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Health Insurance Help

Health Insurance Help

Old Aug 3rd 2011, 10:48 pm
  #1  
moi
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Default Health Insurance Help

Anyone ever dealt with deductibles with your company's health insurance plan? In the past, we have never had a deductible on my husband's current health insurance plan and just a $20 copay. But a job interest with more salary has 3 different plans and they all have deductibles - a) 4K deductible b) 1K deductible and c) $600 deductible.
The 4K plan has everything 100% covered and no copays and the others say 90% covered with $25 copays.
There is also employee family contribution.
This is all confusing and a 4K deductible seems ludicrous.
I can offer more info if needed.
It could be a deal breaker in my opinion.
Any help please?????
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Old Aug 3rd 2011, 10:54 pm
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Default Re: Health Insurance Help

Which is the best deal will likely depend on how well or sick you are.

That's the trade-off when they offer you several levels of deductible, you will come out better off one way if you are well, and better off another way if you get sick or are in an accident.

The trick is guessing right!
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Old Aug 3rd 2011, 11:53 pm
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Default Re: Health Insurance Help

Higher deductible usually means lower premium.

If you are generally healthy and don't go to the doc other than for an annual check up and can save $4000 in a year go for that one. If you have on going issues, I don't know diabetic or perhaps expecting a baby something where you'll be in and out a lot, lower deductible could make more sense.

Sometimes it depends on the doctor whether something counts against the deductible. If he just charges a procedure off as an office visit rather than a procedure it might not count. It's weird like that.
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Old Aug 4th 2011, 1:15 am
  #4  
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Default Re: Health Insurance Help

Time for a spreadsheet.

How much in medical services (i.e. The real cost, not just the copayment) did you use last year. Add it up. Then realize the first $4,000 of that would come out of your pocket. Also tally up the 10% amount that you would have to pay for certain expenses.

Now how much cheaper is the high deductible plan each month in premiums?

Finally, are you getting older? How likely are some new ailments this year?

In the end, which is the cheapest option? You have to work that out and maybe gamble a bit as to what is best this year.

High deductibles are often for young kids needing more money each month from lower premiums and not likely to have many health costs this year.
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Old Aug 4th 2011, 3:57 am
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Default Re: Health Insurance Help

The problem is I never kept track of last year's medical expenses or Explanation of Benefits.
We worry because we have a 6 year old son and anything can happen with kids.
With his current plan at his current job we pay a premium total of 3.9K per year, but no deductible, just $20 copays. Which I like it that way best.

Last year, we had 3 physicals, 1 mammogram, 1 obgyn visit, a couple of unwell visits, an injury doctor visit, and an emergency trip to the hospital when my son got heat stroke, but no hospitilization. A miscarriage, but no hospitalization. My son falling and banged his ear up. That is kind of how our life looks like. Plus my son falling and getting a bloody nose in Turkey, but that was free and doesn't count, but tells me that anything can happen.

We think that with the current 3 plans offered with new employer the premium PPO plan might be best for us - It is $4800 premium/$600 deductible/$25 copays.
What worries me though is that it is only 90% after deductible for emergency room and inpatient hospital. So what kind of ball park am I looking at for that 10% if I have to pay for it if we have another visit to the emergency room?

I think this is better than $2688 premium and a $4K deductible, but 100% emergency room and inpatient hospital after deductible.

It is a 9K salary increase, but then when you start weighing in health benefits I wonder if it is even worth it.
I'm confusing my bloody self now.
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Old Aug 4th 2011, 4:44 am
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Default Re: Health Insurance Help

Is there a "maximum out of pocket" expense associated with the 90% plan? Generally what that means is you pay 10% of your health costs unto a "maximum out of pocket" cost.

So let's say maximum out of pocket is $10,000 or so.

* You pay first $4,000.
* You pay 10% of the next $60,000 in expenses (i.e. $6,000)

You have now hit your maximum out of pocket for the year, $10k. After that you are not on the hook for additional expenses. The insurance company pays for those medically necessary treatments.

HOWEVER, not all plans have a maximum out of pocket clause. You will need to check if that is the case with the offerings you have.
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Old Aug 4th 2011, 4:50 am
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Default Re: Health Insurance Help

Originally Posted by penguinsix View Post
Is there a "maximum out of pocket" expense associated with the 90% plan? Generally what that means is you pay 10% of your health costs unto a "maximum out of pocket" cost.

So let's say maximum out of pocket is $10,000 or so.

* You pay first $4,000.
* You pay 10% of the next $60,000 in expenses (i.e. $6,000)

You have now hit your maximum out of pocket for the year, $10k. After that you are not on the hook for additional expenses. The insurance company pays for those medically necessary treatments.

HOWEVER, not all plans have a maximum out of pocket clause. You will need to check if that is the case with the offerings you have.
It states $4400 for out of pocket max - that makes me feel better about the emergency room/hospital 90% - I guess.
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Old Aug 4th 2011, 7:09 am
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Default Re: Health Insurance Help

Originally Posted by moi View Post
It states $4400 for out of pocket max - that makes me feel better about the emergency room/hospital 90% - I guess.
I'd double check to confirm whether the deductible is part of that $4,400 or if that is in addition to the deductible. It's likely it is included but as you are probably discovering with the 'fine print' it really varies. My advice is to call your HR person at the new place and ask them specifically about the out of pocket maximum to confirm that's all you'll pay.
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Old Aug 4th 2011, 2:47 pm
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Default Re: Health Insurance Help

I did the mistake of signing us up for high deductible plan last year. Never knew my husband had/has so many issues and he is only 28!
We were at our $6,150 deductible limit in 8 months - after that the insurance started paying almost everything. Preventive services all free.

This year I picked the PPO where everything is paid out at 90% and we have a lower deductible. This after the company organized webcasts touting the benefits of high deductible plans. I can see this becoming standard (and it seems the only) option in couple of years.

Switching jobs in September and will love the new health plan - PPO with combined max deductible of -- $300.
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Old Aug 4th 2011, 6:26 pm
  #10  
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Default Re: Health Insurance Help

If you're fit, young, no kids...do with a deductible you are comfortable with if you don't have to contribute much.

If you've got kids, best to avoid this route, as it quickly gets expensive.

90% coverage is still a bit shit tbh, we have this...our baby is still costing the shit out of a fortune paying back the 10% because she was 6 weeks premature and spent 3 weeks in hospital.
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