Health Insurance

QueenNub · November 2016

So I recently started a new job and my employer offers 2 different plans. Never had the option of choosing plans so I want some feedback.
In the last 2 years, DH was hospitalized 1x for a staph infection (6 nights) and DS hospitalized 1x for an asthma attack (1 night). We owed $3k for DH and $1k for DS. Our current (soon to be old) coverage was a 600 deductible then 80/20 coinsurance. We paid $526 monthly- through my previous employer..

DS has asthma and takes QVAR and Singulair daily. Cash cost both runs about $70 a months (without insurance).

1st option:

$330 monthly premium
$6250 deductible $0 coinsurance
$50 office visits/ $60 per prenatal visit
Prescriptions: no coverage until deductible is met then coinsurance is 0%, 20%

2nd option

$1220.00 monthly premium
$0 deductible 90/10 coinsurance
$30 office visits/ $45 per prenatal visit
Prescriptions: $15/40/75 copays

Help me choose... I have to decide by tomorrow.

Im leaning towards the high deductible because I feel like I save the difference and easily reach the deductible but it's something about security especially being pregnant and having an toddler with respiratory issues. High deductibles freak me out, I guess.

doodleoodle · November 2016

What is the max out of pocket for each?

QueenNub · November 2016

Prettydoodleoodle said:

What is the max out of pocket for each?

I read it wrong:

Option 1:
Max OOP: $6350 ind/ $12,700 family

Option 2:
Max OOP: $3250 ind./$6,500 family

mkrel · November 2016

Wow, nothing in the middle, huh? The way I see it, either way you'll be spending that $6,250 plus some. I would generally choose the better policy, no deductible, but that premium is outrageous so I would get the high deductible plan and also put money in an HSA if that is an option get the pre tax benefit.

mkrel · November 2016

I posted before I read your last comment. Seeing those out of pocket maxs, I would choose the 2nd option just in case something unexpected happens.

QueenNub · November 2016

I've updated the Max OOP. I was using the numbers from out of network.

But yes, nothing in the middle. Crazy! My employer offers a FSA but no HSA but I guess I can get that on my own since HSA offer more protection than FSA. I'm leaning towards your suggestion because the premium is beyond outrageous even with awesome coverage.

swanbrooner · November 2016

If the high deductible has an HSA option, that would be my pick.

QueenNub · November 2016

I haven't asked but do you know if I can get a HSA outside my employer? They only offer a FSA and I can only contribute up to $216 a month.

swanbrooner said:

If the high deductible has an HSA option, that would be my pick.

doodleoodle · November 2016

With the $0 deductible plan you'll be paying over 14k for the year. Even with the out of pocket maxes being so different I think I'd still go with the high deductible plan and utilize the HSA like pp suggested. I think you'll save money in long and short game that way. Even if something awful happened and you had a lot of medical bills you can always work out an interest free payment plan with the doctor/hospital. I am by no means an expert regarding medical insurance though, just giving my opinion.

mkrel · November 2016

I believe that you can because not all high deductible health plans are employer sponsored.

And with your latest numbers update, I stick with my original suggestion of option 1.

swanbrooner · November 2016

@QueenNub I honestly wasn't sure before you asked, but appears that you may be able to do so. It wouldn't necessarily be pre-tax like it would be through and employer, but you would be able to use it as a deduction. Plus, the money is yours to keep for the future if you don't end up using it healthcare expenses.

Our family premium for a traditional plan was outrageous and unaffordable, so we went the high deductible HSA route. We are only putting $300 in it per month, and even that paired with our premium, we are paying less than 1/2 of the traditional plan's premium.

QueenNub · November 2016

Thanks ladies! DH is no help with these things and usually goes for the cheapest option. lol I think I'll go with the cheaper premium and save as much as I can for the unexpected. I'll ask about HSA tomorrow.

email2ash · November 2016

I would definitely go with the deductible route. Yes, you will pay the $6K but the other way they are cornering you to pay $13K+! Ugh insurance these days is painful

brij2006 · November 2016

I would go with the high deductible plan.
Reason being, you'll save $10,680 a year by going with the cheaper one. That more than makes up for the deductible difference.

n0soup4u · November 2016

Hands down option 1. If your employer doesnt offer an HSA you can still open one on your own. The year contribution is $6750.00 which is over your deductible!

BelhurstBride · November 2016

High deductible, hands down.

QueenNub · November 2016

so HSA isn't an option because there is a copayment for doctor visits. I'll max out the FSA this year.

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