Health Insurance Questions

lifeonthehill · March 2014

I went to the meeting for the health insurance for this upcoming year. I have no experience with this so I have no idea if there is something I am missing or if it is just actually a good plan.

Deductible: $1,500 individual/$3,000 family
Maximum out of Pocket: $4,000 individual/$8,000 family
Monthly Cost $130.14 individual/ $370.88 family

Also the school contributes to a HSA(Health savings account):$1,275 individual/$2,550 family

formerlyGDaisy09 · March 2014

are there co-pays or co-insurances? what's covered?

Is this covering just you, or your whole family?

is this an indemnity plan? or a PPO plan? or something else?

brij2006 · March 2014

Sounds like a pretty decent plan to me.

Will it just be for you or for your husband also?

That price is good for individual, but family seems a bit high to me. But keep in mind that a lot of family plans stay the same price when you add kids. Looks like you will be TTC soon, so you could likely be adding another dependent.

lifeonthehill · March 2014

Gdaisy09 said:

are there co-pays or co-insurances? what's covered?

Is this covering just you, or your whole family?

is this an indemnity plan? or a PPO plan? or something else?

it seems like everything is on us until the deductible is paid. Wellness visits are covered 100% from the start and prescriptions are $10/$25/$50.

This is the whole family same price no matter how many kids.

PPO

vlagrl29 · March 2014

oh I know all about insurance plans and what to look for. Find out what services are offered or not. Find out Urgent care and ER co pays. On our old plan I thought we had an ER co pay but not until the main ind. ded. was met. Find out if maternity services are covered. They should be on all plans since it's no longer considered a pre existing condition thank god. For the first time in our self employed life we have fabulous insurance and I couldn't be happier

We even have chiro benefits

Xstatic3333 · March 2014

Also, find out how to get an in-network doctor, and if you'll have to pay more at out of network hospitals. This is a big one before you TTC! I've heard horror stories of people being charged thousands more because the on-call doctor when they delivered was out of network.

vlagrl29 · March 2014

Xstatic3333 said:

Also, find out how to get an in-network doctor, and if you'll have to pay more at out of network hospitals. This is a big one before you TTC! I've heard horror stories of people being charged thousands more because the on-call doctor when they delivered was out of network.

DD's newborn hearing test was out of network at the hospital we stayed at. Didn't really have a choice and had no idea it was until we got the bill. Most likely something will be out of network at your hospital stay.

lifeonthehill · March 2014

vlagrl29 said:

Xstatic3333 said:

Also, find out how to get an in-network doctor, and if you'll have to pay more at out of network hospitals. This is a big one before you TTC! I've heard horror stories of people being charged thousands more because the on-call doctor when they delivered was out of network.

DD's newborn hearing test was out of network at the hospital we stayed at. Didn't really have a choice and had no idea it was until we got the bill. Most likely something will be out of network at your hospital stay.

That is something I hadn't thought about! Everything out of network is 20% until you reach the out of pocket maximum so we really should have that entire amount saved and not just our deductible. Thank you for pointing that one out!

formerlyGDaisy09 · March 2014

alyssa32713 said:

Gdaisy09 said:

are there co-pays or co-insurances? what's covered?

Is this covering just you, or your whole family?

is this an indemnity plan? or a PPO plan? or something else?

it seems like everything is on us until the deductible is paid. Wellness visits are covered 100% from the start and prescriptions are $10/$25/$50.

This is the whole family same price no matter how many kids.

PPO

So I'd make sure you have a good portion of the difference between the HSA and the max-out-of-pocket on hand, but it sounds like a decent plan. you should be able to use the HSA for prescriptions and prescriptions should count towards your maximum.

does the max-out of pocket only apply when you're in-network? do some research about who is in your network and for what services. my insurance changed a few years ago and we were told that our PPO network hadn't changed. turns out that my opthamologist I had been using was covered for medical issues but not for basic vision...i got stuck with the whole bill after my annual vision exam.

