

I think I ended up saving $1500+.
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rubybeth

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Re: Health & health insurance
« Reply #3 on: November 13, 2017, 06:23:22 PM »
So what you are saying is that your husband's deductible is the same for himself as it is for him +you? Are you sure about that? I mean it's possible but I have never seen that. Just figured I would double check since all employers here have separate family deductibles (usually double) from individual deductibles.

If that is true, I would probably do his for the year if I really thought I had a lot of tests coming up. But usually the family deductibles are 2x the individual so then I would choose my own policy (which I have actually done in the past because of the deductible issue).

No, the deductible is actually irrelevant for his plan, regardless of single or family coverage, because of complicated reasons related to his chronic conditon and a co-pay card that basically covers the deductible for the year. But the insurance for both would cost more, and I typically haven’t met my own deductible so we’ve been saving a lot by having separate plans. I should probably confirm that him meeting the deductible would apply for both of us.
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Miss Piggy

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Re: Health & health insurance
« Reply #4 on: November 13, 2017, 07:01:09 PM »
Basically, the way I am thinking about this is: if I have more than $3,108 in health expenses in 2018, I am better off being on my husband's plan and paying the higher premium ($3,108 in expenses plus $3,672 in premiums would be equal to just the premium cost for the 1st plan).

It won't take much at all to reach $3108 in expenses. Are there any guesses/assumptions about what condition you are possibly dealing with?

Are you 100% certain you can get back on your own plan later if you jump off for 2018?

Hotstreak

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Re: Health & health insurance
« Reply #5 on: November 13, 2017, 10:22:34 PM »
But if I have less than $3,108 in health expenses in 2018, I would have saved money by being on my own plan and simply paying my costs with my HSA funds (already have funds in HSAs but would contribute more in 2018 regardless of health situation for the tax benefit).


A side note - you probably shouldn't be spending the money in your HSA at this point.  It's one of the best retirement accounts available, and ideally any contributions you make would be invested until retirement.  See https://forum.mrmoneymustache.com/investor-alley/investment-order/ .

rubybeth

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Re: Health & health insurance
« Reply #6 on: November 14, 2017, 07:39:29 AM »
Basically, the way I am thinking about this is: if I have more than $3,108 in health expenses in 2018, I am better off being on my husband's plan and paying the higher premium ($3,108 in expenses plus $3,672 in premiums would be equal to just the premium cost for the 1st plan).

It won't take much at all to reach $3108 in expenses. Are there any guesses/assumptions about what condition you are possibly dealing with?

Are you 100% certain you can get back on your own plan later if you jump off for 2018?

Right, that's kind of what I'm thinking--$3,108 would be nothing if I need surgery and the follow-up that goes with that. I jumped off of a state exchange plan at the end of 2016 since my husband's plan for 2017 was really good--and then he got laid off, so I went back on the exchange plan mid-year. It wasn't a big deal, and they kept all of my information the same--even down to my member number with the insurance company. I mean, politically, anything could happen, but Minnesota has always kind of lead the way with options for people, so I'm not overly concerned (unless the ACA dies a firey death--then I'd be a little sad, but that would affect all plans, not just the ones via the exchanges).

The issue is that I'm having pain in my hip area; it could be anything from arthritis in my hip joint, to a labral tear in my hip joint that needs surgery to repair, or it could be my back (spine) and referred pain to the hip area. I did have a joint injection a little over a week ago, and initially, it didn't seem like it helped, but now it's feeling pretty good. The injection was supposed to tell us something--if it worked, it's likely the joint, if not, it's likely the back. It seems like it sort of worked, and I have a follow-up with the orthopedic PA this Friday, so I'm hoping he can narrow it down a bit before we have to make any decisions.

But if I have less than $3,108 in health expenses in 2018, I would have saved money by being on my own plan and simply paying my costs with my HSA funds (already have funds in HSAs but would contribute more in 2018 regardless of health situation for the tax benefit).


A side note - you probably shouldn't be spending the money in your HSA at this point.  It's one of the best retirement accounts available, and ideally any contributions you make would be invested until retirement.  See https://forum.mrmoneymustache.com/investor-alley/investment-order/ .

Yes, I understand that theory of saving HSA funds until later. We aren't doing that currently for a variety of reasons, but if we were both on the same deductible for 2018, we wouldn't have to touch any of our HSA funds next year. DH's Rx discount card would essentially cover the deductible for both of us. We do tend to max the HSAs and only use what we need--hence the large cushion we have right now.
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Miss Piggy

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Re: Health & health insurance
« Reply #7 on: November 16, 2017, 04:37:07 AM »
Okay,so thinking about this logically...you have a known problem.

How likely is it to go away on its own?

If not very likely, then what are your treatment options? Surgery? Physical therapy? Periodic shots? A combo approach? Other options?

My guess is that most of your options will cost more than your decision threshold. And of course don't ignore the possibility of an additional issue, related or not, popping up during the year.

