Health Insurance Questions

jjbmstinco

Hello!

I am just wondering which plan is better. I posted my budget a few months back and it helped so much. Also because of you all, we got retirement funds up and running!  Now we are moving onto a new money issue in our live.   Any help is appreciated.  We are currently TTC.  Plan A- this is the one I am on now, but now I am wondering if I should change to plan B.  My boss said it was cheaper to have a baby on plan B.

Plan A-at zero cost to me

2500 deductible-your co pay is part of this as well, I think

4500 annual out of pocket

80-coverage by them, 20 by me

30 co pay

labs-covered 100%

Plan B- 129.95/month out of my paycheck- this = 1559.40 a year

1500 deductible - you co pay does not count towards this

1500 annual out of pocket

100% after deductible

25 co pay

labs-covered 100%

Which is the better cost?  I have no idea what it costs to have a baby.   I almost never meet my deductible, but I have never had to get anything other than preventive care.  

I think I have time to change, but I am not sure. Coverage is July 1-July 1.   

Do I have to pay my dr. co pay each visit during pregnancy, because I would assume I would want that to count towards my deductible.  

Prescription is the same for both plan.

Thanks in advance!

hoffse

Plan B is better by a couple grand, according to my calculations.  I haven't had kids, but I would assume you will max out your deductibles and out-of-pocket when having a baby.  Plan A has you paying $7,000 (plus 20% of everything left).  Plan B has you paying $4,559.40 with $0 after you hit that amount.

Co-pays are relatively small.  Even if you go to the doctor a lot during baby's first year, it's really unlikely that you would wind up making up that difference.

You also might want to see if the health insurance premium is deductible.  I know mine is - so it's pre-tax and actually doesn't "cost" as much as it seems.

I would sign up for Plan B for your pregnancy and through at least the first two years of baby's life.  Then maybe look at your costs and consider whether it's more cost-effective to switch back to Plan A.  That's something to determine at a later date.

I'll let the moms chime in with more info on specific costs.  I have no experience with this, so take my suggestions with a grain of salt.  They will know more than me about this!

formerlyGDaisy09

Are the copays $$ or %%? 

Do you have either of the annual maximums in an e-fund(factoring in the additional monthly cost of Plan ?

in plan-B, is there a coverage breakdown?

most preventative care should be free. I *Believe* that most pregnancies are "bundled" now as one event....so there may not be co-pays for prenatal care anyways? I just did a project in OB/GYN at my hospital and the only payment structure mentioned was bundled payments. 

It seems odd to me that the insurance year is July to July? I thought everywhere did open enrollment in the fall and insurance plans ran on the calendar year? 

jjbmstinco

Just looking at the paperwork, it says the premium is 129.95 a month out of my paycheck.

I just would hate to sign up for a plan and not get pg right away. We have been trying for awhile.

Thanks for your feedback.  

Mom987

If you plan to have a baby with the plans, assume you'll max everything out. Also the payroll deductions should be pre-tax. I work at a broker's office doing group benefits and it is always per pay period, is that the same for you or is it definitely per month? Most prenatal visits are a copay for the first visit only, other plans are towards the deductible which would help out later if you end up maxing it out by having the baby the same year. By the way, having an option that is $0 cost is a good deal. Not all companies do that.

Mom987

I'm in GA so plan designs and features could be totally different.

formerlyGDaisy09

hoffse said:

Plan B is better by a couple grand, according to my calculations.  I haven't had kids, but I would assume you will max out your deductibles and out-of-pocket when having a baby.  Plan A has you paying $7,000 (plus 20% of everything left).  Plan B has you paying $4,559.40 with $0 after you hit that amount.

Co-pays are relatively small.  Even if you go to the doctor a lot during baby's first year, it's really unlikely that you would wind up making up that difference.

You also might want to see if the health insurance premium is deductible.  I know mine is - so it's pre-tax and actually doesn't "cost" as much as it seems.

I would sign up for Plan B for your pregnancy and through at least the first two years of baby's life.  Then maybe look at your costs and consider whether it's more cost-effective to switch back to Plan A.  That's something to determine at a later date.

