A few months ago you all chimed in on hubby’s health care options and now it’s time to tackle mine. 
Here are my two health insurance options:
Option 1 – High Deductible Plan – $1.38 per paycheck or $35.88 a year
Lifetime Max Benefit – Unlimited
Annual Deductible – $2750
Out of Pocket Maximum Excluding Deductible- $3000
Office Visit – We cover 100% until $2750, then we cover 20% up to another $3000.
Coinsurance – We cover 20%.
Hospital Visits, Etc – We cover 100% until $2750, then we cover 20% up to another $3000.
Preventative Care – They cover 100%
Medicine – I would cover 100% until we hit our deductible.
Option 2 – Base Open Access Plus – $38.31 a paycheck or $996.06 a year
Lifetime Max Benefit – Unlimited
Annual Deductible – $750
Out of Pocket Maximum Excluding Deductible- $4000
Office Visit – $25
Coinsurance – We cover 20%.
Hospital Visits, Etc – We pay 20%.
Preventative Care – 100%
Medicine – $30 for one month or $75 for 3 months.
I am personally leaning towards the second, more expensive, option simply since I don’t want to worry about the cost of every doctor’s visit and my medicine is $150 for 3 months normally…
I still pay the same for extra life insurance and disability insurance either way, so that doesn’t effect my decision at all.
What do you think? Which plan would you pick?
Well, if I had 0 health issues, I would consider option 1. However, since you are on medication and such, and option 2 seems to make you more comfortable, then I would go with option 2!
(If you think the second option will save you more than $950.00/year, then go for it!)
How often do you visit the doctor? If your medicine is the only concern, option 1 saves you money… you’re paying $150 * 4 or $600/year for your medicine, plus the $35 in premiums. In option 2, you are paying $75 *4 or $300/year for your medicine, plus the $996 premium. Option 2 costs much more!
If you visit the doctor frequently, you could easily make up the $996, making option 2 a much better plan. My husband rarely visits the doctor (maybe once a year), whereas I always have random things come up and visit the doctor (sprained ankle, sinus infections, etc). He would do well on plan 1, whereas I’d probably eat up the premium savings easily and be better on plan 2.
@Everyday Tips, it’s all about comfort levels, isn’t it?
@Valerie, I have a wellness checkup annually that would be covered 100%. Other than that, I usually have to see the doctor at least once a year for something hubby brings home from elementary school. Last year I had to go see my doctor twice.
I think the cheaper option could work for me…I just don’t want to ever say to myself, “Yeah, you feel bad, but a doctor’s visit is going to be at least $150…you’ll be fine. Suck it up.”
Your breakdown of costs looks just like the one in my notes, lol. Would you go with the cheaper option for your husband or spring for the extra peace of mind?
Based on the information here, I’d go with option two as well. Are you and your husband on separate plans though? Maybe being on the same plan in the future might be beneficial.
@Jackie, yes, we are on separate plans. I can’t add him to mine since my job doesn’t allow people that have other options.
It would cost $200 a month to add me to his and his is a high deductible plan as well ($2500 deductible, out of pocket max of $5500 I believe), they just front him $500 (which is perfect for him since he very rarely goes to a doctor anyway and that would cover 2-3 visits to our physician).
It was just cheaper for us to stay separate for now, but thanks for bringing that up! We only looked into it last night so it really is easy to forget!
I would go for the second one as well. I stuck with the cheaper HMO option and completely regretted it by how hard it was to see a doctor, etc. So now I’m all for the PPO.
If you can swing it … I’d go with option 2. But that’s just because of any unknowns that could come up. Otherwise, you’re still basically paying out of pocket until the deductible is met. ASNd that is ….. A$2750…??? A $2000 dollar amount that is cut in half by taking option 2. Assuming I’m reading it correctly.
And medicine/prescriptions “ain’t cheap” if you are buying it at full, basically uninsured and slightly discounted, retail prices. Same for the doctor visits too.
Crystal … you need to find a job at an O&G type of company, or closely related. The differences are like night and day.
One thing about “adding a spouse” or dependent to a plan is that the pre-existing condition clause usually takes up to 9 months before they will start covering anything they might bring with them to the coverage/plan. If my wife were to switch over to mine, we’d still have to pay out of pocket for 6-9 months before she would be considered “covered.” And her current plan still does pay for what she needs. Finding a good time to switch …. that’s the trick.
If one has no pre-existing conditions … great. But if you do?
I would go for option 2 then atleast you budget for the expense. Option 1 seems good but it’s the unexpected that could hurt you in the long run.
I’m I reading that correctly that you are responsible for 80% of a hospital stay?
@Ken, I was totally flipped around. We cover 20%, not the 80%. Thanks for pointing that out!
@Newlyweds on a Budget, thanks for the advice!
@thefrugalcheapskate, thanks…I’ll keep looking for better work options, lol. Yep, a $2750 deductible does seem to be a “bit” much….
I think it depends on how often you go to the doctors? Does this cover just you or you and the family?
I’d go with option 2. My family has no health issues.
We went through this a few years back and had coverage similar to option 2. My husband got a job with health benefits. We did not do the research and opted into the new coverage ($400 per month vs. $425 for the previous insurance).
With the new ‘fabulous’ insurance we ended up paying more out of pocket expenses because I didn’t take the time to understand the policy.
We’ve made some adjustments to the policy and I don’t see a doctor until I have call the insurance company first.
