https://boards.hellobee.com/ Pregnancy, Baby and Parenting blog, by Hellobee en Mon, 25 May 2026 12:30:45 +0000 https://boards.hellobee.com/topic/insurance-options#post-1719443 Tue, 24 Jun 2014 18:29:48 +0000 MamaG 1719443@https://boards.hellobee.com/ <p>My DH's is the way @Adira: was explaining. We had three people on the plan and it was $800/individual $2400/family. He met his $800 deductible and then was on co-insurance. Me and our daughter never met our deductible. </p> <p>I think in @Adira's last example ifA, B, and C each had $2000 of expenses ($6000 total) the deductible would also be met even though no ONE person met the individual deductible and co-insurance would then kick in on the next expense regardless oh which person it was.</p> <p>It is certainly plan dependent and worth clarifying. </p> https://boards.hellobee.com/topic/insurance-options#post-1718967 Tue, 24 Jun 2014 14:10:53 +0000 sunny 1718967@https://boards.hellobee.com/ <p>Gosh, insurance is so complicated!!! </p> <p>I didn't realize there were individual vs. family deductibles. I'll have to check with my plan! </p> https://boards.hellobee.com/topic/insurance-options#post-1718941 Tue, 24 Jun 2014 14:06:03 +0000 Mrs. Jump Rope 1718941@https://boards.hellobee.com/ <p>@Adira: @aegie: it depends entirely on how your insurance is set up. Regardless, there is always a max. Each family member wouldn't pay the full deductible each. </p> https://boards.hellobee.com/topic/insurance-options#post-1718920 Tue, 24 Jun 2014 13:59:15 +0000 Adira 1718920@https://boards.hellobee.com/ <p>@aegie: Your statement made it sound like there is ONLY a family deductible and once you (whether it's just you OR your whole family combined) meets it, then your insurance kicks in.</p> <p>With MY insurance, there is both an individual deductible ($3000 for us) AND a family deductible ($6000). If I personally meet my individual deductible ($3000), insurance will kick in for ME. Then the next person has to meet their individual deductible ($3000) OR the family deductible ($6000), whichever is hit first. So let's say there are three people: A, B, and C. A has surgery and has to pay $3000 up front (the individual deductible) and then insurance kicks in. Then B has surgery and has to pay $3000 up front (also the individual deductible) and then insurance kicks it. But now together as a family, they have met their family deductible ($6000), so when C has to have surgery, insurance kicks in IMMEDIATELY because the family deductible has already been met. </p> https://boards.hellobee.com/topic/insurance-options#post-1718807 Tue, 24 Jun 2014 13:28:40 +0000 aegie 1718807@https://boards.hellobee.com/ <p>@Adira: I was trying to point out that if you personally had $6000 in medical bills, yes, YOU would meet the deductible and co-insurance would kick in. FOR YOU. But your family members would not have met their deductible. So they would still need to pay out of pocket until that happens.</p> <p>I feel like in that scenario, you're paying more out of pocket because everyone needs to meet a deductible. </p> <p>I kind of like knowing that we all get to contribute to the deductible. but i guess that's preference. </p> https://boards.hellobee.com/topic/insurance-options#post-1718703 Tue, 24 Jun 2014 12:57:33 +0000 Adira 1718703@https://boards.hellobee.com/ <p>@Mrs. Jump Rope: So frustrating! </p> https://boards.hellobee.com/topic/insurance-options#post-1718698 Tue, 24 Jun 2014 12:56:28 +0000 Mrs. Jump Rope 1718698@https://boards.hellobee.com/ <p>@Adira: that's exactly what happened! </p> https://boards.hellobee.com/topic/insurance-options#post-1718696 Tue, 24 Jun 2014 12:55:58 +0000 Adira 1718696@https://boards.hellobee.com/ <p>@Mrs. Jump Rope: hahaha, yeah, I guess you'll find out as you're billed, haha! </p> https://boards.hellobee.com/topic/insurance-options#post-1718682 Tue, 24 Jun 2014 12:51:53 +0000 Mrs. Jump Rope 1718682@https://boards.hellobee.com/ <p>@Adira: gotcha-- that's how ours was originally explained to us. I was told that it's called "non-aggregated". Our plan is aggregated, which apparently means all of us have to meet the deductible before anything kicks in. </p> <p>But they could be lying again. Ha. </p> https://boards.hellobee.com/topic/insurance-options#post-1718675 Tue, 24 Jun 2014 12:50:26 +0000 Adira 1718675@https://boards.hellobee.com/ <p>@Mrs. Jump Rope: So for example, say my insurance had a $500 individual and $1000 family. Then I personally ended up with a $1000 bill. I would pay my $500 deductible and then the coinsurance would kick in. So I, as an individual, would have met my individual deductible and as a family there's still $500 left. But anything for ME, insurance will help cover because I've met MY deductible. Now if Hubs needs any work, he will have to meet his deductible. Once he's met his (or a combination of him and Xander have met the rest of the family), we'll be done with deductibles! </p> https://boards.hellobee.com/topic/insurance-options#post-1718662 Tue, 24 Jun 2014 12:46:42 +0000 Mrs. Jump Rope 1718662@https://boards.hellobee.com/ <p>@Adira: maybe I misunderstood your example then.