Health insurance question

bcarb · November 2015

Hi All! Since it is open season, I have a what would you pick health insurance question.

Option A:
No deductible.
355/month medical/dental
No coPays for medical, dental has a 1,000/person maximum.(co insurance is 80/20 for preventative and fillings, then 50/50 for major.
All of our current providers are within the network

Option B
No deductible
328/month for medical
40/month for dental, no maximum per person (that I can find) the co-insurance is nothin for preventative, then we would have to pay 45% for fillings, and pay 65% for big items(crowns, wisdom teeth etc) . All current providers are in this network.
CoPays, 25/ general visits etc, 40/ specialist

A background, this upcoming year my H will need his wisdom teeth taken out, we go to dentist 2x/year for check ups. I have terrible teeth, fillings 3 root canals, crowns etc. knock on wood I haven't had issues in the last 2 years, but no idea if/when I will need more work(even just replacing a filling).

We just had a baby so my LO most likely will be at the doctor more often than we would be(seems like babies are always sick) I se a specialist 1x a year and my Ob 1x a year, then my PCP 1x a year. My H never goes to Doctor.

What option do u think is best? I think the main attraction for option A is no co pays, the main attraction for option B is dental insurance.

Thanks!!

Erikan73 · November 2015

Is the dental plan on option b the same as option a in regards to which dentist is covered? The reason I'm asking is that my company just started offering 2 different dental plans. One is less expensive and sounds great because it has better coverage for braces, but my dentist who I just found and love, isn't covered under it. For me, being able to stay with a dentist that I was comfortable with made a difference. That being said, based on what you said you'll need to get done on dental work, if you have a dentist that you like that is covered under option b, I would go for that because in the long run, I think you'll save money on what you pay for the dentist since you don't have a max on the coverage.

bcarb · November 2015

Option b is with our current dentist who we love. We would still be able to go to same dentist under option A tho as well. It's the unknowns in terms of my teeth! If I don't have any issues, then option A is probably best bet

Xstatic3333 · November 2015

I'd probably go with Option B. It's not that much more for better dental coverage. We both have had a lot of dental work lately (way over $1,000 a year) so that may be coloring my opinion.

julieanne912 · November 2015

What's the co-insurance on the medical? Based on what you've given here, Option A sounds better to me.

bcarb · November 2015

We just have coPays in option B, no CoPays in Option A at all. Also note we do have the option, and will have a flex spending account

julieanne912 · November 2015

bcarb said:

We just have coPays in option B, no CoPays in Option A at all. Also note we do have the option, and will have a flex spending account

Copays are different than coinsurance. For example on my plan, I pay a $25 copay when I go to the doctor, but I also have coinsurance of 20%. Meaning I pay 20% of anything up to the out of pocket maximum.

simplyelise · November 2015

bcarb said:

We just have coPays in option B, no CoPays in Option A at all. Also note we do have the option, and will have a flex spending account

Right, no copays, but what are your coinsurance amounts? What percentage of your health expenses does the insurer cover? For plans with a deductible, you pay for most non-preventative care until your deductible is met and then you pay a percent of the services after that. For me, once I hit my $300 deductible, the insurance covers 90% of costs and I cover 10% of costs up to the point where I would hit my out of pocket max ($2000). Plan A Health Premium: $355/mo Deductible: None CoPays: None CoInsurance: ? Out of Pocket max: ? Plan B Health Premium: $238 Deductible: None CoPays: $25 CoInsurance: ? Out of Pocket Max: ? Since you have options for dental either way, I would be focusing more on the health coverage and not the dental coverage. You can put your wisdom tooth surgery amount in your FSA either way. Without info on the question marks above, I'm not able to give advice as to which I would pick.

simplyelise · November 2015

simplyelise said:

bcarb said:

We just have coPays in option B, no CoPays in Option A at all. Also note we do have the option, and will have a flex spending account

ETA: this website is so screwy today. formatting!
Right, no copays, but what are your coinsurance amounts? What percentage of your health expenses does the insurer cover? For plans with a deductible, you pay for most non-preventative care until your deductible is met and then you pay a percent of the services after that. For me, once I hit my $300 deductible, the insurance covers 90% of costs and I cover 10% of costs up to the point where I would hit my out of pocket max ($2000).
Plan A Health
Premium: $355/mo
Deductible: None
CoPays: None
CoInsurance: ?
Out of Pocket max: ?
Plan B Health
Premium: $238
Deductible: None
CoPays: $25
CoInsurance: ?
Out of Pocket Max: ?
Since you have options for dental either way, I would be focusing more on the health coverage and not the dental coverage. You can put your wisdom tooth surgery amount in your FSA either way. Without info on the question marks above, I'm not able to give advice as to which I would pick.

bcarb · November 2015

We don't have co insurance for medical. We literally just pay the co pay.

bcarb · November 2015

And no deductible. oh if we use an out of network provider for medical it is a 20% co insurance for option A. All of our providers are in network and OOP is 10k for both options

bcarb · November 2015

And once again that OOP is for out of network

simplyelise · November 2015

Okay, this is a very atypical insurance plan.

So for plan A, you only ever pay the $355/mo or $4260/year. And as long as you go to in-network providers, you never have to pay any copays or a single dollar more for in-network care? So the most you would pay for medical coverage is $4260 unless you go to an out of network provider which would cost 20% coinsurance up to 10k. So your absolute max you could spend would be $14,260.

For plan B, you only pay the $328/mo or $3936/year with $25 copay. But any medical care you receive is covered 100% after the copay. So if you have maybe 10 visits in a year, the absolute max you would pay would be $4186.

Sorry, just want to make sure I understand this correctly. I have never heard of a plan where there is no deductible AND no coinsurance.

bcarb · November 2015

@Simplyelise-that is correct. We currently have Plan B. I only ever pay the $25 co pay when going to a general doctor/visit. When I see a sepcialist (my Rhemy) I pay $40. I had a baby a few months ago, I paid the hospital co-pay which was $150, that is it for having a baby. We only use in network doctors, which honestly is the majority of doctors in our area. So Option A is the same set up, except we wont be paying the CoPay, All of the doctors we currently see are In Network and we really dont/wont have a reason to use out of network.

simplyelise · November 2015

Cool!

Alrighty, I think I'd recommend switching to Option A. With the dental included, you'll be paying less per month on premiums and you'll be paying less for dental work with A based on those coinsurance amounts. But the plans are pretty similar when it's all said and done really.

bcarb · November 2015

Agreed, I think the whole No Co Pay's is what is going to save us in the end, esepcially have a new baby--you just never know when they will be sick and how often. I will still figure out an amount to put in the Flex spending account to account for wisdom teeth etc.

short+sassy · November 2015

simplyelise said:

Okay, this is a very atypical insurance plan.

So for plan A, you only ever pay the $355/mo or $4260/year. And as long as you go to in-network providers, you never have to pay any copays or a single dollar more for in-network care? So the most you would pay for medical coverage is $4260 unless you go to an out of network provider which would cost 20% coinsurance up to 10k. So your absolute max you could spend would be $14,260.

For plan B, you only pay the $328/mo or $3936/year with $25 copay. But any medical care you receive is covered 100% after the copay. So if you have maybe 10 visits in a year, the absolute max you would pay would be $4186.

Sorry, just want to make sure I understand this correctly. I have never heard of a plan where there is no deductible AND no coinsurance.

Me either, I'm super jealous @bcarb,

.

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