So the health insurance situation is changing drastically in 2013 for the StashinIt family.
For two reasons
- We had our first child in October
- My wife will be quitting her job soon to be a stay at home mom
- Company I work for was acquired bringing a new health plan
In 2012 my health insurance was fully covered by my employer (they never covered dependents). My wife has insurance through her work and has our child as a dependent. Our out of pocket expense cumulatively is currently $260 monthly.
In 2013 I can either choose to purchase the insurance my employer provides or find my own policy. The cost to me will be $715 a month for the family plan. A $455 monthly increase from last year! I contacted an insurance broker and the broker was able get us approved for a high deductible policy for my family for $548 monthly. Since the insurances are very different in what/how much they cover it's not an apples to apples comparison. So I wanted to ask the Mustachians if my employers plan is worth the extra $167 a month?
For brevity and accurate comparison I'll try to summaries the key differences in the plans. They don't exactly match up perfectly but I'll do my best to create an equal comparison. These are both PPO plans so I'm going to assume we always use In-Network services.
Employer's Plan:
Deductible: $1,500 individual; $3,000 family
Out of pocket maximum: $4,000 individual, $8,000 family
Prescription Drugs: $10/$35/$60 copays (generic/brand/non-preferred brand)
Office visits: $30 PCP/$50 specialist copay. Then covered 100%
Well Care Adult/Child + Maternity Services: covered 100%
Medical/Surgical Services: 20% co-insurance
Inpatient/Outpatient hospital services: 20% co-insurance
ER visit: $150 copay
Private plan:
Deductible: $2,500 per member = $7,500
Out of pocket maximum: $5,500 per member = $16,500
Prescription Drugs: $250 deductible per member = $750 plus $15/$30 or 30% contracted rate copay (generic/brand/non-preferred brand)
Office visits: $45 (first three visits) then 35% co-insurance
Well Care Adult/Child + Maternity Services: 35% co-insurance (unless it's a preventative health service covered by federal/California law)
Medical/Surgical Services: $100 to $500 copay (depending on the service) plus 35% co-insurance
Inpatient/Outpatient hospital services: $1,000 copay per admission plus 35% co-insurance
ER visit: $100 per visit plus 35% co-insurance
So obviously my employers plan covers much more (as it should since they are paying 60% of the total cost). Am I a fool to decline this insurance? With the old company, they would pay the benefit amount for the employee only policy if I declined health insurance from them so I could buy elsewhere. This is no longer the case. Also of note, my employer deducts the health benefit pre-tax. I could put $2,500 in a HSA to pay for the private policy.
Hopefully that's enough information for an informed discussion. Feel free to ask for any relevant details I have missed.