Author Topic: Which health insurance plan?  (Read 432 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?

lhamo

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Re: Which health insurance plan?
« Reply #1 on: August 25, 2018, 03:27:43 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%?

notmyhand

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Re: Which health insurance plan?
« Reply #2 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.

lhamo

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Re: Which health insurance plan?
« Reply #3 on: August 25, 2018, 06:44:02 PM »
Well then go with the cheaper plan and cross your fingers you don't need the surgery, or delay it until 2020 if it is not urgent. As long as kiddo doesn't need too much care, then you will still do better on the lower cost plan, marginally worse if the surgery is urgent/required this year.

Don't forget to include the PCP copays for all the well baby visits you will need in the first year for vaccinations, etc. Those add up quickly, too.