Time to pick a health care plan

Author: Ashley

13 Nov

It’s open enrollment again. We were pretty sure we weren’t going to change our plan, but my husband brought home the explanation of benefits for me to take a look at.

There are 4 different plans, and we have the cheapest one. Right now we pay $62 a paycheck (biweekly), which I don’t think is bad at all. $124 a month for health insurance for 4 people is pretty good. Our coverage is basically a $20 copay and 100% coverage for all the basic everyday stuff. Like check ups, immunizations, urgent care visits, office visits, ect. Then 60% of everything else. Two things really caught my eye here. A trip to the ER has a $50 copay and then only 60% coverage. And for maternity care they only pay 60% of the delivery. Prenatal and postnatal care is 100% covered, but the actual pushing the baby out is only covered 60%. Which I’m pretty sure both those things have changed for this year. They certainly paid for my delivery and ER trip when I was pregnant. Anyways, it has a 2 million lifetime maximum and $5,500 max out of pocket per person. The deductible is $1,000 per person/ $3,000 for the family.

There are 3 plans above this one, each one costing about $40 more a month than the previous one. They are basically the same but the more you pay the higher percentage is covered. We get 60% coverage, if we wanted to go up a step, we could get 70%. Two steps up, would get us 80%. Each step up also has a lower deductible and max out of pocket.

The best plan that is offered would cost us $179 a paycheck. We would have a $20 copay when we went to the dr, but everything that they cover is covered 100%, basically. It has a 2 million lifetime maximum benefit, $1,500 max out of pocket per person, and no deductible. Nice, I wish we could afford that.

The only thing that would make me consider switching plans would be to get more coverage for prescriptions. But all 4 options have the same coverage. We pay $10 for a month’s supply of generic meds and 25% of brand name drugs. Which for us we spend $30 a month on prescriptions. So I would be willing to up our premium if we were going to save money at the pharmacy and get some additional coverage. But since they don’t offer a better prescription plan, we won’t be switching.

So everyone… keep your fingers crossed that no one ends up in the ER.

I’m curious to know what everyone else is paying and the coverage you get.

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Filed under: insurance

6 Responses for "Time to pick a health care plan"

Slinky November 13th, 2008 at 4:39 pm 1
My plan covers preventive care and pays 80% of emergency sorts of care. Things like prescriptions and ear infections visits are paid for out of an HSA, deductible is $1250, max out of pocket is $5500 - cost per paycheck $3. I took the amount I used to pay, subtracted the cost of health and dental insurance and throw the rest in to the HSA. Very nice for someone who typically goes to the doctor every other year or so.
lawschoolmom November 13th, 2008 at 6:59 pm 2
We pay $75/mo. ($37.50/paycheck) for family health, medical, and dental coverage. We are a family of five so I think we have a great deal.

For the health plan, routine office visits and immunizations are 100% covered after we pay a $25 copay. Same coverage for specialist visits but the copay is $30. The plan then pays 90% of everything else after our annual deductible is met. The deductible is $100 per person/$400 family.

The 10% we pay is capped at $1000 per person/$3000 family so once we meet those maximums the health plan pays 100% for the remainder of the calendar year. There is no maximum lifetime benefit on how much they will pay. Prescriptions are $10 - $50.

If we had opted for the High Deductible Plan ($1400pp/$2800 family), then there would be no monthly premium.
Kristy November 14th, 2008 at 5:44 am 3
We have a high deductible HSA. We pay $380 per month, have a $20 copay and a $2,400 deductible for the family. Once we hit the deductible everything is covered 100%. Things like well-check visits are covered per the plan. A copay for specialists is $30. We also put $100 per paycheck into the Health Savings Account.

I want to add that this is a huge step up from previous years, I know it sounds high to some, however, before the high deductible plans came out we were paying $1200 per month for health care coverage. So even if we hit the deductible on this plan we are still saving money. I work for an industry that doesn’t typically contribute to health insurance, but my company pays $250 a month towards ours, not much but still something. Dh works for an even smaller company with no health care insurance. Sure we could switch jobs/careers but we probably wouldn’t make as much money so this is the health insurance that we have.
Cindy November 14th, 2008 at 9:11 am 4
I find it interesting to see what others are paying for health insurance. Our options weren’t as nice as what we have now and the top plan available for next year, cost more but gave less coverage. We are taking a bit of a gamble and taking the middle option for 2009. Our cost per week will be $15 less than this year so we’re going to put $20 a week in a HSA. Starting next year, our health insurance will be $60/month for a family of 6. There’s a $500 individual/$1500 family deductible. 80% company/20% member coinsurance, $25 pcp/$45 specialist copay, and prescriptions are a 4-tier plan with generics $5 (the one thing better than the 2008 plan). Our annual out of pocket maximum is $2500 individual/$7500 family. Routine preventive care is covered 100% after the copay. We also have dental and vision coverage for $8 more a month.
lawschoolmom November 14th, 2008 at 9:30 am 5
I just re-read my post and instead of “family health, medical, and dental” it should have read “family medical, vision, and dental.”
Budgets are Sexy November 14th, 2008 at 11:11 am 6
yeah man, all that stuff is TRICKY tricky! it’s hard sometimes to figure out what the *best* plan is before stuff happens….but i think you’re on the right track

Our company only has 1 plan, and it covers a lot (although not sure what exactly, but i will soon after our latest ER visit). it’s 100% free for us (co. pays in full), so def. no complaints at all….i’m just hoping it covers alot!