which insurance plan and why?

By matador84 Oct 12, 2013

So DH's company just came out with their new benefits plan for the year. Currently, I carry LO on my plan and DH has his own benefits. We are tossing around the idea of dropping off my insurance and joining DH's. I made a little chart to figure out if it would be worth it, but I feel like I don't know enough about insurance to make a positive choice. Can anyone help me out? Let me know if I am overlooking something big please?!

Current plan:
Carry LO, and myself: $280, will stay same when I have LO 2.
High Deductible plan, overall deductible is individual $3000, family $6000
Max out of pocket is $6000

DH has a choice of two plans:
Can carry DH, myself, 2 kids for $420 but could get it lower if we complete some health incentives.
Deductible $2400
Company contributes $1000 to deductible
Out of Pocket Max is $7000

Plan 2 under DH:
$350 to carry whole family, could get down to $175 with health incentives
Deductible is $3600
Company contributes up to $1500 towards deductible
Out of pocket max is $7600

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27 comments

regberadaisy
GOLD / wonderful pomegranate / 28905 posts

Oct 12, 2013

DH came on mine because my employer offers free family plan.

LO is on a state funded health insurance plan that is $60/month.we are keeping her on that instead of in my free plan bc the state plan ROCKS. Almost everything is covered.
matador84
papaya / 10560 posts

Oct 12, 2013

@locavore_mama: you are so lucky! insurance is so expensive and you have to pay so much any way out of pocket, i feel like it's a rip off either way!
Boopers
pear / 1548 posts

Oct 12, 2013

I'm not very good with insurance either, but your district is so much more affordable than mine! To carry me and a child would be $500+ and to carry a whole family is $900+!

How much does he currently pay for just himself on his own plan? That would factor in to my decision making. Would switching to his make it more cost effective as a whole for your family? Does him staying on his new plan alone and you stay on yours make it more cost effective?
regberadaisy
GOLD / wonderful pomegranate / 28905 posts

Oct 12, 2013

@matador84: yes, it's such a crock of you know what!!!
We're very thankful my employer offers free health insurance!
matador84
papaya / 10560 posts

Oct 12, 2013

@Boopers: it really is sick how much it costs for insurance. a friend of mine's husband is a landscaper and works seasonally, and of course she teaches so she carries the whole family on her insurance and it is nearly $600. to carry a whole family for $900 is absurd!

if he were to remain on his plan solo it would be $145 a month on plan 1 and $125 on plan 2. i am glad you brought that up, we need to factor whole family insurance cost in the mix.
SleepyMonkey
grapefruit / 4006 posts

Oct 12, 2013

@matador84: is the $280, $420 and $350 per paycheck and how often do you get paid?
matador84
papaya / 10560 posts

Oct 12, 2013

@SleepyMonkey: yes, all costs are deducted per month.
SleepyMonkey
grapefruit / 4006 posts

Oct 12, 2013

@matador84: also what happens after you hit your deductible? does co-insurance kick in?
matador84
papaya / 10560 posts

Oct 12, 2013

@SleepyMonkey: on my plan it is a high deductible, so i meet my deductible and it pays 100%.

the other two plans are 80/20
shinymama
persimmon / 1128 posts

Oct 12, 2013

My insurance costs are $900/month for all four of us. That includes a "discount" for 3+ people. Interestingly enough, our 2014 premiums went down despite the ACA implementation.
SleepyMonkey
grapefruit / 4006 posts

Oct 12, 2013

just a back of the envelope calculation...

Option 1: $280+$125=$405 x 12 = $4860 out of pocket each year plus $6000 deductible = $10,860 max out of pocket per year

Option 2: $420 x 12 = $5040 out of pocket plus $7000 deductible minus $1000 contribution = $11040 max out of pocket per year

$175 x 12 = $2100 plus $7600 - $1500 = $8200 max out of pocket per year

depends on how low you could get the $420 to. i think the choice is probably between 2 & 3, if you can get the premium down with health incentives. if you think the family will go to the doctor a lot and have a lot of healthcare expenses, then maybe the lower deductible plan would be better because the coinsurance would kick in much faster. if you guys are pretty healthy and don't see the doctor a lot, then higher deductible might be better.
matador84
papaya / 10560 posts

Oct 12, 2013

@SleepyMonkey: you are awesome! i am just not good with this kind of stuff, but am trying to minimize cost with the options we have.

having a baby in february so we will have pretty significant insurance costs. it's a tough decision! i had a baby last year and was under the HD, and it was about 5K in out of pocket costs.
lawbee11
GOLD / watermelon / 14076 posts

Oct 12, 2013

I would do plan 2 under your DH if you can get it down to $175/month. Deductible is a little higher than plan 1, but the savings in premiums makes up for it.
matador84
papaya / 10560 posts

Oct 12, 2013

@SleepyMonkey: was just looking at numbers more, why add $125 to option 1?

