Author Topic: Please help me with an insurance question/logic of choosing a healthcare plan  (Read 3887 times)

StaceStache

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Getting ready to enroll in an ACA plan. Neither myself nor my husband have employer-provided health insurance.

I'm 24 and he's 30. Both healthy. On average get sick enough to go to the doctor maybe 1-2 times each (usually a bad sinus infection or something, nothing major).

Have an HSA that has roughly 6500 in it, and also plan on maxing it out next year (an additional 6550).

I'm trying to decide between these two bronze plans, difference of about 20 bucks a month:

Plan 1: $265/month, $8K deductible, 50% coinsurance after deductible, $12.7K out of pocket max.
Plan 2: $284/month, $10.6K deductible, no charge after deductible so $10.6K out of pocket max.

My limited understanding of insurance is that worst case scenario, we are better off with plan 2 because it's a lower out of pocket max.

So...should we pay $20/month more for the reason that in a statistically unlikely event of a major accident/hospitalization that we would pay about $2K less? Am I missing anything in my understanding of how this works?

huadpe

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How many years of the past 5 years have you spent more than $8000 on healthcare?  If the answer is none, then you should take Plan 1.  Unless there's an even cheaper plan with an even higher deductible.  Then you should take that plan.

The only reason to take a plan with lower deductibles and out of pocket maximums is if you don't have the cash to pay for the higher deductibles in the unlikely event of a major health cost.  Since you have $6500 in an HSA already, I am assuming you have some other money too and can swing the big deductible in the event of a major health incident.

One bit of bad news is that ACA plans are generally not HSA eligible, though I may be mistaken about that (or it may be something specific to NY, but none of the plans I found here were eligible).

geekette

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It must be by state, since there are several Bronze HSA plans available here.  With the higher priced plan, you're paying $228/year on the chance that you'd have higher than expected health care expenses.

On another note, do you have to have earned income to contribute to an HSA?
« Last Edit: December 03, 2013, 10:07:24 AM by geekette »

rocketman48097

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If you are Christian, I would suggest a health sharing ministry instead.  Much cheaper "shares" and they cover a lot more bills at much smaller amounts of money.  These organizations, about 4 of them in existence since 1999, are specifically exempt from the individual mandate tax.  If I wasn't under a generous employer plan, this would be my self insured plan. 

Daleth

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You at least should be eligible for a catastrophic-only plan, since you're under 30. And depending on when he turns 31, maybe he is too. Those should be way cheaper. That said, with a catastrophic plan, you'd be screwed if you got pregnant--at least if you got pregnant early enough in the year to have a reasonable chance of delivering before 12/31/14.

StaceStache

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@huadpe: Neither one of us has ever had a "major" healthcare event or anything, and so I am leaning toward plan 1 as you suggested. This is the cheapest plan option available to us, unless I would choose catastrophic only coverage for myself (husband not eligible, turns 31 in January). But I would possibly be in trouble I believe if I got pregnant (as @daleth said)

These bronze plans for my state are HSA eligible, thankfully.

@geekette, a quick search shows that you do NOT have to have earned income to contribute to an HSA http://www.kiplinger.com/article/insurance/T027-C001-S001-qualifying-for-a-health-savings-account.html
http://www.hsaforamerica.com/faq-contributions.htm#c8

@rocketman, we did actually look into Medishare, but honestly it didn't appear to be much cheaper for us. Also, my understanding is that it wouldn't cover any kind of physical/annual health exam OR maternity coverage at all - EVERYTHING is paid out of pocket up until your deductible. But a health plan would (no out of pocket expenses for normal pregnancy/delivery, or for your annual recommended physical exams etc under the ACA). I may be wrong about that, but that was my understanding after some research.



huadpe

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Research a bit, but I don't think you get screwed with a catastrophic plan if you get pregnant.  In fact, it may provide you the most coverage for the least money.

If you don't mind providing your county of residence I can plug it in to find the actual plans available.  But maternity is an "essential health benefit" under the ACA, so all plans (incl. catastrophic) have to cover it.

A catastrophic plan for you would have a $6350 deductible/out of pocket max for you only.  Your husband would then pay $132.50 (maybe a little more) for a bronze plan with a $4000 deductible, +50% coinsurance to $6350 out of pocket max.  But the good part is that you're much better covered there, because if EITHER ONE of you has a major medical cost (like childbirth) it takes less to hit the deductible.  The only case where you're worse off is if both of you had major medical costs in the same calendar year, which is very unlikely.  So I would go that route, assuming the catastrophic plan is cheaper.*

*If you qualify for ACA subsidies it changes things since those can't be applied to catastrophic plans.

pac_NW

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@StaceStashe, where did you conduct your search for the plans?  I am interested in which online resources if you don't mind sharing.

StaceStache

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@huadpe - hmm doing this separately and getting myself catastrophic may be the way to go then. Going to look into this!

@pac_NW - The information for the ACA plans just came straight through the healthcare.gov website. Though it obviously took some time for them to get the website working, I was finally able to submit my application a couple of weeks ago. Then I could pull up the plans available to me and my husband based on age etc. and compare the plans directly on the site.

Information on the Christian medi-share plans that I looked at were on this site: http://mychristiancare.org/medi-share/

earlybird

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StaceStache, by any chance do you live in NC? If you do I can highly recommend an insurance broker, Rusty Williams, who just helped me and my husband with the ACA. He also posts here on MMM. That's how I found him. It costs you nothing to work with him. We will soon have good coverage with a combined monthly premium of $76. That's TOTAL per month for 2 of us! Of course it all depends on your personal situation. You can contact Rusty at:   rusty@obamacarefornc.com. Hope this helps!

Paul der Krake

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Earlybird: I assume you are getting some subsidies? As a young invincible male in Durham County, the absolute cheapest I can find is $98 for a catastrophic plan.

earlybird

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@Paul der Krake, yes we received subsidies. I am retiring in a few short days, husband already retired, so no employer insurance available, estimated 2014 income low at $16k, so we are definitely eligible for subsidies. Of course that could change if our 2014 income is higher. We are in Chatham County, ages 49 and 47. Maybe you should give Rusty a call to see if he can help you? I had already applied back in October but not finished the enrollment and I can tell you the website had vastly changed since then. Having him help speeded up the process and he's also just a super nice guy!

StaceStache

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@earlybird - not in NC. That amount you all will be paying is awesome!

Based on our estimated income and info, we won't be eligible for any subsidies regardless.