Help evaluating health plan options

[mrteacher]

Hi all,

I need some determining which health plan payment structure to pick.

Both options are for the same health plan -- we just have two options for payment.

Both options have a $3,300 deductible.

Option 1:
$5,532 premium
$7,300 out of pocket maximum
0% coinsurance

Option 2:
$3,524 premium
$8,300 out of pocket maximum
10% coinsurance

Thank you!

[geekette]

There's information missing.

For the lower premium plan, I assume you have a 10% coinsurance (the plan pays 90%) between $3,300 deductible and the $8,300 oop max.

For the higher premium plan, what happens between the $3,300 deductible and the $7,300 oop max?

[mrteacher]

There's information missing.

For the lower premium plan, I assume you have a 10% coinsurance (the plan pays 90%) between $3,300 deductible and the $8,300 oop max.

For the higher premium plan, what happens between the $3,300 deductible and the $7,300 oop max?

Sorry. The higher premium has a 0% coinsurance. I'll edit my original post.

[Sibley]

This is really a "how much will you use health care" question. Use lots? Option 1 may well be more cost effective. Use little? Likely option 2.

[geekette]

So if they pay 100% after the deductible, how do you get to the $7,300 oop max?

But yeah, use a little, go with 2.  Use a lot, go with 1.  Feeling lucky?

[mrteacher]

What if we were to incur significant ($20k+) health expenses that were not covered by the plan. Would this tip the scales towards Option 2 since the premium is $2,000 lower and the OOP max is only $1,000 higher?

[Sibley]

What if we were to incur significant ($20k+) health expenses that were not covered by the plan. Would this tip the scales towards Option 2 since the premium is $2,000 lower and the OOP max is only $1,000 higher?

You need to do the math. Figure out what you expect to have. How much would insurance cover under each plan, how much would you pay, how much are premiums. The one the lower grand total is the one you should go with. If you have expenses that won't be covered under either plan, then they don't matter.

[sonofsven]

Option 2 would be my choice.
You'll save $2k on your premium, and the max oop is only $1k more, so in the worse case scenario, you spend $1k of the premium savings on your max oop.
Since you'll have a 10% coinsurance, this will cost an additional $500, so even if you hit your max oop you'll be $500 ahead with option 2.