I'll let the moms chime in with more info on specific costs.  I have no experience with this, so take my suggestions with a grain of salt.  They will know more than me about this!

I get different numbers...Plan A $4500 max, Plan B 3059.90 max. 

Deductible=Maximum charge for a medical episode of care (co-pays should count)

Annual Maximum=Total maximum you'll pay in a year (deductibles, copays, pharmacy...) why is the deductible for Plan B the same as the Max out of Pocket?

jjbmstinco

Gdaisy09 said:

Are the copays $$ or %%? 

Do you have either of the annual maximums in an e-fund(factoring in the additional monthly cost of Plan ?

in plan-B, is there a coverage breakdown?

most preventative care should be free. I *Believe* that most pregnancies are "bundled" now as one event....so there may not be co-pays for prenatal care anyways? I just did a project in OB/GYN at my hospital and the only payment structure mentioned was bundled payments. 

It seems odd to me that the insurance year is July to July? I thought everywhere did open enrollment in the fall and insurance plans ran on the calendar year? 

I work at a school so I am not sure if that is why we do July to July. But that is what our paperwork says.  

The co pay is $30.00. I am sorry. I was trying fast.  

Plan B's breakdown is what I tryed up.  There is more detailed like ambulance or inpatient care.   I can add more detail if you like.  

Yes, we have the money in an E fund if we need too.  My husband has an HSA just for his health, but I would just use our E fund.  

jjbmstinco

Mom987 said:

If you plan to have a baby with the plans, assume you'll max everything out. Also the payroll deductions should be pre-tax. I work at a broker's office doing group benefits and it is always per pay period, is that the same for you or is it definitely per month? Most prenatal visits are a copay for the first visit only, other plans are towards the deductible which would help out later if you end up maxing it out by having the baby the same year. By the way, having an option that is $0 cost is a good deal. Not all companies do that.

I am paid once a month, so it would be the same for me.

I am in CO and I work for a school district.

I am very thankful for the health insurance we have. I am not paid real well compared to other parts of the state, but I feel like health insurance makes up for that. 

hoffse

OP, have you set up a pre-baby budget?  By that I mean medical costs, costs for unpaid leave (if applicable), and gear.  That amount will be different for everybody.  H and I plan to save more than we'll probably need - and then hopefully use whatever is left to jumpstart a 529.  We could end up spending all of it though.  You never really know.

The ladies on these boards also gave me a great suggestion to practice living on a REAL baby budget while pregnant.  Set aside money you would be spending in the future for daycare, costs to raise the baby, extra medical expenses, etc.  That way when baby arrives, you don't have to suddenly make big financial adjustments while sleep deprived.  Whatever you set aside while living on your baby budget can be used for whatever - H and I plan to use it to fund a nice babymoon.

hoffse

Gdaisy09 said:

hoffse said:

Plan B is better by a couple grand, according to my calculations.  I haven't had kids, but I would assume you will max out your deductibles and out-of-pocket when having a baby.  Plan A has you paying $7,000 (plus 20% of everything left).  Plan B has you paying $4,559.40 with $0 after you hit that amount.

Co-pays are relatively small.  Even if you go to the doctor a lot during baby's first year, it's really unlikely that you would wind up making up that difference.

You also might want to see if the health insurance premium is deductible.  I know mine is - so it's pre-tax and actually doesn't "cost" as much as it seems.

I would sign up for Plan B for your pregnancy and through at least the first two years of baby's life.  Then maybe look at your costs and consider whether it's more cost-effective to switch back to Plan A.  That's something to determine at a later date.

I'll let the moms chime in with more info on specific costs.  I have no experience with this, so take my suggestions with a grain of salt.  They will know more than me about this!

I get different numbers...Plan A $4500 max, Plan B 3059.90 max. 

Deductible=Maximum charge for a medical episode of care (co-pays should count)

Annual Maximum=Total maximum you'll pay in a year (deductibles, copays, pharmacy...) why is the deductible for Plan B the same as the Max out of Pocket?

