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Private Health Insurance Update – Need to Choose by February

I can’t believe it’s been almost a year since I’ve tackled the private health insurance issue, but I just received a letter letting me know of my new premium choices for February 2013, so it’s time to play the game again.  We will probably be paying more.  The question is how much more and what are we willing to sacrifice.

Current Policy with Celtic

  • $5000 annual family deductible
  • $4500 additional family annual coinsurance maximum ($9500 a year maximum out of pocket)
  • 20% coinsurance
  • Two $35 doctor’s visits per year and the 20% coinsurance thereafter.  I asked my doctor’s assistant about regular costs of visits – they would range from $80 for a sore throat to $200 if some tests needed to be ran for an infection.
  • Our total cost is now $310 per month.  It will rise to $461.64 per month.

New Policy Option from Celtic

  • $10,000 annual family deductible
  • $6000 additional family annual coinsurance maximum ($16,000 a year maximum out of pocket)
  • 20% coinsurance
  • Two $35 doctor’s visits per year and the 20% coinsurance thereafter.
  • Total would be $357.24 a month.

New Policy Options from Others

Cigna TX Open Access 5000/80%

  • $10,000 annual family deductible
  • $10,000 additional family annual coinsurance maximum ($20,000 a year maximum out of pocket)
  • 20% coinsurance
  • All doctor’s visits $30, no max.
  • Better RX rates.
  • Total cost would be about $300 per month.

Cigna TX Open Access Value 2500/70%

  • $5000 annual family deductible
  • $10,000 additional family annual coinsurance maximum ($15,000 a year maximum out of pocket)
  • 30% coinsurance
  • All doctor’s visits $40, no max.
  • Better RX rates.
  • Total cost would be about $320 per month.

Cigna TX Health Savings 5000 (aka Emergency Plan Only)

  • $10,000 annual family deductible
  • $0 additional family annual coinsurance maximum ($10,000 a year maximum out of pocket)
  • 0% coinsurance AFTER deductible
  • $0 copay AFTER deductible.
  • Total cost would be about $245 per month.

Which Way I Am Leaning

Honestly, I am leaning towards the Emergency Plan (Cigna TX Health Savings 5000).  Seriously, every insurance company and plan seems to suck.  If I just pay cash for everything, I can probably keep our costs to $2000 a year or less for doctor’s office visits and prescriptions.  Plus we each would get a full physical/wellness check once a year for free with any of these plans anyway.  So paying about $3000 a year for a policy that generally just covers us after $10,000 is annoying but at least we’d be protected if we broke a bone or had a big accident or whatnot.

But I have not come close at all to making up my mind.  I’m also wondering about new policy from Celtic or the Cigna TX Open Access Value 2500/70%…

Which plan would you choose?  Any suggestions?

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10 comments to Private Health Insurance Update – Need to Choose by February

  • MikeS

    I would say I’m torn between CIGNA 5000 and the CIGNA Health Savings. Not having 2 kids and a decent emergency fund, I would probably go the Emergency Plan route.

    Just to give you an idea of what a broken ankle would be without insurance, the total cost was about $3,500 including the physical therapy. That was the gross cost, not what the insurance company had negotiated for rates. So, something like that won’t break the bank for you.

    Only other thing I would check is make sure there are not lifetime maximums. Just in case a severe illness should occur, you don’t want to have to worry about exhausting your coverage down the road.

  • I’d probably lean the same way. You can take the $70 per month in your savings and stock it up in a health fund that will cover at least your first $840 of costs next year.

  • Check out Texas Cattle Ranchers Association, they offer group rates to individuals and families as well as policies for businesses. It is Texas based but you do not have to live in Texas (you do so it really won’t matter).

    It is underwritten by Blue Cross Blue Shield, I have no basis for comparing their policies with what you are looking at, I know they had great coverage for reasonable prices though it is worth checking out Texas Cattle Ranchers Association

  • It is a personal choice based on your history and what you expect to happen next year. I might widen your choices by checking out Jay’s suggestion. Anytime you can join a group, it is bound to be better if not cheaper for the same coverage.

  • I’m not eligible for insurance at my new job until March. In the meantime, we picked up a Medica policy. It’s got a $10000 deductible, but also allows unlimited office visits. For the 5 of us, it’s $422/month.

  • I woud choose Open Access out of all of these plans, but for me, health insurance is a must. I can’t imagine having a plan that wouldn’t cover at least a little of prescriptions. But if you only need emergency coverage, the plan you chose would be the way to go.

  • retired

    We went with Aetna’s version of the emergency, high deductible plan through the company from which my husband retired. The premiums were so low, that I broke my ankle bones (compound fractures from biking accident), went into surgery, physical therapy, then removal of the hardware in the same year; and we still did not exhaust the amount we had saved by going the high deductible route. We received the free checkups, vision checkups were covered almost 100%, and we used their negotiated rates with the hospitals and doctors. We did not even meet the max for the year despite three other emergency room visits and two ambulance rides. But we have very few medical problems usually. That year was a rough year. This year we had no out of pocket expenses except for 2 doctors visits at about $100. So we using the high deductible plan for fourth year in a row. So far I think we are almost $7K ahead in the premiums we would have paid with any other plan, over the past 3 year period. We have 60 yr old male, 54 year old female and two dependent children (16, 21). We get the negotiated rate for prescriptions, with the ability to use their mail in pharmacy too. Yes, this is a good rate from a good group retirement plan; but earlier in our careers we used a high deductible plan and still came out $1200/year ahead of paying the higher premiums. You do have to be more proactive with your health and just don’t worry about flu and colds. It’s not like doctors can help much with them anyways. You might check out a few more companies. And see if you can compare their negotiated rates. Aetna is very tight with their rates and it makes a big difference on how much we pay, best rates are from those in their network.

  • Crystal, are any of these HSA plans? You will end up saving 35% or whatever your tax rate is of that $2000/yr. I love my HSA and it has allowed us to do some pretty creative things at tax time. Last year it saved us about $2K in taxes!

  • @MikeS, yep, none of these have lifetime maximums thankfully. :-)

    @Money Beagle, that’s what I’m thinking…

    @Jay, I will look into that next week, thanks!

    @krantcents, thanks!

    @Jason, not bad!

    @Christa, thanks for chiming in!

    @retired, yeah, I’ll have to look into a bunch of other options that got emailed to me…we may actually get a good deal yet. :-)

    @Kim, one is I believe. If we go with an HSA, we will definitely use it. :-)

  • Crystal,

    Good luck with all of this! I would say go with the highest deductible plan IF you are able to put the difference in a savings account just in case.

    I am so jealous; The best plan we can find in NJ is $1500 a month! If anyone can help me find something better for a family of 4 I would be eternally grateful!

    Great post!