Health Insurance

jjbmstinco · June 2014

I just got a horrible bill for 1300 for my ER visit. I am sad about because A) they didn't tell me anything and

I don't need another reminder about this process. I have never had a baby clearly, so I need help on health insurance. Please help...

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 it 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/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. It took us about 8 months to get this far, so I am not sure how long it will take to get pg again.

Do I have to pay my dr. co pay each visit? Even when I go once a week at the end?

Thanks in advance!

Prescription is the same for both plan.

jtmh2012 · June 2014

Our doctor has a "OB fee" that covered from the first time they see you until birth. When we did the math on the two plan options we have (a standard plan and a high deductible) it was pretty much pay now or pay later. Meaning, if we took the difference in premiums and added them up over the year, they equalled the increased deductible. Even with the high deductible, certain things are covered 100% and others are covered partially. By my rough math, looks like yours are similar.

We also have an HSA in place to help cover the deductible, but so far we've been eating it so we can build up the HSA for later.

As for the co-pay, depends on how your doctor handles it. Ours just bills our part of the OB fee in monthly installments.

one2andnow3 · June 2014

I am no help here since we do not have insurance. If I were having a baby I would go for lowest deductible because of chance of having a c section.

ImperiumWife · June 2014

I would say B. I also have no idea what it cost to have a baby, but looking at it, it seems that you still have to pay 20% of your bills on the first one, and the second one you don't. Also, if I'm reading it right, it looks like you have a cheaper pay in on the second one as well, but if not it's the same. But god forbid you have a more difficult pregnancy-aka end up on hospital bed rest or something like that- you certainly don't want to be paying 20% of that.

Am12712 · June 2014

Plan B is the way to go. You should talk to the billing department at the OB office that you will likely use. Often they have a plan where you pay x amount and then call it a day. I know my OB office sat me down at my first appointment and went over what my insurance would cost and what I would need to pay. At the end of the day I only had to pay about 500 for all my OB visits and that was reimbursed to me because I had an FSA account.

My plan did not have co-pays so I didn't have to pay each visit. The plan I will have when baby 2 happens will have co-pays and I have no idea if I will have to pay that each visit or not.

Oh I would also highly suggest getting a flexible spending account to cover your deductible. It is so much less stressful to have the FSA money come out of your paycheck then to have to figure out how to come up with 1500 at the drop of a hat. Plus it helps reduce what you get taxed on.

I'm decently versed in benefits so I will help as much as I can!

jjbmstinco · June 2014

Am-

What are your thoughts on this? Benefit period is July 1-July 1.

I am in my one month waiting period currently. AF will be here next week and then I can try. If magic happens, I would be due March. If I don't get pg for a few months, I could be due in July, therefore wasting money this enrollment period. I will get a chance to re-enroll next May. We aren't promised that we'll still get the same insurance next year. Should I just save my money and go with the free plan until next year and risk the money?

Thoughts?

Am12712 · June 2014

When I got pregnant in 2012 the OB office went based off that insurance. So when 2013 rolled around I didn't have to pay anymore of my deductible, just the plan we had already agreed upon. Until I (you) know how the office bills it's kind of up in the air on how it will work.

Since you want to save some money and use plan A, I would recommend at least enrolling in a Flexible Spending account to help cover some of your deductible. Just remember whatever money you contribute to a flexible spending account you need to use or you lose it.

If it were me and option B was affordable and you wouldn't miss that money coming out of your paycheck I would still go with that. It's going to save you money in the long run. Even if you count your paycheck deduction and your deductible you're going to spend at most 3,000 for 1 year. That is saving you 1500 dollars.

Do you understand the out of pocket maximum and all that? I was going to jump in and explain it all just so you know every aspect of it but didn't want to insult you if it was perfectly clear already. LOL

jjbmstinco · June 2014

I get it in a vague sense. I just hate spending money on anything that isn't needed. But it's better to be safe than sorry. I am going to go enroll today. I don't like the use if or lose it idea. So I will have to look into that. We have the deductible in an account already, so it's just a matter of moving things around. I like tax free but if it takes me 10 years to use my money, I would want that rather than losing it.

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