Gah you're right - REALLY long day, sorry!

jjbmstinco

Hoffse- Thanks for the suggestion.  We have the daycare cost coming out automatically, so we are already not living on that.  I have work time saved up that can be used for bedrest if needed or mat leave once the baby is born.  Those days are paid my daily rate.  Mat leave is almost covered 100%.  A few more months, and it will be completely funded in a savings.  Things like medical and gear are already in savings.  

I think we are pretty set, but in case we aren't, we have savings ready.

formerlyGDaisy09

I guess that would explain the July-July thing...now that I think about it  

I would look into how plans pay maternity care...if its bundled and you don't use much care otherwise it might be better to be on the high er deductible plan and switch once you're pg or have baby and need to spend more for pediatric coverage.  

Is your H's HSA an insurance plan? with a deductible also? i'm wondering if you considered his plan as an option too?

jjbmstinco

His isn't.  His district gives him $750.00/yr to put into an HSA. He funds the rest.  Its terrible.  If I was to get pg this month (highly unlikely) it would be due April.  If it takes awhile, I think then I could change next July and for when its born.

Thanks for all your insight!

blondie42107

Based on premiums and out of pocket maxes, plan b is better. It really doesn't matter what your copays are (imo) since your out of pocket max is the main concern.

Also is this per individual or family coverage?

We have a $300 deductible per person or $600 per family (whichever is met first). We also have individual out of pocket maxes as well as a family out of pocket max (whichever is met first).

jjbmstinco

This is individual. 

Family is much more.

brij2006

Do either of these plans have fertility coverage?  If so, what are the maximums for those?

I only say this because you said you've been trying for a while. 

blondie42107

My pregnancy was several bills. I received one bill for prenatal care and delivery. All labs, ultrasounds, tests were billed separately as I received them. Ultrasounds can vary - I was always billed for the actual ultrasound but then received an additional bill for having a special ultrasound read by a specialist. Also I had an epidural - the first only partially took and when I ended up with an unplanned c-section, I needed a spinal so I received 2 bills from the anesthesiologist.

With my first kiddo I had a 24 hour hospital stay for monitoring so I received a bill for that from the hospital. Also received bills from the hospital for each labor and delivery on top of the OB bill. Then baby gets a bill from the hospital for care after the delivery. :-)

I just filed away all my EOBs from each of my pregnancies. I should look to see how much each of them were. I had non-complicated pregnancies.

Well visits are covered... But early on weight checks, etc were not.

jjbmstinco

********loss mentioned**********

That is a good question Brij.  I have thought about that.  I am a longtime lurker on GP/GPM.  You ladies are so informative.

IF DX-2,000 lifetime max but there is no cover of IF treatment. 

My "a while" is much different than yours "a while".  We have been trying for 8 months with charting.  We did get pg in April, but MCed 2 weeks ago.    We just got the bill for that and horrified at the cost for that.  

This promoted this discussion.

brij2006

jjbmstinco said:

********loss mentioned**********

That is a good question Brij.  I have thought about that.  I am a longtime lurker on GP/GPM.  You ladies are so informative.

IF DX-2,000 lifetime max but there is no cover of IF treatment. 

My "a while" is much different than yours "a while".  We have been trying for 8 months with charting.  We did get pg in April, but MCed 2 weeks ago.    We just got the bill for that and horrified at the cost for that.  

This promoted this discussion.

I'm so very sorry for your loss.  Our IF diagnosis and loss in November prompted us to dig into the details of our insurance policies too.  It's definitely something that I would recommend checking into with both of those plans, knowing your past situation.  It's always better to have the coverage if you were to need it, than not.  But I really hope you won't even have to worry about that situation at all.

jjbmstinco

Thanks Brij. That is very sweet of you.  It certainly has crossed my mind while watching what you ladies have been through. 

I am sorry to read about all your troubles.  I have been following you guys for longer than I like to admit.

brij2006

jjbmstinco said:

Thanks Brij. That is very sweet of you.  It certainly has crossed my mind while watching what you ladies have been through. 

I am sorry to read about all your troubles.  I have been following you guys for longer than I like to admit.

There's nothing wrong with that.  I was a long time lurker over there for a while too.

ta78

I haven't read all of the responses, so I'm sure it was answered already. But Plan B would definitely be the way to go at least for your pregnancy and the first few years with things like vaccinations.

