Health Insurance Comparisons

[vanpotheos]

Hello,

I’m a bit of a novice when it comes to health insurance details. I have two job offers of similar amounts, so benefits might be the tie breaker. Could any experts please take a look at these two plans and provide any advice?

Details: Family plan (spouse and one dependent). All relatively healthy, just annual checkups and a few medications. That being said, planning to have another baby soon.

Job 1:

https://drive.google.com/file/d/1YLc5lAEBl8GoNtyGQZEaUMNvXZuXUjqf/view?usp=drivesdk

https://drive.google.com/file/d/1cgv4JjZjYXroDYQca9zuHF0UcjW4oFSv/view?usp=drivesdk

https://drive.google.com/file/d/1ggn0esH4RsHqBoi09pCvA3koa_vJEhBb/view?usp=drivesdk

Job 2:

https://drive.google.com/file/d/1AjbS8P9g5P1wE8-Jprm6Nn4G3MmNWbLH/view?usp=drivesdk

https://drive.google.com/file/d/1H_nblNB6RamCr78CxIwGtVFgkFWDs-5Y/view?usp=drivesdk

https://drive.google.com/file/d/1pEpbJIZYpWAgvCq45n_FzdxBHWu1FNnA/view?usp=drivesdk

 

[foreverthankful]

@vanpotheos Are we looking for the best financial deal?

Two ways to look at it:

1. First method is adding the deductible to the annual premiums and then subtracting any EMPLOYER contributions to an HSA, FSA or HRA. This will give you the max financial liability for all in-network, medically necessary and non-excluded care. Should you have an "oh shit" year- high utilization, chronic illness, a surgery, a birth, etc. The LOWEST total is the most financially sound offer.
2. if you want to know which plan is best for your "normal" needs (a non "oh shit" year)- you'll have to spreadsheet that out. Total number of doctor visits, total prescriptions (what tier they are), and figure out the cost under each plan.

 

[vanpotheos]

@foreverthankful Thanks for this info. I’ll crunch some numbers. One thing I’m confused about is the plan that has a $0 deductible but $7,000 out of pocket maximum. What does that look like in reality? Say I have a $10,000 hospital visit.

 

[parousia1]

@vanpotheos If the contracted rate is 10k you would pay the 500 copay and the coinsurance (I think I saw 80%) so it would be 2400 patient responsibility. Basically you pay whatever your portion is based on the benefit and after the 7k is met, insurance will pay 100% on in network services

 

[foreverthankful]

@vanpotheos So- a zero dollar deductible, just means you don't have to meet a deductible before you start the coinsurance.

So, based on your plan document posted---

If it was a $10,000 ER visit that was a true emergency- that benefit is showing that you'd pay a $200 copay and then the rest would be picked up by insurance. If you end up being admitted over night, the $200 copay would be waived. You'd owe nothing. If it was a non-emergency situation (let's say you sprained your ankle) you'd owe a $200 copay and then 50% of that bill- insurance would pick up the other 50%. (assuming you have not accumulated the $7000 out of pocket max). If you accumulated HALF of that out of pocket max already, you'd only owe $3500 for the visit.

If it was a $10,000 inpatient or outpatient planned surgery, you'd owe a $500 copay, and then 20% of the bill (insurance would pick up 80%) Again, this assumes you'd not yet met your out of pocket max.

The out of pocket Max is the most you will pay for Medically Necessary, non-excluded, in-network care for your entire family for the entire plan year. After you meet the $7000- whether it's a bunch of doctor visits, a surgery, prescriptions, or any combination of care, anything else is free.