Author Topic: Which health insurance plan?  (Read 672 times)

notmyhand

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Which health insurance plan?
« on: August 25, 2018, 03:13:37 PM »
It's election time - hubby, myself, and expecting a baby boy in the fall.  Deductible is met through the end of the year so I am more wondering about what to elect for next year coverage.

I use a good amount of health care, have hit my individual OOP for two years.  Might have ear surgery next year, otherwise I see 1-2 specialists once a month at least.  I'm not sure what a newborn requires in terms of pediatric care but I have also passed my genetic disease onto our baby so he will also likely be seeing a specialist monthly.  Husband takes a prescription drug and sees his PCP once every six months but nothing outside of that.

Base Plan - 333.79 a month for the family
Individual Deductible - 2500
Family Deductible - 7500
Our coinsurance until OOP 40%
Individual OOP 6000
Family OOP 12000
PCP visits 30
Specialist visits 40
ER 300 copay
Hospitalization 500 copay
Out patient surgery 250 copay

Buy Up Plan - 701.66 monthly for the family
Individual deductible - 1000
Family deductible - 3000
Coinsurance 20%
Individual OOP 3000
Family OOP 9000
PCP/Specialist visits 30
ER 100 copay
Hospitalization 500 copay
Out patient surgery 200 copay

It's a $4400 difference a year in premiums.  Is there a calculator out there that will tell me how much healthcare I will need to break even?  If I need the surgery, I suspect I should go with the more expensive one but what if I don't?

notmyhand

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Re: Which health insurance plan?
« Reply #1 on: August 25, 2018, 03:58:32 PM »
Can you confirm whether the surgery is next year? You save $1500 on your deductible for sure with that, plus probably another 3k on your individual OOP alone.

With specialist appts for both you and baby monthly I think the buy up plan is going to be the better option anyway. How much are your copays for those at 40% vs 20%?

I can't unfortunately, at least not in time to pick the plan (HR moved up election a month from regular and I am not seeing the surgeon until next month).  Copays for specialists are 40 on the base and 30 on the buy up plan.  The 40% coinsurance is scary but outlaying almost 8500 for premiums a year sounds unappetizing too.