I guess because you already have a known issue, i am leaning toward assuming you will reach the 3100 threshold.

rubybeth

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Re: Health & health insurance
« Reply #8 on: November 17, 2017, 06:16:26 PM »
Met with orthopedic surgeon. Next step is an MRI. It could be arthritis, but he said my X-ray was "beautiful" (I think that's good?) and the MRI will tell us more. If it's a labral tear, that can be repaired with surgery. If it isn't something for which surgery can help, it might mean I get treated for the pain with whatever options they give me.

I am fairly certain I will go on my DH's plan for peace of mind but I do need to confirm the details of that. I am thankful we have options but annoyed that they aren't better. When will the US get on board with that terrible socialized medical stuff for everyone, not just veterans and the poor and elderly? :D
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rubybeth

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Re: Health & health insurance
« Reply #9 on: November 20, 2017, 05:08:11 PM »
Ugh, so it turns out I would have my own deductible with DH's insurance of $3,250, and he has his own (which would be covered by his Rx card). So not only would the premium be higher, I'd still have to meet that deductible on my own. A shared combined deductible is known in the insurance industry as a "contracted plan" whereas DH's insurance is "non-contracted nested individual in family deductibles."

I get it--that's probably better for most people--if one spouse has a higher medical need than the other, for example, you don't have to meet the $6,500 deductible for one person, just $3,250.

Unfotunately, we have to decide about a plan before I have my MRI next Tuesday. Sigh.
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Miss Piggy

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Re: Health & health insurance
« Reply #10 on: November 21, 2017, 05:43:43 PM »
I guess I don't see how this new piece of information about your deductible would change things. Am I missing something?

rubybeth

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Re: Health & health insurance
« Reply #11 on: November 22, 2017, 11:10:59 AM »
I guess I don't see how this new piece of information about your deductible would change things. Am I missing something?

Yes, it does, significantly. I previously thought our full deductible under my husband's plan would be covered by his Rx card. But now I understand that only his deductible of $3,250 would be covered by that, and I'd have my own separate deductible of $3,250 to meet. I have to decide on Friday (end of open enrollment for DH) if I want to go on his plan. Otherwise, I can stick with my current exchange plan.

How this breaks out:

1) Premium of $565/mo. for employee +spouse, premium is pre-tax. Annual premium cost would be $6,780. Deductible and out of pocket max cost to us: $3,250. Total annual cost to us: $10,030.

2) Premium for DH of $35, pre-tax. Premium for me alone $270, after tax. Annual premium cost would be $3,672. My deductible and out of pocket max would be $6,600. Total annual cost could range from just premiums of $3,672 all the way to $10,272 if I somehow meet my deductible.

So now the difference is much closer--if I meet the $6,600 deductible on my exchange plan, then I could pay $10,272 for our combined insurance and deductibles in 2018. If I go on my husband's plan and meet the $3,250 deductible for myself,  it's a total of $10,030. So going on my DH's plan might save me $242 if I have medical costs of more than $6,600 in 2018. But my MRI for my hip isn't until next Tuesday, so I have no way of knowing what's wrong with me until after I have to decide.

In other words, I could save a lot on premium costs with option 2, but if I reach the $6,600 deductible in the year, I would have been better off being on his plan (by $242). It's not a huge difference if I meet the deductibles, but I have the potential to save more money with my own plan. But if I need surgery and subsequent appointments, then being on his plan might be better. I'm kind of back to the drawing board but leaning toward still going on his plan, but it will cost stupidly so much more, and I might end up not needing it.
« Last Edit: November 22, 2017, 11:13:26 AM by rubybeth »
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Miss Piggy

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Re: Health & health insurance
« Reply #12 on: November 30, 2017, 06:29:09 PM »
Okay...so are the following two items true?

1. Worst-case, if something is wrong (and you meet either deductible), the difference between the two plans is $242.

2. Best-case, if nothing major is wrong, and you don't come close to meeting the deductible, you can save a significant amount of money by choosing one plan over another (husband's plan if I read correctly, but honestly, I'm not sure I did).

If the above points are true, I would probably go with the lower premium. You'd give yourself an opportunity to potentially save a lot on premiums, and the risk is only spending $242 if things don't turn out as planned. $242 is pocket change when it comes to healthcare costs.


rubybeth

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Re: Health & health insurance
« Reply #13 on: December 01, 2017, 07:01:35 AM »
Okay...so are the following two items true?

1. Worst-case, if something is wrong (and you meet either deductible), the difference between the two plans is $242.

2. Best-case, if nothing major is wrong, and you don't come close to meeting the deductible, you can save a significant amount of money by choosing one plan over another (husband's plan if I read correctly, but honestly, I'm not sure I did).

If the above points are true, I would probably go with the lower premium. You'd give yourself an opportunity to potentially save a lot on premiums, and the risk is only spending $242 if things don't turn out as planned. $242 is pocket change when it comes to healthcare costs.

Had to make my choice last Friday (end of husband's open enrollment), and went with the higher cost premium. I highly suspect I will need surgery in 2018, and having up to $6,600 in medical bills in 2018 isn't ideal for our current situation. I realize it's kind of "6 of one, half a dozen of another," but having the higher premium/lower deductible seemed to make the most sense for us, and I strongly suspect I will have more than $6,600 in medical costs in 2018.
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