Is the higher premium worth it?

[earnestq]

I deleted my most recent post, I wrote it while freaking out in the bathroom I wanted to write something more coherent

I signed up for a job based healthcare plan, and I found out today (3 days before the enrollment deadline) that the amount listed is not a monthly cost, but is taken out per paycheck.

I am a 24 year old man working full time for $18/hour in Central Florida.

I have to see a psychiatrist for medications, and I'm on Hormone Replacement Therapy so I have bloodwork done every 3 months. I have sleep apnea, I'm currently renting a machine with my current insurance. I'd like to get surgery this year, but it is something that can wait.

These are the two cheapest options offered by my job:

UnitedHealth High Deductible ($90.61 per paycheck): https://drive.google.com/file/d/1kKkSNtPI4bwd9n3Szvx80OAqo_g8nZQk/view

UnitedHealth Surest ($129.36 per paycheck):
https://drive.google.com/file/d/1C5FJ9YZHRQERH3057eQCVmd_ivF_gwR1/view

I'm not sure if the price difference for the more expensive one is worth it. I'm not sure if either plan is worth it, but the idea of having no coverage makes me nervous.

Based on y'all's knowledge and experience, is either one of the plans worth it? I'm not sure if it would be cheaper to pocket the money instead and pay out of pocket (minus the surgery obviously but as I said, does not need to be done this year)

Edit: the High Deductible plan is HSA eligible, there are more details in this link: https://drive.google.com/file/d/1_NUBAC0dNHDZwIS582JoK-2p28etHubT/view

 

[redponydriver]

@earnestq Generally it is costs less to go on a High Deductible plan (lower premiums but higher deductible that you must meet until the plan pays for anything other than preventative care) but it doesn’t make sense here.

The high deductible plan would cost $2356 in premiums (assuming 26 pay periods) and you would have to cover the first $5000 in expenses before they would cover anything (again, routine preventative care such as an annual physical is covered at no cost).

The Surest plan would run you $3285 in premiums but there is $0 deductible so you would only pay the copay amount for in-network visits. This one has a higher out of pocket max but hopefully you don’t come anywhere close to reaching that if you are staying in network.

You need to check if your doctors are in network and medications are covered under each of the plans.

 

[earnestq]

@redponydriver That's a good point, I'm worried that anything I would save by switching to the high deductible plan's premium would just go to the uncovered medical costs

 

[ayleeann]

@earnestq Is the High deductible plan HSA eligible? Does your employer offer an HSA? Does the employer contribute to it? That could make that plan more favorable.

 

[earnestq]

@ayleeann Oh I didn't think to include that, yes it is HSA eligible

 

[driftless]

@earnestq Insurance isn't really for the small costs. It's more for if you get into a car accident and end up in the ICU for six weeks, or if you're diagnosed with cancer and you need several rounds of chemotherapy. I would never recommend that anyone just skip it and pocket the money, even a 24-year-old. In my brief experience with an HDHP, I did not like it, and in retrospect, I wish I had just paid for the slightly more expensive PPO. (We never came close to the deductible, and I did not like having to pay hundreds of dollars when I needed a shoulder X-Ray.) Definitely make sure that these plans cover your medications and psychiatry visits, however.

Two other things I want to point out. First, at age 24, you're still allowed to be covered under your parents' insurance. If that's an option, you might want to consider continuing coverage under their insurance plan. Second, both these documents you linked have "Coverage for: Family" at the top right corner, and I wanted to make sure that you've actually elected for individual coverage (if that's what you need) and not family coverage (which could be more expensive).

 

[earnestq]

@driftless I'm trying to see, my dad is on a marketplace plan and from what I see I'm only allowed to be on it if I'm a dependent of his (which I'm not). I'm also worried that since my job makes me ineligible for the ACA tax credits, that my dad would end up having to pay the credit back if I'm found ineligible

The document linked is the only document they gave me I know the amount I'd have to pay would be higher if I added someone onto it

 

[driftless]

@earnestq You don’t need to be a tax dependent to be on your parents’ plan. You can even be married and have access to your own health care and still be carried by your parents until age 26.

https://www.healthcare.gov/young-adults/children-under-26/

 

[earnestq]

@driftless I found out through this subreddit, I thought I had to he a dependent without job-related healthcare

I'm gonna give the marketplace a call and try to get re-added

 

[jennyj]

@driftless There are small costs? You make a point, you really do, but unfortunately, the point is, if I I'm ever sick enough to really need the insurance, I'll lose my job anyway and I won't have insurance. (Sorry for the irony.)

 

[driftless]

@jennyj There’s a lot of middle ground between “getting in a car accident and needing surgery to repair a shattered tibia” (very expensive but not catastrophic) and “losing your job forever.”

I will never advise someone to skip health insurance altogether.

 

[jennyj]

@driftless I agree. Even though I believe in my precept, I still get the insurance. I was self employed all of my adult life, or most of it, until high speed internet came along and my career changed. And that was without health insurance, even though I wanted to have it, I had a pre-existing stomach disorder. So I'll never go without if I have the option. At least it limits what they can charge you in certain cases.

 

[juie]

@earnestq You don’t have a deductible on the second one so yea, absolutely.

 

[earnestq]

@juie That's fair! It's an extra $40 per paycheck which sucks but the no deductible is nice

 

[sawco]

@earnestq Look into surest before you take it. It is very specific in who you are allowed to see and the rates/who they cover changes with no notice. A copay for my PCP would be $90 a and my kids would have been $60 each. It just seemed really inconsistent and expensive for our families medical needs on top of the $400+/check premium.

This was a post I read that helped seal the deal for me choosing another plan; https://www.reddit.com/r/HealthInsurance/s/yMCmObctIt

Also your employer should have a code for you to use on the surest website that will let you check copay/in network info but it can change at a moments notice from what I read so take it with a grain of salt. If your employer doesn't offer a code I think you can call surest and they can help you with it.

 

[earnestq]

@sawco My employer gave me a code, it seems like most things I need would be covered. My pcp copay would be $70 which isn't ideal
I don't love the plan, but it's either the Surest plan or the high deductible plan (There's a third plan offered by my job, a buy up plan, but that's $400 a month and does not seem good)

 

[jjsu1991]

@earnestq You can usually only get an HSA with a high deducible plan, but you can take that with you when you leave a company, and at a certain point it can be used for investments.

 

[oupajoe]

@earnestq I look at network and freedom first. The less precert requirements the better and narrow networks means limited access.

Next is maximum out of pocket. Plan on paying your incidentals yourself. HSAs are preferred because the tax benefits and lower price usually make them the cheapest way to buy healthcare.

Look at 2 plans in the same network. The difference in out of pocket is how much more insurance you buy for increased premium.

Answer the question "is it worth it to you ". Once you choose plan a or b, compare that plan with the next. Choose again. Once a plan is out, leave it out. Don't bring it back.

You may not like the result but you have the best choice out of what's available.