What is "better" (I know it's different for everyone) and why?
What factors need to be taken into consideration?
Anyone want to dumb it down for me? I'm a generally smart person but insurance makes my brain HURT!
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I'm no expert, but I would think a lower deductible would be better (assuming everything else is the same) because then you'd hit that sooner and only have to pay whatever your remaining percentage is.
For example, our plan is a $400 deductible, 80/20 with $4500 OOP Max. That means we'll have to pay copays and full-price until we've paid our deductible ($400) and then the insurance kicks in, paying 80% of the remaining bills while we pay 20%. Then once we've hit $4500 total, the insurance pays the rest.
So really, it's the OOP Max that probably matters the most (if you think you're going to hit it regardless of what your deductible is).
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@Adira: Thanks. This has been explained to me more than once but it never *sticks*
Work provided us only with the amount of $ taken out of each check so far. No deductible/%/OOP info yet. We have one day to ask questions (today) and of course it's during my pumping time,
I'm stressed!
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@cmomma17: That's really weird! Our work did the opposite - it gave us the deductible/%/OOP info first and then later how much it would actually cost us! But it sounds like you don't really have any options...?
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@Adira: I have three choices. I just feel like they were sprung on us with very little time to make decisions (we don't have to decide today, but the meeting is today and I haven't had time to digest/process all the info yet!)
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We chose a low deductible. We pay $300 combined as a family for our deductible. After that, our plan kicks in at 100%. Hospital stays are 1k though. Our plan is the most expensive per month. However, some of the cheaper plans (less per month out of DH's check), had a deductible of 6k per family. Which would mean, we would have to pay 6k before insurance even kicked in. I felt more comfortable paying more per month, since it comes right out of DH's check, rather than trying to come up with thousands of dollars to pay health bills.
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I'm on a high deductible plan because it's FREE. DH & I never go to the doctors so this makes sense for us.
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@cmomma17: I think without more info on the deductible/%/OOP, there's really no way for you to decide which option is better (unless money is a factor, then you may be forced to choose based on that)!
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So let me try to understand this:
Plan 1
Deductible is $0 in network, $1200 out of network
OOP Max $3,500 in network, $3,000 out of network
Copays are $15-$75 depending (primary care - ER)
Coinsurance is 90% in network, 80% out of network.So ..... we go to the doctor as many times as it takes until we have paid $3,500 out of pocket and then insurance kicks in and covers 90%?
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@Adira: I found the paper with that info
D'oh!
I'm having a brain fart/mommy brain week! -
@cmomma17: No, you go to the doctor as much as you want without having to pay anything (or only paying 10% while your insurance covers 90%) and when you hit the OOP Max, your insurance takes over 100%
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@Adira: so is it just me or does that sound like a good deal? or is it bad? aaargh, I feel so stupid!
ETA: LOL, never mind, I just looked at how much would be taken out of my check for that plan, and that's NOT happening unless we want to give up diapers, gasoline and groceries!
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I'm honestly not sure how copays work though - are they separate and part of the OOP Max? Or do they go to the deductible? And if they go to the deductible, does that mean you don't have copays if you have a $0 deductible?
My guess is you pay copays (which contribute to the OOP Max). Anything that's more than a copay, you'd pay 10% (assuming it's in-network). Once you've paid $3,500, your insurance covers everything after that.
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@cmomma17: It sounds like a perfectly good plan to me (better than mine) but it all depends on how much it will cost you. I'm guessing this is the most expensive plan for you?
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For example, my company has two plans. One has a $1200 deductible with 80/20 until $3000 OOP Max. The other is $400 deductible with 80/20 until $3000 OOP Max. The first plan costs $3500 a year, the second plan costs $7000.
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@Adira: Yeah, that's the most expensive of the three options. It would essentially cut my paycheck in half
I think overall my work offers pretty good insurance though
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@cmomma17: what are your prescription benefits? Are your doctors in network? What goes toward the OOPmax?
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@cmomma17: You'll have to consider how often you'll think you're be going to the doctor's and stuff. And if you think you'll be going enough to hit the OOP Max anyway, do all plans have the same OOP Max? If they do, it might make more sense to go with the cheapest plan, unless it has other restrictions.
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It also makes sense to see what doctors and hospitals are in network for the different plans. We have traditionally used an HMO, but not what my son is here, I want the flexibility of going outside network for specialists if needed, so I am willing to pay more for that.
I wish it were easier to pick a plan, but in my honest opinion, they're not out there for you to benefit. Insurance companies are out to make money.
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@Adira: I'm texting my sister who works in insurance and she says co pays do not usually go toward OOP max.
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@Mrs. Jump Rope: all good q's! The most expensive plan lists prescription costs by tier. the other two plans just say "subject to deductible and coinsurance"
in/out of network doctors shouldn't change (that I'm aware of), most specialists end up out of network just because of where I live (smaller town)
@looch; we only have one hospital so it is in network. specialists are rare in our area so will likely be out of network. good things to think about though! you're totally right about insurance companies!!!
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@cmomma17: it's possible that the hospital has different departments and some are in network and some are out of network...happened to a coworker of mine, otherwise I wouldn't have known that to be possible.
It's so mind boggling!
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@cmomma17: copays did not go towards my OOP max either. I did some crazy calculating while pregnant.
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I think you have lots of good advice already . . . it's really about risk you are willing to take and expected expenses.
high deductible is cheaper monthly but you risk paying way more at one time if you have a big expense. if you expect only small expenses (office visits etc) and are willing to risk owing a lot if something big happens, it's good.
low deductible is better if you expect big expenses (like a birth or major procedures, or if you have any illnesses that have to be managed), or if you'd rather pay more per month but have lower risk of owing a lot at once. basically that's how insurance works, you pay more to lower your risk of a big financial hit.
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@cmomma17: ok, "subject to deductible" likely means you have to pay out of pocket for all prescriptions until the deductible is met. Then you'll pay a co-pay, nothing, or your co-insurance amount.
I'd find out if that's correct, and what prescription benefits are once you've met the deductible.
And, I'd find out if you pay full price or the contracted rate.
Lastly, find out of te prescription costs go toward the deductible and OOPmax. Ours does!
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@cmomma17: our prescription co-pays actually DO go toward our OOPmax. This year is the first they have.
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@Mrs. Jump Rope: there are three plan options. one does not have prescriptions going toward the deductible, the other two do (high deductible plans).
The meeting got HEATED! I understand it's a touchy subject but some people were just rude!
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@looch: just found out that our insurance offers "in network" hospitals. So the whole hospital is covered, no matter if the individual doctor, anesthesioligist, etc. is in or out network. So our local hospital plus other major hospitals like Johns Hopkins in MD and UVA are all 100% covered.
D'oh!
I think overall my work offers pretty good insurance though
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