Can someone please help me with this?

[dincali]

I have these options at my new job for health insurance, and I have no idea which to pick. I don't WANT to spend 119.95 every single paycheck, but I will if it's my best option. I've been on Medicaid the last few months so I don't know much about this. I have adhd, so I have to pick up Vyvanse every month, and I typically see my doctor every 2-3 months, but he accepts United Healthcare so that shouldn't need to change, but I have no idea how much things typically cost. I try to go to the doctor as little as I can, I'm relatively healthy. !'m 24, I make $15.80 an hour at this full-time job, in NC. I just don't want to make a hasty decision and be stuck paying out the ass a whole year for something I may not use, and I'd greatly appreciate any advise.

|1-Provider

2-Deductible - Individual

3-Deductible - Family

4-Out of Pocket Maximum - Individual

5-Out of Pocket Maximum - Family

6-Copay - Primary Care

7-Copay - Specialist

8-Rx Copay (Generic)

9-Rx Copay (Preferred Brand)

10-Rx Copay (Non-Preferred Brand)

|UHC Base PPO $104.53 per paycheck-

Plan Detail 1-United Healthcare 2-$1,250 3-$2,500 4-$6,000 5-$12,000 6-$35 7-$35 8-$10 9-$35 10-$70

|UHC Buy-Up PPO $119.95 per paycheck-

Plan Detail 1-United Healthcare 2-$750 3-$1,500 4-$3,000 5-$6,000 6-$25 7-$25 8-$10 9-$35 10-$70|

|UHC Base HSA (TAS) $65.62 per paycheck-

1-United Healthcare 2-$3,200 3-$5,800 4-$6,000 5-$12,000 6--- 7--- 8-$10 9-$35 10-$70

|UHC Buy-up HSA (TAS) $89.65 per paycheck-

1-United Healthcare 2-$1,800 3-$3,600 4-$3,600 5-$7,200 6--- 7--- 8-$10 9-$35 10-$70|

 

[samuelc]

@dincali Questions: 1) does your employer contribute any money to the HSA accounts? 2) is your paycheck biweekly? (Trying to figure out your monthly premiums).

 

[dincali]

@samuelc No, they don't contribute, and Yes, it's Biweekly pay

 

[samuelc]

@dincali Ok then that's not a factor. You need to do the math on how much your prescription will cost you for the year with each plan. If there's a pharmacy deductible, you'll pay full price (that can be $400+) until you meet the deductible. Afterwards, or if there is no deductible, you'll pay just the prescription copay (for a brand name drug, it's the most expensive copay). Same goes for your doctor's appointments. If there's a deductible, you have to pay in full until you meet it. I would estimate $200-300 per visit for a physiatrist or a copay after the deductible. Check the plan documents and for example where they show you $35 copay for a specialist, see if it says deductible waived or after deductible. Unfortunately, you have to look at all these details.

Then for each plan calculate the cost of the annual premium + your cost for the medication on that plan for the year + your cost for the doctor's visits for that year. That will show you which of these plans is best for you.

 

[dincali]

@samuelc Thank you!

 

[christeveanity]

@dincali These are your possible annual total in-network costs. Please note that any co-pays do not go toward deductible, but do go toward your OOP max.

UHC Base PPO: Ann Prem $2,717.78 + OOP Max $6,000 = $8,717.78 (Ded $1,250/co-pay $35)

UHC Buy-Up PPO: Ann Prem $3,118.70 + OOP Max $3,000 = $6,118.70 (Ded $750/co-pay $25)

UHC Base HSA (TAS): Ann Prem $1,706.12 + OOP Max $6,000 = $7,706.12 (Ded $3,200)

UHC Buy-up HSA (TAS): Ann Prem $2,330.90 + OOP Max $3,600 = $5,930.90 (Ded $1,800)

What does TAS mean? Also, note that under the HSA plans, you will be paying the contracted rate to visit the doctor, not a co-pay, so if the visit were to be $200, and the contracted rate is $175, you will be paying those full amounts to meet the deductible.

Am assuming the HSAs are PPO plans?

 

[dincali]

@christeveanity HSA is a Health Savings Account, but i'm not sure what tas is. I copyed and pasted all of this from the page where I need to choose my plan. Thank you btw

 

[jander8629]

@dincali I like plan 2 better but I need to know what you’re giving up if anything for it.

You should be able to check their formulary.

Copay cards will deff help.

Hospital charity care can also be helpful in subsidizing a deductible should you need those services

 

[dincali]

@jander8629 I'm losing medicaid, but thats just because I now earn too much to stay on it. It cost's $119 every paycheck, and I'm paid biweekly, so that's 119*26=3094 a year. Idk if it's really worth that, because unless there's an emergency I shouln't see my doctor more than 4-5 times a year, and need to pick up my vyvance 12 times a year. I probably will need a dentist a few times, but my dental coverage is only like $12 per paycheck.

 

[jander8629]

@dincali I am in the mist of helping somebody right now who had about $35,000 in medical debt because of something stupid and they didn’t have health insurance. So far, we have gotten one of three bills paid.