Poll

How Bad is this plan?

Awful
0 (0%)
Pretty bad
8 (47.1%)
Average
6 (35.3%)
Pretty good
2 (11.8%)
Excellent
1 (5.9%)

Total Members Voted: 17

Author Topic: How bad is this employer-sponsored health insurance plan?  (Read 1060 times)

rantk81

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How bad is this employer-sponsored health insurance plan?
« on: January 28, 2019, 10:53:00 AM »
Over the past couple years, my employer has trimmed and trimmed and trimmed employee benefits.  The medical plan has shifted a lot more of the out-of-pocket expenses to the employee, raised the out-of-pocket-maximum amounts, and decreased the network of doctors, dramatically over the past 2 benefit years.

Water-cooler conversations with co-workers about the benefits vary a lot:  Some folks say the benefits are awesome, and some folks say they are terrible and pathetic.  I haven't looked at potential new employers in quite a while, and I'm not keenly aware of what medium-to-mega corps are offering these days, so I thought I'd "crowd-source" an answer to the question:  How bad (or good?) is this plan from my employer?

The details (specific to my situation):

- HDHP/HSA compatible plan, for me and my spouse.
- Bi-weekly payroll premium paid by me: $65 ($88 premium cost, but then reduced by $23 dollars because I went through their "biometric" screen process.. Privacy invasion perhaps?)
- Company matches the first $500 of HSA contribution.
- Deductible:  $2700 per individual, or $3000 for family.
- Co-insurance: After deductibles, we pay 30%, the insurance company covers 70%.
- No Co-Pays for anything.  Everything is subject to Co-insurance.
- Out of pocket maximum is $6650 per individual, or $10,000 for family.
- Very small network of doctors. Probably only about 20% of the doctors in my city are in the plan's network. The plan's network excludes most of the doctors at the major nationally ranked research hospitals that are available in this city.  Also distressing is that: No hospital-system from the city is 100% in-network, so you have to mix-and-match the care yourself, and make sure each doctor is part of the network.
- It's not an HMO.  I don't have to get referrals from a PCP to see anyone else.... But the network is very narrow.
- Zero out of network benefits.


As a Mustachian, the high out of pocket costs don't bother me too much (in fact, I fancy having high out-of-pocket-costs, vs high payroll premiums).  However, the biggest thing that perturbs me is the restrictive and annoying doctor network.

What does the crowd think?  Is this plan good? Or shite?

« Last Edit: January 28, 2019, 11:04:09 AM by rantk81 »

rantk81

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Re: How bad is this employer-sponsored health insurance plan?
« Reply #1 on: January 28, 2019, 11:49:55 AM »
My own take on my plan... with a little bit of channeling clint eastwood...

The GOOD: effective monthly premium after discount and HSA match is about $100/mo only!
The BAD: unless something extremely major/bad happens medically, I'll be footing just about all of the costs of medical care in the year
The UGLY: the doctor network  (half-joking conversations among co-workers have gone along the lines of: "If something major happens and I need to see a good doctor that isn't in the network, I'll create my own ACA qualifying event by resigning, so I can get on a ACA Marketplace plan for the rest of the year"
« Last Edit: January 28, 2019, 11:52:15 AM by rantk81 »

scantee

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Re: How bad is this employer-sponsored health insurance plan?
« Reply #2 on: January 28, 2019, 11:59:21 AM »
If I had this plan I would certainly consider it crappy, for all of the reasons you outline in your second post. Iíve worked at a number of different types of organizations so Iíve experienced a pretty wide range of health I surance quality. First was at a university: amazing insurance, truly a ďCadillacĒ plan/ next was at a think tank type of non-profit: very good insurance, not as good as the university, but few complaints. Now, Iím at a megacorp: insurance is adequate, but far behind the other two in terms of quality coverage.

Yours seem much worse than my megacorp I nsurance. Iím sure it is fairly typical for a lot of American businesses, comparatively however it is quite poor when you know the full range of options.

Is there any choice though? It sounds like you are stuck with this and have to make the best of it.

wenchsenior

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Re: How bad is this employer-sponsored health insurance plan?
« Reply #3 on: January 28, 2019, 11:59:49 AM »
I can't compare your plan to the national 'average' in the U.S., b/c there is such variation.  Here is a link to the federal civilian health care insurance options (which many in the U.S. seem to consider 'Cadillac' health insurance; I think they might be overestimating civilian federal benefits).


https://www.fepblue.org/benefit-plans/compare-plans-2019

tralfamadorian

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Re: How bad is this employer-sponsored health insurance plan?
« Reply #4 on: January 28, 2019, 03:59:25 PM »
I think everyone's opinions would be colored by their experience. Personally, I've been buying my own health insurance almost my whole adult life so it seems pretty good to me. The lack of in network doctors isn't great, though.

slothkey

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Re: How bad is this employer-sponsored health insurance plan?
« Reply #5 on: January 28, 2019, 05:25:07 PM »
I pay $38 every 2 weeks for my HDHP/HSA  for me and my spouse. My company pays fully for me, and that cost is for my spouse.
My company doesn't match my  HSA contribution. But if you take into account your match, and my lower cost, we are about even.
I have a wide network of doctors I can go to (but I also live in a large metro area). My plan is better in this regard. 
For these last items, it depends on what you think is more important-
My deductible and max out of pocket are also higher than yours (highest allowed).
After deductible,  we are covered, while in network. But prior to that, we pay all costs.
We also have out of network coverage, but it isn't great.
Depending on what sort of medical event you are trying to protect for (hospital stay, or prolonged treatment), it could be a coin flip as to which plan would lead to lower out of pocket costs.


dandarc

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Re: How bad is this employer-sponsored health insurance plan?
« Reply #6 on: January 28, 2019, 05:28:34 PM »
I think everyone's opinions would be colored by their experience. Personally, I've been buying my own health insurance almost my whole adult life so it seems pretty good to me. The lack of in network doctors isn't great, though.
That's where I'm at too. Cost-wise, it looks pretty good. Bad network is a bigger problem.

