Choosing an insurance plan - UnitedHealth care - Chicago

[happilyretired]

I'm a 28 y/o F with no kids or husband, pretty healthy & make all of my preventative visits. I will have to pay for medications like albuterol.

The cost of insurance has gone up and my company is switching from Aetna to United Health Care. I have an option of choosing from the marketplace and being reimbursed, although the marketplace doesn't seem to show their plans ahead of 11/1 (tried to look and see what my options were). My job will pay up to 450$ a month if I go this route.

otherwise....

I get to choose between UHC Choice Gold Plus and Silver:

ChoicePlus Gold:

No copayment

$1200 deductible

20% co-insurance

OOP maximum is $5000 for individual

I will have to pay $47 out of my paycheck for this plan

ChoicePlus Silver:

No copayment

$6000 deductible

20% co-insurance

OOP maximum is $7500 for individual

I will have to pay $0 out of my paycheck for this plan

Any thoughts on this would be helpful. Im calling all of my providers (therapists, GYNs, Primary care) to see if they take UHC as well.

I wish this process wasn't so damned difficult and we could all just be covered and be friends.

 

[munyaku]

@happilyretired Since you have workplace coverage that is affordable, you won't qualify for the APTC. You're exceedingly unlikely to find a marketplace plan with similar coverages for only $450/mo unsubsidized.

You don't need to ask your providers if they take UHC, you need to ask UHC if they are in-network with your plan. Never take the word of a doctor regarding their network status.

Also taking insurance =//= being in-network. That phrasing just means they're willing to file a claim on your behalf.

Obtain the NPI of the doctors you see and their facility tax ID and call the insurer and ask. They may be able to help before you're enrolled in the plan.

On the gold plan, your minimum cost is $1222, maximum cost is $6222.

On the silver plan, your minimum cost is $0, your maximum cost is $7500.

 

[believerben]

@happilyretired Speaking out of my experience as a Chicagoan with UHC- you will probably be in network with all your doctors as it is widely accepted (I have some providers in the U Chicago system and some in the Northwestern system and have had no issues).

This is difficult because the plans are so different! Does your employer offer any HSA dollars if you take the high deductible plan? The lower deductible plan doesn’t qualify for an HSA. If all of your estimated out of pocket health costs are less than the premium of the low deductible plan (~$1128), then it usually would make sense to go with the high deductible plan. However, you need to have your deductible ($6000) saved in case you have an accident/emergency. Chances are, you won’t have that emergency this year and you saved what you would have spent on the premiums. I personally get $1000 in HSA dollars from my employer every year and that covers all of my expected costs, so it’s a no brained taking the higher deductible in my case (I just have $4k earmarked just in case).

I don’t know enough about the marketplace plans to give you an opinion, but I have a feeling you’re better off with your employer.

 

[munyaku]

@believerben The HDHP eligible HSA plans have a maximum out of pocket capped at $6900 for 2020 and $7000 for 2021. As the silver plan has an OOP of $7500, it does not appear HSA eligible. Deductible alone is not the only metric making a plan HSA eligible (deductible min of $1400/$2800 individual vs family coverage, OOP capped at $7000/$14000, no first dollar coverage, and the OP can't be enrolled on any other disqualifying health plan or have access to an FSA or HRA)

 

[believerben]

@munyaku Thanks for the information! My company is so HSA positive I didn’t think about the restriction at the other end.

 

[munyaku]

@believerben You're welcome! Not a lot of people realize it's more than just deductible. If you want to learn more you can review IRS Publication 969!

I've never understood why a company would offer a plan like the Silver here and not just make it HSA eligible... seems like it'd be a win-win.

 

[maryh]

@happilyretired You’re almost ALWAYS better off with your employer’s insurance policy.

Considering that you’re making so many calls, I’d take the gold. It looks like with all those providers, you’ll be hitting that $1200 deductible.

 

[jwesley]

@happilyretired First thing is you're doing this right by making sure all your providers are in the UHC network. They should be as UHC has a fairly robust nationwide network.

Second, you say you're going mainly for preventive visits only and one prescription. Is there a difference in how your script is covered between the two plans. Rx co-pays usually are not any different between gold and silver but double check that. You don't want to be paying out of pocket to deductible on the silver plan.

Third, does the silver plan offer a Health Savings Account? It looks like it is a high enough deductible that it would be HSA compliant.

If so, I would take the silver since it is no money out of your check and you could start funding an HSA. It lowers your taxable income and provides an account for medical dental and vision expenses, can be invested after a certain amount of funds in the account and is usually used for saving up for retirement expenses as well.

Let me know if you have any other questions!

 

[munyaku]

@jwesley Deductible isn't the only consideration for an HSA. There has to be zero first dollar coverage and OP can't be on any other disqualifying type of health plan. The maximum out of pocket allowed on an HDHP eligible HSA is capped at $7000 for 2021. The plan does not appear HSA eligible as the OOP value is $7500 in excess of the federal cap.

 

[jwesley]

@munyaku Good call. I can't believe that qualifies as a "silver" plan but its probably better than anything on the marketplace. Interesting that the company is offering her money for the marketplace. I have not seen that in very many companies so far.

 

[munyaku]

@jwesley I wonder if they're a smaller company and or a tech based company, that tends to be more where I see that on the fewer occasion that I do see it. It's also just somewhat messy to set up if you're doing some sort of HRA or QSEHRA compared to just payroll deductions.

I can't believe that qualifies as a "silver" plan but its probably better than anything on the marketplace.

Agreed. Unfortunately.

 

[jwesley]

@munyaku Not sure if you have heard of ICHRA in your part of the business but its this exact thing. Instead of paying part of the rates and claims in a self funded case, give employees an HRA to get coverage from the marketplace. Lowers the companies risk and supposed to give the employees more choice. Also more headache.

Edit:hah QSEHRA looks to be the close to the same as ICHRA.

 

[munyaku]

@jwesley I'd not heard of one called ICHRA, I don't deal too often on the business side of things, but it looks like that's QSEHRA's descendant! I'll read into it, thanks!!

 

[jwesley]

@munyaku Of course. ICHRA hit the market i think a year or 2 ago so its fairly new. I believe about 100 or so of the clients at the company I work for use it. Would seem like something that applies to a smaller company like this one.

 

[needmorejesus]

@happilyretired Can you afford the deductibles? Could you write a check for them today with no pain? If so, get the gold plan after you make sure your preferred hospitals are in network. If you can't afford your deductible, then go to the marketplace. And get a decent dental plan that your dentist accepts. If they are available, get a short term disability (maybe your job funds this?) and long term disability policy.

 

[munyaku]

@needmorejesus

If you can't afford your deductible, then go to the marketplace

Uhh, you will not find a marketplace plan with a $1200 deductible for $47/paycheck or ~$101 per month. If they can't afford the $1200 deductible why would you recommend a marketplace plan that will be more expensive with an even higher deductible? I'm not clear why that would help OP.

 

[needmorejesus]

@munyaku It depends on if the hospital(s) and the providers accept that plan, right? She has no prescription coverage, which is why the plan is so affordable.

 

[resjudicata]

@needmorejesus Why are you thinking she has no prescription coverage? Having to pay for prescriptions is common even with some coverage.

 

[munyaku]

@needmorejesus Why do you think there is no prescription coverage? Prescription benefits are an essential health benefit and on HDHP plans, the Rx is commonly tied into major medical. If it's combined, you won't see it separated out into tiers of coverage like some other plans may state, as it'll be subject to the deductible. No sane employer in 2020 would offer non-ACA compliant coverage if they have over 50 employees.