if you're TTC this may be a good plan, once you hit the max you won't have to pay anything...but some women have gotten in trouble when their baby is due near the beginning of the year...so you get close to or hit your max with prenatal care in one year, then all that resets before delivery so you have to cover the deductible again. just keep that in mind once you do conceive, if you're still on this plan. That type of problem should get better as more hospitals bundle services under the ACA so they can do more under the new capitated payment system (so you'd be billed for the entire pregnancy all at once and easily hit your deductible and not have to pay twice) but that's several years away.

blondie42107 · March 2014

vlagrl29 said:

Xstatic3333 said:

Also, find out how to get an in-network doctor, and if you'll have to pay more at out of network hospitals. This is a big one before you TTC! I've heard horror stories of people being charged thousands more because the on-call doctor when they delivered was out of network.

DD's newborn hearing test was out of network at the hospital we stayed at. Didn't really have a choice and had no idea it was until we got the bill. Most likely something will be out of network at your hospital stay.

That's when I would suggest contacting your heath insurance. DS#2 had two charges that were considered out of network but because our hospital was in-network, they waived the out of network status and covered them as in-network.

Also my H went to the ER for a nasty cut that required stitches. The PA that he had was out of network even though the hospital was in-network. We called the insurance company and they switched it to in-network.

For both pregnancies, I called our insurance company and reviewed ALL maternity benefits. They were great about it and after our conversation, they mailed me some print outs that also explained our coverage.

vlagrl29 · March 2014

Also, anything that your insurance company does not cover can be negotiated. That's what we did with the hearing test. They took 30% off.

brij2006 · March 2014

vlagrl29 said:

Also, anything that your insurance company does not cover can be negotiated. That's what we did with the hearing test. They took 30% off.

Agree with this. None of our Infertility stuff was covered. So we were able to negotiate a cash price.

KatieCutie05 · March 2014

I have a similar plan...yours costs more per month but you get more in your hsa from your employer.(you can have a total of 3,300 in your HSA for an individual or 6,600 for a family i believe. So minus what your employer contributes you can contribute pre tax an additional 2k for individual or 4k for family. Which you'll want to do because HSA carries over from year to year and you can use it for all qualifying medical expenses but its all pretax so if you think about it you are essentially paying 15-25% less depending on your tax rate.

I did the math on mine and mine was cheaper regarless then it was for the higher plan (even factoring in the cost for a childbirth since i'm also TTC - but it looks like unless god willing i'm pregnant now - baby wont be born til atleast 2015 anyway.

Mines a 1500 deductible with a 3000 out of pocket max and i get only 500 from my employer in my HSA. After deductible, they pay 80%.

Mom987 · March 2014

vlagrl29 said:

Xstatic3333 said:

Also, find out how to get an in-network doctor, and if you'll have to pay more at out of network hospitals. This is a big one before you TTC! I've heard horror stories of people being charged thousands more because the on-call doctor when they delivered was out of network.

DD's newborn hearing test was out of network at the hospital we stayed at. Didn't really have a choice and had no idea it was until we got the bill. Most likely something will be out of network at your hospital stay.

I would try to fight that. Getting the bill doesn't mean you owe it. I'd call insurance, explain the situation and there's a good chance they'd reconsider.

vlagrl29 · March 2014

Mom987 said:

Xstatic3333 said:

Also, find out how to get an in-network doctor, and if you'll have to pay more at out of network hospitals. This is a big one before you TTC! I've heard horror stories of people being charged thousands more because the on-call doctor when they delivered was out of network.

DD's newborn hearing test was out of network at the hospital we stayed at. Didn't really have a choice and had no idea it was until we got the bill. Most likely something will be out of network at your hospital stay.
I would try to fight that. Getting the bill doesn't mean you owe it. I'd call insurance, explain the situation and there's a good chance they'd reconsider.

that is great advice and what we plan on doing next time. At the time I was recovering from a c/section, on pain pills and had SO many hospital bills coming and just wanted to get it paid off. It really wasn't that much in the grand scheme. After discount we paid around $45 I think.

vlagrl29 · March 2014

The hospital I just got my surgery at has an out of network blood lab. I had to go to an in network lab before my surgery. Just silly to me!

Health Insurance Questions

Re: Health Insurance Questions

Choose Another Board

Search Boards