DreamFIRE

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Re: How bad is this employer-sponsored health insurance plan?
« Reply #7 on: January 28, 2019, 06:13:06 PM »
Your premium for you and your spouse combined is very good, not much more than mine.

But your deductible is 27 times as high as mine!

Your out of pocket is about 3 times as high as mine.

Your insurance only pays 70% after deductible.  I just have to pay some co-pays for some services.

And no out of network?? Yikes.  I have out of network, although coverage isn't as good.

fuzzy math

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Re: How bad is this employer-sponsored health insurance plan?
« Reply #8 on: January 29, 2019, 06:39:06 PM »
Your out of pocket max sucks. I'd find that more frustrating than the narrow network of doctors.
For reference my family HSA has similar pricing (except for 5 ppl I pay $230 s month) and our deductible/ OOP max is $3k/$6k. DH"s offered HSA a at work (which we didn't choose) is free for him and would max at $100 per month for a family with a deductible/OOP Max of $3k/$9k. Neither have a restrictive network, and both offer nationwide benefits

cl_noll

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Re: How bad is this employer-sponsored health insurance plan?
« Reply #9 on: January 30, 2019, 07:17:28 AM »
My savings rate would be non-existent if I had your insurance plan, and don't even go to the doctor that much. Just a couple prescriptions that have absurd pre-insurance monthly costs attached to them. I hope you stay in good health!

Car Jack

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Re: How bad is this employer-sponsored health insurance plan?
« Reply #10 on: January 30, 2019, 07:45:17 AM »
This sounds more or less like my plan, which honestly sucks.

The doctor network is important to us and we have stayed with a couple who are out of network because it's impossible to get a new doctor.  I have looked at new doctors from the network's plan list and found some interesting responses when calling various doctor's offices.  All of these have been replies:
1) Doctor no longer in the practice...retired years ago.
2) Doctor died years ago.
3) Doctor not accepting new patients.
4) Doctor moved outside of area.

We use medical services a lot for our family.  Pre-existing conditions that we have no control over whether we have them or not plus heredity have made use and cost high.  We have about the same out of pocket family and hit it every year by late June....early July.  We have the same water cooler talks and the young, single guys who have a physical once a year think the plan is great and take the lowest cost plan.

I will say that if you have specific, detailed complaints, and bring them to the attention of the benefits coordinator, they may take action.  We have done this and we've been told that on large part, because of our complaints, the company fired the previous provider and have someone new this year.  If only we could get the drug plan and doctor's network fires......both rate last in rankings and have for years.  I'm convinced they spend all their money on fancy advertising instead of on their plan.

Another Reader

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Re: How bad is this employer-sponsored health insurance plan?
« Reply #11 on: January 30, 2019, 08:28:10 AM »
If you work for a large company, they are likely self-insuring, using an insurance company as the administrator.  Their objective is to minimize utilization, and that's what the policy is intended to do.  If you get really sick, you will likely have to go out of network for care.  You will end up paying for most of that.  Small costs that cost money to process are similarly eliminated.

In your shoes, I would start looking for another job with better benefits.  I would also politely raise the issue of how effective an employee can be when they are chasing care for themselves or a family member with this insurance.

chasesfish

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Re: How bad is this employer-sponsored health insurance plan?
« Reply #12 on: January 30, 2019, 10:00:01 AM »
It just depends on your needs and what is the approval process for care provided when a specialist isn't part of their network.

Up until 34, that plan would have been incredible compared to what I pay for company insurance.

After 34, my wife suffered a pretty rare form of a spinal injury and we've had to see specialists in California and North Carolina.  The micro-network part scares me.   Of course, all that being said her care is handled now by a private-pay neurologist and I just file under out of network benefits with no expectation of ever being reimbursed.   Her recovery just doesn't fit these 8 minute appointment windows that all managed care (insurance or medicare/medicaid) write their reimbursement models to

StarBright

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Re: How bad is this employer-sponsored health insurance plan?
« Reply #13 on: January 30, 2019, 10:18:54 AM »
I said Pretty Good. I work for a small company and what you have is better than what we offer our employees (both price and coverage wise).

DH works for a state university and I'd say your coverage is almost as good as my DH's university coverage.

The good: Your per paycheck premium is great! The deductible is as low as legally allowed for an HSA plan (for a family) and you get an HSA match! The deductible is a little high for an individual.

The average: I'd say your out of pocket max is average (and comparable to any plan that I or my husband have been offered that isn't an HMO), your coinsurance might be a bit high, but comparable to what we offer our employees.

The bad: the network does sound small, but honestly, we're supposed to be on a large network through my husband's job and we can never find anyone who takes our insurance/is accepting new patients so who knows?

To compare - we pay about 300 a month for a family of four, no hsa match, $4,500 deductible, 20% copay after deductible, 10k out of pocket max. Large in state network, no out of state coverage (Which is a little rough because I'm a remote worker and travel).