</p> <p>Ours has a $500 individual and a $1,000 family.<br /> We were originally told that one person in our family had to meet the individual deductible before the co-insurance kicked in. That meant there's be a $500 balance left for my husband and Chloe to meet ($250/ea) before their coinsurancr kicked in. </p> <p>For us, this was a huge cost savings. Our prescription benefits don't kick in until we've met our deductible-- so id get my advair filled ($450 out of pocket) once and my deductible was (almost) met. From there on after, each prescription is $35.</p> <p>It would have been a huge cost savings for us, but customer service gave us the incorrect information. We have to meet $1,000 as a family before any benefits kick in. We pay 100% until the deductible is met. </p> https://boards.hellobee.com/topic/insurance-options#post-1718631 Tue, 24 Jun 2014 12:42:01 +0000 Adira 1718631@https://boards.hellobee.com/ <p>@Mrs. Jump Rope: If my plan is NOT aggregated, why do you think aggregated sounds better? Seems like with my plan, insurance will kick in sooner since each individual only has to meet their individual deductible before insurance kicks in, vs having to pay the whole family deductible upfront. </p> https://boards.hellobee.com/topic/insurance-options#post-1718601 Tue, 24 Jun 2014 12:36:08 +0000 Mrs. Jump Rope 1718601@https://boards.hellobee.com/ <p>@Adira: So your plan is not aggregated!</p> <p>Our insurance company initially gave us the same set of information. We have a $500 individual and a $1,000 family deducitble. I was told that one person had to meet $500 before coinsurance kicked in. In actuality, the entire family had to meet $1,000 before coinsurance kicked in. It didn't matter if I had 1,000 in bills or $500, the entire family had to meet $1,000 combined before coinsurance kicked in.</p> <p>Aggregated sounds so much better, though! One ER visit could easily be that $500! </p> https://boards.hellobee.com/topic/insurance-options#post-1718512 Tue, 24 Jun 2014 12:09:05 +0000 Adira 1718512@https://boards.hellobee.com/ <p>Another example: Hubs breaks his thumb and it costs $400. That's applied to his deductible. He now has $2600 left to meet his deductible and the family has $5600 left. Now I have knee surgery which costs over $3000. I pay my $3000 deductible plus whatever coinsurance is left. I've now met my deductible and the family has $2600 left. </p> https://boards.hellobee.com/topic/insurance-options#post-1718503 Tue, 24 Jun 2014 12:07:07 +0000 Adira 1718503@https://boards.hellobee.com/ <p>@aegie: If I personally have $6000 in bills, I have to pay the $3000 deductible and then the 20% coinsurance (and my insurance pays 80%) after that. :D </p> https://boards.hellobee.com/topic/insurance-options#post-1718489 Tue, 24 Jun 2014 12:03:16 +0000 aegie 1718489@https://boards.hellobee.com/ <p>@Adira: so what happens if no one else in your family makes their individual deductible but you rack up $6000 by yourself? That seems odd because then even though you've clearly hit the individual deductible, you still haven't met the family deductible. </p> https://boards.hellobee.com/topic/insurance-options#post-1718475 Tue, 24 Jun 2014 12:00:42 +0000 Adira 1718475@https://boards.hellobee.com/ <p>@aegie: @MamaG: @Mrs. Blue:</p> <p>&lt;&lt; individual deductible applies only when it's just employee. True family deductible applies when you are covering employee + family. So regardless of who is racking up the bills, you need to meet the family deductible, not the individual. &gt;&gt;</p> <p>This will probably depend on your plan. Our insurance is a high deductible plan but definitely has an individual vs family deductibles. So with our insurance, each individual's deductible is $3000 and the family deductible is $6000. So each individual only has to pay $3000 and then once the family as a whole has hit the $6000, we (as a family) no longer have to make payments towards our individual deductibles. </p> https://boards.hellobee.com/topic/insurance-options#post-1718359 Tue, 