Health insurance

In My Humble Opinion
1

Well, it’s time for the annual premium increase. (For me, and I’m single, $143/month to either $160/month or $162/month.) We can vote for one of two plans, and everyone will be in the plan that receives the most votes. There are about 19 or 20 people in the office.

Plan A costs $160/month. It has a $500 deducible, a $5 co-pay on medication, and a $2,000 maximum out-of-pocket cap. It pays 80% for ‘preferred’ doctors, 60% for ‘in network’, and 60% out-of-network.

Plan B costs $162/month. It has a $300 deductible, a $10 co-pay on medication, and no cap on out-of-pocket expenses. (I don’t have the memo here, so I don’t know about an in-network cap; but ISTR that there wasn’t one.) It pays 80% for ‘preferred’ doctors, 60% for ‘in network’, and 60% out-of-network. It includes $20,000 life insurance.

I’m not the youngest person in the office, but I’m toward the lower end. Our president started with the company when I was starting kindergarten. Still, I’m not as young as I used to be and I can foresee a time when I have to worry more about illness more than injury. For now though, I tend to think of being injured as my greatest risk. I spend a lot of time on the freeway, and I’ve seen some real boneheads out on the road. It’s too far, too wet, and too cold most of the year to commute on my motorcycle, but I ride it recreationally. Wet roads and fallen leaves increase the risk of a crash. I’ve been thinking of getting some cross-country skis for the Winter. I’ve not fully recovered from my high-school skiing injury, nor the car crash a year after that. Bad knees increase the chances of skiing injuries, though cross-country should be less risky than alpine skiing.

I went to the doctor once two years ago for laryngitis. I’ll catch a cold occasionally, or even the flu. No need to visit a doctor for those. My last serious condition was in 2000 or 2001 when I had a cyst removed from my back. Generally, I’m pretty healthy.

So which is the better plan for me? My first thought is that a serious injury would cost a lot more than $2,000, so Plan A would be better for me. On the other hand, Plan B has a lower deductible that might be better if I get sick. I don’t have a family, other than my sister, so the life insurance doesn’t really matter to me. The president didn’t notice the lack of an OOP cap on Plan B, and will check on it.

I know the plan I’t like to have, but we don’t have it in this country.

2

Man, I would kill for those options. I have no access to insurance at any price in the USA because of a pre-existing condition and I own the company I work for (which does not qualify for a group plan).

My UK based insurance costs me $220/mo with a $1500 deductible… valid everywhere in the world except the USA.

I’d take option A.

Must be nice.

3

That should have read annual out-of-pocket cap.

4

I would say Plan A since it has a cap on your out of pocket expenses.

5

That’s the main attraction of Plan A. The lower deducible of Plan B means that it would cost me less if I became sick enough to require multiple doctor visits. But the apparent lack of an OOP cap is scary. When I bought my house I chose a 30-year fixed rate instead of the lower adjustable rate, since I didn’t know how high an adjustable rate might rise.

6

As a fellow rider, I’d say your cycle poses a greater than than getting sick, so I vote for Plan A.

7

Cap your out of pocket expenses. Seriously. I am not joking. Screw the lower deductible. Unless, of course, you can pay 20% of $100,000 or $500,000 or $1,000,000 with no problem.

At best you’d be paying 20% for an accident/injury, but it looks like Plan B saddles you with 40% of out-of-network… and if you get pulled into a hospital by an ER I guarantee at least a few of the people touching your case will be out of network. You will have no control over out-of-network people working on you, particularly at first, but you will still be expected to pay those bills.

They’re trying to entice you with that lower deductible but it’s not worth it. Anything that lands you in the hospital with no out of pocket cap will definitely cost more than $2,000 whether it’s injury or illness.

8

Definitely the one with the cap.

9

Do you have any reason to believe that, if you were in a car accident, your health insurer wouldn’t try to force your or the other person’s auto insurer to be primary on medical costs? Don’t put too much weight on the likelihood of a car accident if they’re going to avoid paying for it anyway.

10

A car crash is just an example that anyone can relate to. My point was only that I’m more likely to be injured in some way than to suffer illnesses.

11

Not if you really try :smiley: Vive le telemark!

12

But for your purposes the distinction in immaterial. Either one could easily cost you tens of thousands of dollars. Hundreds of thousands is not to be ruled out. You need to cap your out of pocket costs.

13

That’s what I was thinking.

14

Just in case anyone is wondering, we went for Plan A.


                                 OLD PLAN                         NEW PLAN
Deductibile:                        -0-                       $500/$1,500 (family)
Copay, Office/Emergency:          $15/$75              $20 Preferred)/$35 Participating
Doctor visits                     80%/50%      80% Preferred)/60% Participating/60% Non-contracted
Max. out-of-pocket:               $2,500                     $2,000/$6,000 (family)
Rx benefits:                    $10/$20/$40                      $5/$25/$50
Vision:                          Base Plan                     **-See below

Dental
Deductible:                         $50                              $50
Max. annual benefit:              $1,500                           $1,500
Prevention/Restoration/Major:  100%/80%/50%                     100%/80%/50%
** Office visits are covered at 100% after co-pay anfd the first $400 lab and outpatiend radiology covered at 100%.

The employee contribution goes up from $146.88/month to $160.14/month.