Insurance choice suggestion

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I'm trying not to make this political at all here. Work places' insurance has changed due to various political and non political reasons.

Formerly we have Blue Cross HMO, UnitedHealth PPO, UnitedHealth EPO. Based on what I know they are very typical plan that HMO and EPO have 100% coverage above a certain amount, HMO has to visit the PCP first while PPO and EPO don't, and PPO can visit out of network with higher out of pocket expense, etc.

This year the HMO is removed as Blue Cross increased its premium up to 40%. Employer replace it with a "Saver" PPO plan that gives you a $500 Health Savings Account, and has been promoting it aggressively.

The price of this plan is about $750 cheaper than the other 2 (PPO and EPO), and the deductible is $1250 before the plan will kick in and pay 90% of cost. The maximum out of pocket is $4000 ($3500 after subtracting the company's $500 contribution) for the saver PPO vs the $2000 for PPO and $1500 for EPO. All preventive care (screening, etc) are 100% covered. Infertility is the 90% covered.


I've asked a couple coworkers and they have different opinion about this new plan.

One say it is a good money saver because they rarely see doctors and the amount of best case saving is the $750 you save vs other plan, and the maximum worst case expense is $3500. The money you don't use is rolled over to next year unless you leave the company, then you have to pay a bunch of $1 or $2 maintenance or withdraw fee if your balance is below $500. If you withdraw with cash then the amount of $ is taxable.

My other coworker who had a $110k neck surgery said any sort of medical procedure will cost you 30-200k easily these days, and 3.5k out of pocket isn't a good saving if problem arise.


Any opinion? I do visit chiropractor pretty often but next year they increased the copay to $30 from $20, and I'd probably not visit as often unless my neck and shoulder are falling apart regardless of any plan I join.
 
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Does your insurer (are both of these plan options from the same insurer?) have a "compare insurance options" online tool that will compare the plans based off of your anticipated health care usage?

My wife's insurance did and we made our decision based off of that (actually we didn't pick the estimated cheapest one because in the event of an unexpected surgery or something it would have bankrupted us).
 
Originally Posted By: wallyuwl
Does your insurer (are both of these plan options from the same insurer?) have a "compare insurance options" online tool that will compare the plans based off of your anticipated health care usage?

My wife's insurance did and we made our decision based off of that (actually we didn't pick the estimated cheapest one because in the event of an unexpected surgery or something it would have bankrupted us).


Yes we do have an online tool for that, and no it won't bankrupt us because the maximum out of pocket is $3500 a year.

So it is a gamble of saving $750 and losing $1250 (90% coverage by insurance up to $4k maximum out of pocket, and company contribute $500).

So:

1) If we don't use more than $500, we win because company paid $500. Remaining balance will roll into next year.

2) If we don't use more than $1250, we break even because the other plans (PPO EPO) cost $750, and we don't have the $500 company contribution. May save some $ but probably not a lot, a couple hundred here and there I assume.

3) If we use $20000-40000, we lose because the maximum out of pocket in other plans are only $2000 and $1500, 90% to 100% coverage in PPO and EPO respectively. But this plan is $4000 out of pocket with 90% coverage. The $2000 difference in out of pocket, subtract the $750 cost, will be about $1250 difference.

4) More than 40000, our loss top out at $1250.



It is very complicated, and with the company's comparison tool I'm still very confused on how much we may save or lose, but we won't go bankrupt for sure.

They are doing everything to try to discourage people from seeing doctors and apply unnecessary work.
 
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Is it a family plan? If so, I'd rule out the "saver" PPO, because you will almost surely use more than $500 of health care.

I'm still confused on what option has what deductible, maximum out of pocket, etc. for the other three options.

Really, it comes down to how much health care you plan to use.
 
I would personally err on the conservative side. Assume one of you has an extensive procedure. Plug in some numbers $10,000, $50,000,etc. Assume each of you has 3 Dr. visits. That's what I always did.

The other stuff is chump change.
 
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The $500 is individual, we don't have kids and my wife works for a big pharma that has good health care coverage on her own.

The cost / coverage of all the plans are:

Saver PPO:

company provide $500 in your saving account, $5 bi weekly cost, $1250 deductible, 90% coverage in network, 70% coverage out of network, $4000 maximum out of pocket. You can contribute as much as you want in your savers account (Fed tax free, state taxed), but if you contribute so much because you anticipate a lot of expense, might as well buy a better plan.



Plus PPO:

$34 bi weekly cost, $300 deductible, $2000 out of pocket maximum, 90% coverage in network, 70% coverage out of network



EPO:

$34 bi weekly cost, no deductible, $1500 out of pocket maximum, 100% coverage, no out of network coverage.
 
Originally Posted By: wallyuwl
Unless you travel a lot, I'd go EPO. If you do travel a lot, I'd go Saver PPO.


How come?
 
The choice will depend upon your circumstances. try to project how much the copays will be in each plan, prescriptions and any pending health issues you may have and run the numbers under each plan.

If you are handy with excel, it will not take more than 15 minutes to figure out which plan works best if next year you will have the same health status as this year.
 
Originally Posted By: PandaBear
Originally Posted By: wallyuwl
Unless you travel a lot, I'd go EPO. If you do travel a lot, I'd go Saver PPO.


How come?


EPO has no out of network coverage, PPO does. So you're still OK if something happens while you are traveling. I'm assuming your in-network is mostly local. This is, of course, if you think it is highly unlikely you'll have a major procedure or something.

If there is even a 25% chance of that, I'd go the PPO route. Which one depends on how much health care you will use outside of this possible major procedure (Saver if you won't use a lot, the other PPO if you will use more).
 
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