Selecting next year’s health insurance plan.

[Knee Deep in Water Chloe]

A year ago, we changed employers. The new employers did not provide as much toward the insurance premiums. I panicked at a few hundred dollars coming out of our paychecks and selected a lower health insurance plan. I (stupidly) didn’t realize the difference in the prescription benefits. Here’s what I’m thinking about for this year’s plan. What am I missing?

[busymom]

This is difficult for me to navigate, just because I know personally there are so many "levels" of medications.  For example, DS is taking a newer one that is seriously expensive.  


My best suggestion is talk directly to your regular pharmacy and see if they can tell you what you'd be paying if you switched to the better coverage.  That should help you make the decision.


Whatever you decide, best wishes!  The current healthcare system makes it almost impossible to make the "perfect" decision, because there are always exceptions on, for example, medical testing & coverage.

[giramomma]

I would go back to plan 2. Even though I can't really math it out.

I think health insurance plans is one area I'm willing to pay more on.

Mostly, because I'm not disciplined enough to save the difference and put it towards medical costs.

It's not quite the same, but our family HDHP plan was $87 a month. Our PPO insurance was 230.

We did put the difference in an HSA. Plus I got a 1500 contribution from my employer.  While on the HDHP, I blew through about 4500 for prenatal care and delivery of the missy. I'm guessing that was about 10% of the cost.

When I had cancer, I was back on my normal plan. I had a hair under 1K in bills. Which represented less than 1% of the negotiated cost for all of my treatment. The negotiated cost for my radiation was something like 50K alone.

And of that 1K, half of it was for my port getting inserted and removed.

[wvugurl26]

I agree with Gira that it's one area I'm willing to pay more for. My plan has gotten obscenely expensive. Like $320/month for single coverage. Every year I price it out and shop plans. And every year the math says I would owe any and all premium savings to Walgreens.

Additionally we have a very decent income. The money towards health premiums isn't taxed. So I'd owe taxes on the portion that I saved and I would owe a big chunk each month to Walgreens.

Last year I started with DH's plan for my comparison. My daily asthma inhaler required pre-authorization which is not guaranteed. Cash price is $450.

Even with comparison tools, it's a hard thing to shop for. I used to select my grandma's Part D plan. I put in her drugs, 90 day supply pick up at the retail pharmacy and I swear the math never came out like the plan finder said.

[resolution]

It doesn't look like much of a difference between plans 2 and 3 if you max out the family deductible. One has a deductible that is $1200 higher and the other has premiums that are $1200 higher. So six of one, half a dozen of the other.

If you typically have only one person maxing out their deductible, then plan 3 may save you a small amount, but not much in the overall picture.

[minnesotapaintlady]

When the benefits are different between plans it really murks the waters.  Our plans have the exact same benefits, only the deductibles and max OOP numbers are different. 

If you have a known high cost prescription it sure seems like plans 1-3 would be a better choice.

[minnesotapaintlady]

Aug 14, 2023 6:37:46 GMT -5 giramomma said:

I would go back to plan 2. Even though I can't really math it out.

I think health insurance plans is one area I'm willing to pay more on.

Mostly, because I'm not disciplined enough to save the difference and put it towards medical costs.

It's not quite the same, but our family HDHP plan was $87 a month. Our PPO insurance was 230.

We did put the difference in an HSA. Plus I got a 1500 contribution from my employer.  While on the HDHP, I blew through about 4500 for prenatal care and delivery of the missy. I'm guessing that was about 10% of the cost.

When I had cancer, I was back on my normal plan. I had a hair under 1K in bills. Which represented less than 1% of the negotiated cost for all of my treatment. The negotiated cost for my radiation was something like 50K alone.

And of that 1K, half of it was for my port getting inserted and removed.

But, you really need to add $3216 to the $1000 in the second scenario to account for the difference in premiums and the HSA contribution, so really the OOP was about the same in both cases.