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11-01-2009 at 4:00 PM
swinsto3
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Gah! Health insurance is making me crazy - help?

I'm trying to figure out what to elect for 2010, considering that the peanut should make his or her appearance sometime in June. We have two plans to pick from, and I just cannot figure out which would be best! Anyone know any of this (or have a guess?)?

- Both plans have deductibles and OOP max's listed on a per person basis and as a family. The first plan is $750 deduct pp, $2250 family, with OOP max of $1500 pp and $4500 family. Second plan is $300 deduct pp, $900 family, OOP max $600 pp, $1200 family. When I have the baby, do we each incur a per person OOP max charge? Or do we count as family, which would be more $$?

If we both get charged for the max OOP per person, it's only a $100 difference between the total cost for the year (premiums & max OOP). BUT, if they charge us the family max OOP, then the higher deductible/OOP plan ends up costing about $1500 more for the year. The premium is about double per paycheck for the lower deductible/OOP plan. I am SO confused, and there is no one at DH's company that is any help at all. Anyone have any ideas?
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11-01-2009 at 4:04 PM
taratru
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From the limited I know, you are each a person - you, dh, and baby.  Because there are only three of you your deductibles will match the family, so it really doesn't matter.  The family cap only matters to you when y ou have four or more in your family. 

If the difference in premiums is only $8 a month, then I'd do the second plan.  My lord, that is a huge coverage difference for a very small premium difference.

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11-01-2009 at 4:16 PM
swinsto3
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no, the premium difference is about double - $57 for the first plan, $106 for the second. I wish it was only $8! Then there would be no question :)

ETA: so if we are each a person, then delivery should cost no more then $3000 on the lower plan - $1500 for me and $1500 for baby, right? Not $4500 for the family max? That's really the sticking point, and where it makes a difference in annual cost.
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11-01-2009 at 4:32 PM
carrierrie
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The baby will be covered when you delivery under your maternity coverage so there won't be a deductible or OOP max for them, it will be just you. Once the baby leaves the hospital, you will add them then.


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11-01-2009 at 4:38 PM
swinsto3
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carrierrie:
The baby will be covered when you delivery under your maternity coverage so there won't be a deductible or OOP max for them, it will be just you. Once the baby leaves the hospital, you will add them then.

Seriously?!?! That rocks! I just sent you a text, but I think I figured it out, so never mind :)
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11-01-2009 at 4:46 PM
whitdog23
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carrierrie:
The baby will be covered when you delivery under your maternity coverage so there won't be a deductible or OOP max for them, it will be just you. Once the baby leaves the hospital, you will add them then.

This isn't always true - in my case most of DS's delivery and care after birth is covered under my maternity services but if he needs additional care (even slightly beyond the "norm") he starts his own plan and begins to incur individual charges, etc.  Call your insurance company and ask them to explain what is covered under your maternity benefits.

 
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11-01-2009 at 6:03 PM
Karenbird
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Is there any difference in the plans besides price?  For us, knowing we can go to whatever doctor/facility we want is really important, so we are willing to pay more for it. 

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11-01-2009 at 6:10 PM
swinsto3
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Karenbird:
Is there any difference in the plans besides price?  For us, knowing we can go to whatever doctor/facility we want is really important, so we are willing to pay more for it. 

THe only difference is the cheaper premium plan is 80% coverage until OOP max is met, the more expensive is 90%. Both essentially require in network services (coverage for out of network is prohibitively expensive).

 
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11-01-2009 at 6:33 PM
taratru
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taratru is not online. Last active: 03-21-2010, 8:37 PMSilver

I totally misread your last paragraph.  Oops.

Regardless, I'm a fan of paying a bit higher premium for having more coverage later because I'm a worrier about the major things like car accidents, appendectomies and cancer.  

Bloggy McBloggerson
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m/c - 9/09, 6w4d
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