Labor and Delivery alone will be way more than the monthly + deductible amount you are paying.

KatieCutie05

I agree with brij, you have to think about the fertility coverage and realize that while its nothing we hope forfor for you, you need to be prepared with the possibility that if it takes another 6 months to concieve, your delivery cost will come out of the following year - not this year. So either way, with either plan you could potentially "lose" 1,500. Its not that big of a deal to be honest. But for that reason i might pick plan A: because i only "lose" that 1,500 if i have a baby and then its really a win. You could save an extra 130 a month instead of paying it in premiums. If your baby is due in august of the following year all that delivery cost will come out of the following year. You need to get pregnant in 3-4 months for for you to deliver before next july and for it to even apply toward this plan. Plan for the worst but hope for the best.... I played this game in november and i didn't get pregnant in those 3 months. I'm really glad i picked the lower cost plan now.

vlagrl29

Just looking at what you wrote down, plan B is so much better especially when talking baby and pregnancy costs.  The fact you only pay $1500 max oop is great.

jjbmstinco

KatieCutie05 said:

I agree with brij, you have to think about the fertility coverage and realize that while its nothing we hope forfor for you, you need to be prepared with the possibility that if it takes another 6 months to concieve, your delivery cost will come out of the following year - not this year. So either way, with either plan you could potentially "lose" 1,500. Its not that big of a deal to be honest. But for that reason i might pick plan A: because i only "lose" that 1,500 if i have a baby and then its really a win. You could save an extra 130 a month instead of paying it in premiums. If your baby is due in august of the following year all that delivery cost will come out of the following year. You need to get pregnant in 3-4 months for for you to deliver before next july and for it to even apply toward this plan. Plan for the worst but hope for the best.... I played this game in november and i didn't get pregnant in those 3 months. I'm really glad i picked the lower cost plan now.

Thank you. I was thinking this. Getting pg in the next 3-4 months is unlikely, but when we sign up again, I could do it then. It would be money up front but we would have everything covered.

brij2006

Do both of the policies only have $2k of IF DX coverage?

brij2006

Do both of the policies only have $2k of IF DX coverage?

jjbmstinco

I am not sure Brij. I would have to call. I can only see my specific plan online.

brij2006

jjbmstinco said:

I am not sure Brij. I would have to call. I can only see my specific plan online.

It would be worth calling in and asking about.  Especially with option B.

If all that is currently covered is $2k in IF DX, unfortunately that isn't much. :-(  My ultrasound and bloodwork were not covered by insurance and cost us $3k.  That did not include the HSG my Dr didn't require since we had been pregnant before, nor H's SA. 

So if plan B gave some IF coverage, or at least covered all diagnosis testing, then you may come out ahead even this year if you don't get pregnant and have to use it for the IF coverage. 

I believe a rough number for IF testing is $5k.  So if your current coverage only pays for $2k of that, then you would have an additional $3k to pay for OOP.  To where if Plan B covers all testing, but you have to pay an extra $1,560 in premiums throughout the year, you would still be money ahead.  Then even more ahead if you were to get pregnant.

*Welcome to how an IF mind works about insurance. ;-) *

oneplusoneistwo

Just a few more things to think about:

On both plans, does the deductible count towards the out-of-pocket max?  The majority of plans do, but almost 40% of plans don't, so you want to make sure of that.  If one included the deductible and one didn't, that could change the outcome of which one is cheaper (even if by a very small amount).

Second, find out if either plan has a specific co-pay for birth.  The way it worked for me was that I paid one co-pay that covered all prenatal visits ($25).  And then one co-pay to the hospital that covered the birth ($450).  So between the two, it only cost me $475 for all my prenatal care and a c-section that insurance paid over $30K for.  Granted, my monthly premiums for that plan were outrageous, but it all paid off in the end.  It's worth double checking the specifics of what is covered in maternity and birth.

As far as IF, I would definitely consider what is covered there, but it is seriously only something like 8% of people have, so you do have statistics on your side, and hopefully you won't have to go down that road.

Good luck!