Go low, if anything really serious happens you’ll be covered, and assuming this year follows last year’s pattern, you’ll only pay $600 + small stuff vs. $1,200 + small stuff.
Sometimes peace of mind is worth the extra cost. It hurts a lot less to spend $38 a paycheck than it does to get sick and spend a couple hundred bucks on an office visit, blood work, medicine, etc. Even simple illnesses like strep, a uti, etc. require lab work.
Either way, it looks like you have GREAT coverage if you had to deal with a serious or chronic illness, so that is definitely something to be thankful for!
@Jenna, I go to the doctor 1-2 times a year normally and this only covers me. Mr. BFS can’t be on my policy since he has his own option and I wouldn’t get on his since it would be $200 a month. What would you do in my shoes?
@Molly, we made that mistake last year and just got REALLY lucky – we had no idea about my husband’s policy until he went to the doctor once…we were surprised there was no copay. Apparently he had $750 up front that could be used and then he had a $3000 deductible…we got so lucky that nothing bad happened while we were ignorant, lol.
@Daniel, hmmm…I didn’t think you would go that way, lol. It would just be taking a small risk on nothing big happening…maybe…
@AJ, thanks for pointing out a positive. I dislike my job so I am overlooking the good stuff…
I completely agree- I would go with option 2 as well! I like being covered.
@Mrs. Money, thanks for your vote!
For the previous 2 years, I went with an HSA. But I found that I tried to save too much money with it. So this year we are going with a normal plan.
Good luck in your decision! I hate this stuff
Based on ur situation, the 2nd plan makes the most sense. I would also take the 2nd plan as well. The 1st seems to be designed for uber health freaks that have zero health problems.. it’s a trap
Hi Crystal,
Insurance is all about risk. Thats why actuaries do all the hard math and statistics to figure out what your premiums should be.
Personally, I would go with option #1 because I am a risk taker. Plus I am in very healthy condition and never go to the doctor, and never take drugs.
So barring anything else, how much money would you save with option#1 while still taking your medicine and going to the doctor twice a year?
Now take that savings and invest it wherever you would like… That becomes your health fund to cover your deductible and more!
I don’t know all the specifics and only you can make the choice, but I would do the math, weigh the risk, and still strongly consider option #1.
Cheers,
Jeremy
@Money Reasons, yeah, I hate this stuff too…way too confusing and it’s like you need a crystal ball to make the right choice…
@Henway, it does feel a little hinky, right? I wish they’d front us the first $500 or something like my husband’s high-deductible plan…
@Jeremy, the straight up difference in cost every year would be $640 (the difference in premiums minus my extra medicine cost). That means I’ll come out ahead with the cheaper plan if I don’t need to use all of that $640 a year. My reservation is that $640 isn’t all that much money…that’s only enough to cover 3 small illnesses (like infections that require a single doctor’s visit), or 1 medium problem (a major respiratory problem due to my asthma), and totally not enough if I ever need to visit a hospital. That’s what I’m debating right now, lol.
Hi Crystal,
If we could be on separate plans, I’d probably put my husband on the cheap plan and me on the expensive plan. Unfortunately our insurance doesn’t offer a “cheap” option (there’s three plans that come in within $100 of each other, leaving not much choice).
The psychology is difficult. I know my husband in particular gripes over even the $25 co-pays, and so with a high deductible he would probably refuse to go to the doctor unless he was dying, despite the fact we were saving money overall.
The problem of predicting the future is at the heart of this. If you feel safer on the more expensive option, it’s probably worth your peace of mind.
@Valerie, I think you hit the nail on the head. I hate having to make decisions based on predictions, lol. I’d make a cruddy psychic, hahaha.
I would be more comfortable with option 2. Especially since you already pay $600/year! Add a few unknown to that number and #2 makes more sense. But I can completely understand why someone would take the risk of option 1.
Wait, I’ve read through the entire comment list and only one has mentioned of an HSA to go along with your high deductible plan. Were you presented any of the benefits of this type of account? FMF has a great section of posts on this. I think that deductible is high enough to qualify you for one as well. Your rates overall are still pretty low, mine is now $18 for a high deductible plan (that’s if you sign up for the wellness screens, $48 per pay if not).
@Khaleef, that’s the way I’m still leaning too.
@Lauren, yes, we can have an Health Savings Account if we go with the high-deductible plan. Or we can have a Flexible Spending Account if we go with the more expensive option. I can see the benefits of an HSA but don’t know if they are better than the benefits of having a $25 copay at my doctor’s…what do you think? I am lucky enough to have two semi-inexpensive options, which would you go with in that case?
Well, it just depends if you want money to grow in a tax free account for future medical expenses or not. You’re going to end up spending roughly the same amount per year no matter which plan you choose. With the HDHP you’d spend roughly $1,000 on Dr. visits (3 @ $150 ea.) and meds at $50/month, as you would in premiums on the other plan. You have the cash on hand to fully fund your deductible, and it’s money you can use five months or five years from now.
Obviously, I’m a big fan of HSAs
@Lauren, I would agree if I felt more stable right now. If I do end up taking a lower paying job, I’d rather build up our extra cash in our liquid emergency fund account than an HSA. But you make a great point, HSA’s offer long-term options for health coverage and that is a huge benefit!
That’s actually pretty amazing insurance. I paid over $300 a month for my insurance with my last job. You scored! I agree that the 2nd one leads to better coverage in case you need it.
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