Author Topic: Wanna help me choose a health insurance plan?  (Read 617 times)

startingsmall

  • Pencil Stache
  • ****
  • Posts: 620
Wanna help me choose a health insurance plan?
« on: August 19, 2018, 07:49:40 PM »
I'm currently on COBRA from my former employer.... and will remain on it for the next 15 months. Open enrollment just rolled around (9/1-8/31) and I have the option to change my plan. Given an expensive medication that my husband is now on (long-term), it might make sense to do so. His medication is ~$750/month.

Help me decide.

Current plan: HSA Choice Plus Bronze Plan (United Healthcare) - $1455/mo

Deductible: In-network $2.7k/person, $8.1k family
                  Out of network $5k/person, $15k family (we have yet to use any OON services - most providers in this area are in-network)

OOP Max: In network $6k/person, $12k family
               Out of network $12.5k/person, $37.5k family

After deductible is met: 30% co-insurance, his prescription goes down to $150/month.



Our other leading option: Choice Plus Copper Plan (United Healthcare) - $1412/mo

Deductible: In-network $5k/person, $10k family
                  Out of network $8k/person, $16k family

OOP Max: In network $7.15k/person, $14.3k family
               Out of network $12k/person, $24k family

Co-pays: $50 primary care, $100 specialist, $125/month for his meds

After deductible is met: 20% co-insurance


I'm a big fan of having an HSA as a retirement account, but I wonder if a change would be in our best interests.

On our current plan, we're on the hook for the first four months of husband's medication at $750ish/mo before we meet his deductible and it drops to $150/mo.... on the non-HSA plan, his meds would be $125/mo from the start.

- My medical expenses for the last year that counted towards my deductible were ~$800. That will go up a bit next year..... yay forty! mammogram! Not sure how expensive mammograms are, but I suspect I'd still be under either deductible?
- Daughter's medical expenses this year were ~$100, so no big difference between the two plans for her.
- Husband's only anticipated expenses for next year, aside from meds, are one specialist visit and maybe bloodwork. 

It looks like the non-HSA plan would save us ~$3k/yr ($2400 on meds, $516 on premiums, plus some money because we'd have co-pays instead of paying sick visits in full).... which I think would outweigh the HSA tax savings. The higher deductible makes me a little nervous, though. That's silly, though, because the only year that I ever met my deductible was the year that I had my daughter.... it's husband's expenses that we need to optimize.

There are other options, but they're all $1700+/month and I don't feel like we utilize healthcare enough to justify that at this point.

So... any thoughts? I'm really on the fence. Leaning towards switching, but I just don't know.

lhamo

  • Walrus Stache
  • *******
  • Posts: 9616
  • Location: Seattle
Re: Wanna help me choose a health insurance plan?
« Reply #1 on: August 20, 2018, 12:40:50 AM »
I would go with the second option due to big savings on meds and capped costs for primary care. It would take a lot of tax savings on the HSA side to beat those. Yes, deductible and OOPs are higher, but you are unlikely to hit those on either plan, unless you have a major accident or illness.

RedwoodDreams

  • Stubble
  • **
  • Posts: 166
  • Location: Central coast CA
Re: Wanna help me choose a health insurance plan?
« Reply #2 on: August 20, 2018, 11:04:59 AM »
Is shopping for a more affordable ACA plan out of the question?

Have you checked into whether copay assistance is available for your husband's expensive medication? I recently learned about a program called Opus Health that seems to help with copay assistance even if you have private insurance. I was shocked at how much they help: https://www.opushealth.com/

Also, drug manufacturers themselves often offer assistance. For example: https://www.abbvie.com/patients/patient-assistance.html

Maybe you've already gone down these roads, but I was shocked, and then relieved, to use these programs to help pay for my son's expensive medication. In addition, the amount that Opus Health pays for his medication is applied to my annual deductible (!!!) Yep, that's how it works. Saved me a ton of money this year. It looked like we met our OOPM, when in fact I'd paid very little OOP, Opus had.

Good luck.

startingsmall

  • Pencil Stache
  • ****
  • Posts: 620
Re: Wanna help me choose a health insurance plan?
« Reply #3 on: August 20, 2018, 11:40:45 AM »
Is shopping for a more affordable ACA plan out of the question?

Have you checked into whether copay assistance is available for your husband's expensive medication? I recently learned about a program called Opus Health that seems to help with copay assistance even if you have private insurance. I was shocked at how much they help: https://www.opushealth.com/

Also, drug manufacturers themselves often offer assistance. For example: https://www.abbvie.com/patients/patient-assistance.html

Maybe you've already gone down these roads, but I was shocked, and then relieved, to use these programs to help pay for my son's expensive medication. In addition, the amount that Opus Health pays for his medication is applied to my annual deductible (!!!) Yep, that's how it works. Saved me a ton of money this year. It looked like we met our OOPM, when in fact I'd paid very little OOP, Opus had.

Good luck.

The cheapest ACA plan for our family would be $1200/month with an incredibly limited network and a $13.3k family deductible. We're better off staying with Cobra as long as possible.

Unfortunately, his medication (Lialda) doesn't seem to have any assistance programs other than the manufacturer's program, which has income restrictions.


civil4life

  • Bristles
  • ***
  • Posts: 418
    • My Journal
Re: Wanna help me choose a health insurance plan?
« Reply #4 on: August 20, 2018, 11:47:14 AM »
Ok...I guess you answered the first question.  I am guessing you had a qualifying event that would have allowed you to pick up the ACA or your spouses employer.

Option B

It looks like in March a generic came out for this drug.  Has your spouse spoken to your doctor about using generic?

http://www.tevapharm.com/news/teva_announces_the_launch_of_a_generic_version_of_lialda_in_the_united_states_03_18.aspx

startingsmall

  • Pencil Stache
  • ****
  • Posts: 620
Re: Wanna help me choose a health insurance plan?
« Reply #5 on: August 20, 2018, 11:56:09 AM »
Ok...I guess you answered the first question.  I am guessing you had a qualifying event that would have allowed you to pick up the ACA or your spouses employer.

Option B

It looks like in March a generic came out for this drug.  Has your spouse spoken to your doctor about using generic?

http://www.tevapharm.com/news/teva_announces_the_launch_of_a_generic_version_of_lialda_in_the_united_states_03_18.aspx

Just checked with husband - he's already on the generic! Brand-name Lialda is $1200+/mo. Holy cow. Didn't realize the $750 was for generic!