OT: Health Insurance (or: I hate open enrollment)

[Nooch]

**updates on page 3 for 2017-2018 **

Guys, just polling the collective wisdom of the forum...

My health insurance renewal is coming up and we've got two options, one around $230/bi-weekly pay period for the base plan, and the high plan around $345/bi-weekly pay period. Help me rationalize the numbers here...

Highlights:
Low plan:
$3000 family deductible (two individuals)
30% co-insurance after deductible has been met
HRA reimburses 50% of deductible amount
$8000 max out of pocket (realistically $6500 after company HRA reimburses 50% of deductible)
$20 copay to primary care physician, but otherwise covered 100%
ER/Hospital/Etc services, $200 co-pay, 30% co-insurance
In-Network only coverage

High Plan:
$0 deductible
$0 co-insurance
$15 copay
$6000 max out of pocket
ER/Hospital/Etc services, $200 co-pay, then covered 100%
In and Out of network coverage

After the HRA reimburses 50% of the deductible on the low plan, you end up with a $1500 deductible and $6500 max out of pocket.

The high plan costs $2990 more/year than the low plan, but factoring in the deductible portion that I'd be paying on the low plan, it really ends up only costing $1490 more per year. I could probably lower my FSA a little bit with the high plan.

I'm 31, my wife's 28, my daughters are 3 and 18 months, respectively. We're not planning any large events (third child or surgery or anything) over the next plan year. Generally healthy, most of our insurance goes toward kid's well visits, sick visits, and the occasional trip to the ER (twice in three years for the big one, none yet for the little one...)

With this in mind, and while i know it's hard to say without the full plan docs (I can see if I can find a .pdf to upload), what would you pick?

[93legendti]

High plan, because of the deductibles and in and out coverages. I wish my health insurance for family of 4 was only $690/month.

[soulspinner]

You never know whats gonna happen. Dont like the possibilty of another in the family with a simple appendectomy. 36 hours (total time including 3 to 4 hours waiting for a ct scan) and $17500 later we still owed almost 5 thou.

[Idris Icabod]

I'd get the high plan. Your cost spread over a year isn't that much. We've had an annus horribilis when it comes to medical expenses, like you 2 adults and 2 kids (aged 4 and 6). Just had the third family visit to the ER this last weekend, also had clavicle surgery back in January, stitches....nothing medically severe but lots of accidents but man those costs pretty quickly add up. We've paid our full deductible for the year so I guess we are gravy from now on.

[saab2000]

I got the high plan through my employer. We have a couple different options. We don't get it for the small stuff. We get it so we're not ruined financially by a medical issue that is unforeseeable.

Your max out of pocket of $8000 isn't ruinous but it's not insignificant either.

Run your monthly budget numbers and make a decision but for me I get the option with the best overall coverage.

[staggerwing]

Originally thought you were talking high or low deductible. Jealous. Very few people have the option of a zero deductible plan anymore, and certainly not for $690/month for a family.

I work for a very large medical institution with an international reputation, and by comparison, our coverage isn't even in the same realm. The started high deductible plans a few years back, but have now shoehorned everyone onto them. My family deductible is $6000.

Certainly makes you watch the bills more closely, and argue the myriad of add-on charges, particularly those connected with any sort of hospital visit. Amazing the kind of 'adjustments' that pop up with several polite, but probing inquiries.

That said, I would have to pick the high plan for in and out of network coverage. Of course, one ER visit, even for something that would seem minor (simple fracture), would likely cover the actual difference in plan cost.

[Nooch]

For what it's worth, my plan this current year was a $5000 deductible with nearly double the co-pays -- we've finally hit the mark where our company is a mid-sized business and has much better plans, seemingly, than previously before.

I've only hit the deductible the year we had our first daughter, but last year when she got snagged by my father-in-law's dog in the face, we came close as well..

What I suppose has me stuck is that the new low plan is even better than what we have this year (this year is currently in-network only as well).

Out of network on the High plan is billed the same as in-network on the low, 30% co-insurance..

[staggerwing]

Originally Posted by Nooch

Out of network on the High plan is billed the same as in-network on the low, 30% co-insurance..

I hear you, but how good are your 'in network' options outside of your primary geographic area? What if you need to make an ER visit when traveling 3 states over?

FWIW, as our organization has grown, (currently over 9,000 employees and counting, more than doubling over the past 12 years) our insurance options have gotten progressively more costly and restrictive. Pinch yourself for your good fortune.

[jlyon]

Take the high plan.

It is not much more and way cheaper than most would pay for the same choice.

Now that you have two kids it is good to know exactly what it will cost you because when the unknown happens (And it does quite often with kids) the low plan can really have some drawbacks especially if you have an out of Network provider. Which sometime happens even in an in network hospital it can turn out the anesthesiologist or other specialty was not part of the network.

[djg21]

High deductible. You have kids. Why take a chance?

Keep the FSA to cover co-pays and other expenses that aren't fully covered, like glasses, chiropractic, etc. The FSA is use or lose, but it is pretty easy to use $2,550 in a year.

[Nooch]

Originally Posted by staggerwing

I hear you, but how good are your 'in network' options outside of your primary geographic area? What if you need to make an ER visit when traveling 3 states over?

FWIW, as our organization has grown, (currently over 9,000 employees and counting, more than doubling over the past 12 years) our insurance options have gotten progressively more costly and restrictive. Pinch yourself for your good fortune.

According to our broker yesterday, emergency services are always covered 'in-network,' going so far as to tell us 'if the insurance provider denies an ER claim, call us and we'll step on their necks for you.' (Gotta love NJ)

We're just breaking 50 employees here

[Len J]

It's risk vs reward.

You are betting which one will end up costing you more after all costs (at the end of the year).

Place yer bets.

Len

[commonguy001]

I'd do the better plan unless you have a HSA option then I'd put the difference in that and go with the deductible plan. But it's a gamble... especially with kids.


First year I went to a Deductible plan I had a bunch of non-normal events that led to me hitting it before March started. I ended up paying out more that year but have had a couple good years where it's more than paid for itself.

[Nooch]

Originally Posted by Len J

It's risk vs reward.

You are betting which one will end up costing you more after all costs (at the end of the year).

Place yer bets.

Len

It's really the 'If the kid's end up in the ER, the high plan is cheaper.'

Sick visits and well visits are all covered 100% after copay, on both plans.. which is where the bulk of my deductible has gone this year...

Darn unpredictable kids..

Only two of us in the office *really* use the insurance -- she and I are in similar positions, two small kids, spouses aren't offered their own plan, etc... For the most part, everyone else is single, or on their spouses (better) plan..

Trying to figure out what would rack up the deductible on the low plan (to make the difference $1490 vs. $2990, essentially) but if all our Doc's office visits are covered... getting up there seems harder...

[93legendti]

My old plan was $660/month with great coverage . I now pay $1030/month and nothing is covered-ie $1900 for a test for my kid that's was unnecessary.

Take the high plan and sleep well.