Still learning here! Thanks!
yoursilverlining
eggplant / 11824 posts

Oct 12, 2013

Would you be joining the new plan before having baby #2? If so, what sort of maternity coverage and delivery coverage do the various plans provide for?
SleepyMonkey
grapefruit / 4006 posts

Oct 12, 2013

@matador84: since you know you will be hitting the deductible because you're pregnant (btw, congratulations!!), i think if you can get the option 2 premium to around $225 or under, you should go with #2.
SleepyMonkey
grapefruit / 4006 posts

Oct 12, 2013

@matador84: i thought that was how much your DH pays for his insurance? so i just factored that into the costs per year to insure your entire family.
matador84
papaya / 10560 posts

Oct 12, 2013

@yoursilverlining: yes. There isn't anything specific in the booklet, what should I be looking for?
yoursilverlining
eggplant / 11824 posts

Oct 12, 2013

@matador84: there should be a maternity/prenatal section specifying coverage. Since delivery is such a large expense, the levels of coverage each plan offers might factor in, I think?
matador84
papaya / 10560 posts

Oct 13, 2013

@yoursilverlining: in my plan, the only thing is says about pregnancy/maternity coverage is pre/post natal care is no charge with an in-network, delivery and inpatient services is no charge also. of course, that is once the deductible has been met.

i can't find anything about that specific coverage in my husband's enrollment guide.
matador84
papaya / 10560 posts

Oct 13, 2013

@SleepyMonkey: dh would either have 420 deducted from his paycheck for his first plan or 350 for the second plan. not counting incentives right now.
Mrs. Jump Rope
blogger / coconut / 8306 posts

Oct 13, 2013

@matador84: instead of paying so much attention to the premiums, I'd be looking at the copays (do you have them?) and what each plan covers.

Our insurance plan did away with copays in 2013, so we pay full price for each script until we meet our deductible. The script prices go toward our deductible. Then, we have 90/10 and the script price still goes toward our OOP max.
matador84
papaya / 10560 posts

Oct 13, 2013

@Mrs. Jump Rope: on the high deductible there are no copays.

on dh's plan, it's an 80/20, the only copays it lists are for rx drugs.
SleepyMonkey
grapefruit / 4006 posts

Oct 13, 2013

@matador84: in that case, not taking any health incentives into account, then i think option 3 is probably the best. its the lowest premium. it has a higher deductible, but if you think your healthcare costs will exceed $3600 per year (for a family, i don't think that is excessive), then its more cost effective than option 2.

let's say your healthcare costs are $5000 for a year. Here is the breakdown of what your out of pocket costs will be with each of your options (i think this is how the math works, based on what i've read):

1: pay ($280 + whatever your husband pays for his plan) x 12, plus the $5000. this will definitely be the most expensive option since you have no benefit of coinsurance and presumably you have two deductibles (yours and your husband's) to meet.

2: pay $420 x 12 = $5040 for premiums. then add the deductible minus what the company contributes plus how much you will pay under 80/20 coinsurance....

+ ($2400-1000) + $2600 x 20% = $1920

Total = $6960

3: pay $350 x 12 = $4200 for premiums.
+ ($3600-1500) + 1400 x 20% = $2380
Total = $6580

so under option 3, you save some money.
Mrs. Jump Rope
blogger / coconut / 8306 posts

Oct 13, 2013

@matador84: is it possible to calculate how often you saw a doctor (and paid a co-pay) and filled a prescription for the last year? I can log into my health plans website to view the last 6 years worth of transactions.
matador84
papaya / 10560 posts

Oct 13, 2013

@Mrs. Jump Rope: yes. since i was on the high deductible plan last year, i paid no co pays. we paid out of pocket until our deductible was met, which for me was 3000. when i had DS and added him on our family deductible was 6000, so we paid out of pocket until we met that. since i had a baby, we met pretty quick and thereafter 100% was paid until our deductible started over.
looch
wonderful pear / 26210 posts

Oct 13, 2013

@locavore_mama: how did you get your daughter on the state plan? Now that it is open enrollment season, I am looking at all of our options again.

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