24 Jun 2014 11:26:09 +0000 aegie 1718359@https://boards.hellobee.com/ <p>@MamaG: @Mrs. Blue: individual deductible applies only when it's just employee. True family deductible applies when you are covering employee + family. So regardless of who is racking up the bills, you need to meet the family deductible, not the individual. </p> <p>Just as a side note, HSA/HRA plans work like this .... you have insurance, and as long as you go to an in-network doctor, your doctor will bill your insurance. Your EOB will show something like the doctor charged $200. After insurance discount, you will owe $89 or something towards your deductible. Once you meet your deductible, your plan will start paying for some percentage of your deductible. In otherwords, if you paid $7000 out of pocket towards your deductible, your next bill of let's say $1000 less insurance discount comes out to $200. your insurance will pay for a certain percentage of it (i'm assuming 80%). So then you're out of pocket will be $40. The $40 will go towards your out of pocket max. If you ever end up paying your out of pocket max, then insurance/employer ends of paying for the entirety of your bill. </p> <p>Now the HSA part. Your employer will put a certain amount int your HSA account that can only be used towards medical/rx costs. preferrably just medical so you can use it towards your deductible. RX usually doesnt' count towards deductible but does count towards your out of pocket max. Your employer is contributing $3000 to this plan. You can also put in money into your HSA account as well. It's not like the FSA where you lose it if you don't use it. You can even invest the money in the HSA if you want and it rolls over year after year. This is a great plan if you can reasonably plan for medical expenses. </p> <p>A $7000 deductible IS high. But if your employer will contribute $3000, then it's really like $4000 that's truly out of pocket. which is still really high. Are you sure you're not confusing deductible and out of pocket max? </p> https://boards.hellobee.com/topic/insurance-options#post-1717452 Mon, 23 Jun 2014 22:47:24 +0000 birdofafeather 1717452@https://boards.hellobee.com/ <p>yeah, i would check on maternity coverage because i had a deductible of $3500 which i thought i'd pay for R's birth, but it was only $1600 because my insurance covered a good amount before having to meet any deductible! </p> https://boards.hellobee.com/topic/insurance-options#post-1717374 Mon, 23 Jun 2014 20:53:21 +0000 sunny 1717374@https://boards.hellobee.com/ <p>Wow those numbers seem so high! As others have already mentioned, telling us what your max out of pocket cost is a critical part of the equation.</p> <p>I shopped on the exchanges just to compare with my employer provided plan and the one I got through work is way better and way cheaper because my work subsidizes it. Perhaps if your DH's work doesn't subsidize, you might be able to get a plan on the exchange that works better for you and new baby. </p> https://boards.hellobee.com/topic/insurance-options#post-1717370 Mon, 23 Jun 2014 20:50:06 +0000 Mrs. Jump Rope 1717370@https://boards.hellobee.com/ <p>@Mrs. Blue: I would ask each company more questions before making a decision.</p> <p>Our plan has an individual and a family deductible, but the individual doesn't "count" if you have a family plan. It's their way of saying "here is what your plan covers. If you're on an individual plan, your deducible is XXX. If you're a family plan, your deductible is YYY."</p> <p>Are either plans aggregated?</p> <p>What is your OOPmax? What is your prescription plan options?<br /> What is their prenatal plans? (Ours covers prenatal and delivery at 100%, our deductible does not apply.) </p> https://boards.hellobee.com/topic/insurance-options#post-1717368 Mon, 23 Jun 2014 20:46:57 +0000 MamaG 1717368@https://boards.hellobee.com/ <p>I believe under ACA for high deductible plans after some date in 2014 (sorry, I know it's before 5/1, as our plan was impacted), the max out of pocket is 6,350 individual. I know our plan doubles for family but I'm not sure if that's an ACA requirement. So if the individual deductible is 3,500 you could have exposure up to 6,350 with your co-insurance. </p> https://boards.hellobee.com/topic/insurance-options#post-1717358 Mon, 23 Jun 2014 20:36:52 +0000 SleepyMonkey 1717358@https://boards.hellobee.com/ <p>@Mrs. Blue: is there a Max out of pocket cost too? After you pass your deductible and your insurance pays 75%, is there a max...say $8000 and then after that , insurance covers everything 100%? @Bookish: is spot on. The lower deductible is less out of pocket before you hit the deductible but not by much so the max out of pocket might be the deciding factor. </p> <p>Although presumably you have a young and healthy family, so for most years, you won't even come close to hitting your deductible. Let's say you have $4000 in medical costs for the year. With plan A, you spend $8400 for premiums plus $4000, which is $12,400. With plan b, you spend $10,800 for premiums plus $4000 minus the $3000 from your hsa, which is $11,800. So in normal years where you aren't spending a lot on medical costs, meaning no new baby and no major surgeries, it makes more sense to go with plan b. </p> https://boards.hellobee.com/topic/insurance-options#post-1717303 Mon, 23 Jun 2014 20:04:18 +0000 Mrs. Blue 1717303@https://boards.hellobee.com/ <p>@matador84: even after the high deductible is met, it still only pays 80% of most things. :(. I *think* that it has an ind. deductible of 3500 and family deductible if 7000. I think that the other one is an ind. deductible of 2000/family deductible of 6000, and then pays 75% for most things. </p> https://boards.hellobee.com/topic/insurance-options#post-1717266 Mon, 23 Jun 2014 19:35:25 +0000 matador84 1717266@https://boards.hellobee.com/ <p>I just got a chance to read your full post. What are your max oop expense? That will be critical to making a decision. And, are those deductibles family or individual? For example, my individual deductible was $3000 and family was $6000, I am on a high deductible plan that pays 100% after my deductible was met. So go figure, I hit my $3000 between dr visits and L&amp;D, my dr ended up cutting me a check back because I'd overpaid. You'll have more medical expenses this year than not because you're pregnant so I'd probably go with a HD...but I'd have to take a close look at max oop and what pays after deduct met to make a final decision. </p> https://boards.hellobee.com/topic/insurance-options#post-1717264 Mon, 23 Jun 2014 19:33:23 +0000 Mrs. Pen 1717264@https://boards.hellobee.com/ <p>I think that's high. Ours if 2k individual and 4500 family. And I don't think we have a great plan - because it doesn't cover a high percentage of things. The only things it covers 100% are annuals (well child visits, physicals, vaccines, birth control).<br /> But I'm insurance naive too... </p> https://boards.hellobee.com/topic/insurance-options#post-1717259 Mon, 23 Jun 2014 19:27:14 +0000 MrsH 1717259@https://boards.hellobee.com/ <p>@Mrs. Blue: my insurance plan was 6000 high deductible this year - I feel ya. We met it in January when we had E. </p> https://boards.hellobee.com/topic/insurance-options#post-1717257 Mon, 23 Jun 2014 19:25:30 +0000 MamaG 1717257@https://boards.hellobee.com/ <p>I totally misread the premiums! I assumed that the higher deductible had the lower premium (that's what I'm familiar with). In that case, disregard my recommendation. I do think it's important to better understand the deductible and OOP max for the two plans and then look at the exchange prices.</p> <p>DH carries LO on his plan and I'm on my own plan. So certainly don't eliminate differing plans as an option. Though I understand how it can be less convenient. </p> https://boards.hellobee.com/topic/insurance-options#post-1717236 Mon, 23 Jun 2014 18:51:53 +0000 Bookish 1717236@https://boards.hellobee.com/ <p>@Mrs. Blue: Yuck, those sound like DH's insurance options. We went with the high deductible/HSA option because at first, they gave about 50$ a month towards it. Now they don't, and it's just a crappy insurance plan. His 'family' plan is about 700$ a month, which is why LO is on my plan! Look into the TX health care exchange as well if you don't want to go through employer.</p> <p>Anyhoo, it looks like with plan A (assuming these deductibles are individual, not family), you will end up paying $14,400 between premiums and deductibles. With plan B, you pay $14,800 (premiums+deductible - HSA contribution). </p> <p>With them being technically that close in cost, take a look at things like out of pocket maximums &amp; copays to see which is the better deal. </p> https://boards.hellobee.com/topic/insurance-options#post-1717111 Mon, 23 Jun 2014 17:10:27 +0000 MamaG 1717111@https://boards.hellobee.com/ <p>Yes, a good point on the out of pocket maximum. If these are your only two options (and based on the limited information you have), i'd probably go with the higher deductible, lower premium plus HSA option. It's what I did when choosing between the lesser of two evils at my employer :) </p>