Welp, it’s that time. Johnny and I are choosing new health insurance. For multiple reasons — okay, mostly because of the Affordable Care Act — our current health insurance has gone up in price and is now too expensive, and so Johnny’s company is dropping it and opting for different options. And they’re doing it through a small employer exchange. That means that we’re given a list of providers and plans in a certain price range, and we get to choose the one that fits us best. And so the last few nights Johnny and I have have lived up to our “wild and crazy” reputation by poring over printouts, comparing different providers, benefits, and costs. If you’re a little rusty on insurance terms (like we were), here’s a little cheat sheet I made a while back.
Johnny narrowed it down to three, and we’ve been crunching the numbers since. So here are some of the big questions we’ve been asking, in order of importance:
- What’s the deductible?
- What’s the total out-of-pocket maximum over the course of a year?
- Are our current doctors in network with this insurance plan?
- How much would it cost to have a baby with this plan? (It never hurts to plan for the potential future, right?)
- What’s the monthly premium? (This question would be higher up, but the monthly premium will be mostly covered by Johnny’s insurance allowance provided by his employer.)
The three plans we narrowed it down to are as follows:
- Individual deductible: $250 (Once the deductible is hit, insurance then covers 80% and we cover 20% of all costs until the out-of-pocket maximum is met for the year.)
- Out-of-pocket individual max: $5,000
- Out-of-pocket family max: $10,000 (e.g., If all three of us had an emergency surgery, we’d only owe $10k total, rather than $5k per person.)
- Individual Deductible: $1,000 (Similar to Plan A, once the deductible is reached, we would pay 20% co-insurance on all covered costs until the out-of-pocket max is met.)
- Out-of-pocket individual max: $4,000
- Out-of-pocket family max: $8,000
Plan C (HSA Plan)
- Family deductible: $7,000
- Out-of-pocket individual max: N/A
- Out-of-pocket family max: $7,000 (So once the $7,000 deductible is reached, we wouldn’t owe another dime for any covered healthcare expenses.)
- Along with this plan, we’d get a $250 allowance to put toward our HSA each month.
For all of these plans, the monthly premium would be covered (yay!). So we’re not currently considering that into our choice. What would you choose? After pecking around on our phone calculators for a while and talking it over and over, we’ve decided to go with Plan A.
I think each choice would be a good one, but for our needs, Plan A seems to fit the bill. It’s hard to predict our medical future, but we’re hoping for another kiddo sometime in the next year-ish. And so while we love the idea of another tax-advantaged savings/retirement account with the HSA option (plus free cash from Johnny’s employer), the $7000 deductible is pretty steep when you figure a typical pregnancy runs at minimum $7,000 (barring any complications). Meanwhile, Plan A would only cost the $250 deductible and 20% of all hospital costs, totaling somewhere in the ballpark of $1,400 to $2,000 with a maximum cost of $5,000.
If you were us, which plan would you pick? What changes have you seen with your insurance this year because of the Affordable Care Act?