My wife started a new job, and the 4 insurance plans they offer are a bit confusing

[glorydaz]

Like the title says, my wife started a new job, unfortunately they don't have an HR person yet, so no help there

We are a family of 4. I go to the doctor 4 times per year, my wife goes when she's sick, our youngest rarely goes, but my eldest is a competitive athlete and can be injured any given time.

I understand the coinsurance and copay dynamic, but what I don't understand is what is usually the best way to go. A 30% coinsurance sounds great, but I have no idea if the bill would be $10 or $10,000. I'm inclined to go with a copay which seems like the better deal.

Second is the per paycheck amounts are significantly different.

Plan 1

Plan 2

Plan 3

Plan 4

Any help is GREATLY appreciated. Thank you!

 

[jsrg]

@glorydaz Forget about no insurance for out of network. Seriously, you book a procedure and it happens that anesthesiologist or burse or someone is out of network and you are cucked. Let alone if you have an actual emergency and not a planned procedure.

You really only have plan 1 and 2 to compare.

 

[heyyoo]

@jsrg The no surprises act change this, you just have to make sure the main doctor/surgereon and the location are in network....they legally can't fuck you with a out of network nurse or anesthesiologist anymore lol

 

[jsrg]

@heyyoo Legally vs practically. Yes Legally they cannot do this. Practically they can make it a fucking nightmare to resolve.

 

[zeezaa1]

@jsrg With a $60k oop max it’s almost like none of the plans cover out of network.

 

[jsrg]

@zeezaa1 60k is nothing if it comes to catastrophic sudden hospitalization.

Yes all the plans are terrible. But 60k max out of pocket is just objectively better than no coverage.

 

[zeezaa1]

@jsrg I’m not sure it is. It could be $60k or $600k. Either way most people are not writing that check.

 

[jsrg]

@zeezaa1 TRue but you can negotiate 60 k to 10% ie 6k and negotiation 10% of 600k is 60k.

I know which one of these I want to negotiate.

 

[llk68]

@glorydaz Plans 1 and 2 are “open” networks which allow you to go to out of network doctors. They also have the lowest out of pocket maximums. However, they are also extremely expensive (cost per paycheck at bottom of page). Plans 3 and 4 are “closed” networks which do not allow you to go out of network. They also have the highest out of pocket maximums. They are also the cheapest.

I would recommend looking at the cost per paycheck and also looking at the out of pocket maximum per individual. Think about your child who MAY get injured playing sports each year. Can you afford to spend that out of pocket maximum each year vs. can you afford the cost of the insurance coming out of each paycheck during each pay period? That calculation may help you decide.

PS: Google “surprise bill” protections should you accidentally/unknowingly see a doctor outside your network at any given time. These protections are there for you should you choose a “closed” network.

These are not easy choices families need to make each year. Hope all works out for you and your family!

 

[believeall]

@llk68 Similarly—if your child is injured playing their sport, do the doctors you’d want to take them to take this insurance/any insurance? Might help with the open networks question.

 

[nae64]

@glorydaz Is the pay period every two weeks? Or monthly? I’m going to assume monthly.

Plan 1 yearly cost - $3,641.6
Deductible - $5,500
Coinsurance - 30%

Plan 2 yearly cost - $3,250.56
Deductible - $7000
Coinsurance - 0%

Either one of these plans would be reasonable. Plan 2 has no coinsurance after deductible is met so that is pretty great if you ever need surgeries or imaging done.

 

[glorydaz]

@nae64 No, it's a per paycheck deduction. Every 2 weeks

 

[kutiekitty]

@glorydaz Agreed but without a heath savings plan your insurance will not kick in until your deductible is paid so choose wisely and check and see if you have a pharmacy deductible. The FSA or HSA are usually available when you have high deductible plans .

 

[seen121]

@glorydaz I would go with Plan 2 if I had concerns over a child at risk for potential surgeries.

Look at the surgical and medical testing for plan 1. You are looking at 30% after deductible for all 4. So for a $10000 bill after reaching deductible. You pay $3000. Child has a testing and a surgery for $10,000. You pay $3000. Until you reach your OOP max you continue to pay.

Whereas once you reach $3500 in plan 2's deductible you have 0% co-insurance. So if you hit your deductible you can get a CT and it's covered. Yes the OOP max is more and so is deductible but if you're worried over the very real potential of a large medical bill you want to strongly consider if saving $1500 in deductible is worthy paying 30% with CTs in coinsurance until reaching your out of pocket max.

You should always have out of network coverage whenever possible so I would disregard plans 3 and 4.

Anyway that is my thought and should be taken as a thought. You have to do what's right for your situation and balance what you can afford to pay with the amount of risk you potentially might incur.

 

[_marc97]

@glorydaz None of these plans are good. Start looking for another job and ask for detailed information on medical before accepting an offer.

 

[sheisme55t]

@glorydaz So, without knowing if any plans are HSA (and my guess is that plan 3/4 are HSA where the company makes a contribution to reduce high deductible and employee can make contributions that are pre-taxed as well, then that money is used to pay medical costs.), if you add together yrly premium cost and single or family deductible plan 1 edges out the others because pcp/specialist/urgent care don't apply to deductible.

Keep in mind premiums paid will reduce your taxable income overall.

I think getting info on the HSA will help guide your decision.

 

[kutiekitty]

@glorydaz The deductible is crazy. Can you do a FSA or HSA otherwise the insurance is useless. I have never had insurance with more than a 500 deductible and no deductible for pharmacy. The deductible is what you look at first the. The co pay and coverage limits .

 

[glorydaz]

@kutiekitty Honestly, I have no idea what FSA or HSA are.

Edit. Oh wait, yeah, I know what those are.

I think I would still need insurance because at any point my eldest could tear an ACL, or tear a groin (again) which is a significant expense. I know the deductibles are high, but the insurance we have through my company is even higher with a more expensive premium. Unfortunately, I don't know enough about insurance to figure anything else out.

 

[yabu]

@kutiekitty wow yes those are high.

 

[boozle]

@glorydaz Overall for your situation, Plan 2 seems the safest bet. If a sports injury requires surgery, you are going to have to meet a high deductible and OOP max with any of these plans. But at least Plan 2 caps further spending after a point, whereas Plan 1 continues to hit you with % copays. I would discard Plans 3 & 4 altogether since Out-of-Network coverage is very limited to none.

None of these plans is especially good coverage. The premiums are high for what you're getting, and the deductibles and OOP maximums are very steep. But, with a family, it's important that you protect yourself because with kids, especially, one serious injury can run you into tens of thousands.

Some have suggested HSA or FSA accounts. I don't know the rules on that, whether you can have both, or even if you can afford both? If so, look into that. Otherwise, you might want to see if your child's school or athletic league offers any kind of supplemental coverage for a small cost, which is likely accidental injury coverage only, relative to your child's participation in sports. If it can be had & it's cheap, that's something to consider as a way to potentially offset a high dollar deductible.