Tuesday, October 11, 2011

Which Insurance Option

My company is 'improving' its health insurance coverage starting the beginning of next year. Oh boy, I can't wait! I must make a decision on which route I want to go soon.

On the surface, I could choose to have a very similar type of coverage that I have this year. I currently have my company's option 2 for insurance which is going away and it will be replaced by some Consumer Driven Health Plan (CDHP). It sounds real consumer friendly, doesn't it?

Here are my choices. I can choose to have a 305% premium increase if I go with option 1 or no premium increase if I go with the CDHP. I can elect to have the exact same coverage I have today with option 1 except the deductible would be slightly lower, but my increased premium more than exceeds this difference.

With the CDHP, I must meet the deductible before any health benefit coverage kicks in. It sounds like an easy choice until you find out that the deductible for the CDHP is $3800. This means that I would have to pay $3800 out of pocket, while still paying my premium, before the 80/20 coverage kicks in. On the plus side, prescriptions would count toward that $3800, but there would be no script coverage either until that deductible is met.

The 305% premium increase would take me a few years of salary increases to make up the difference which assumes there are merit increases and no premium increases like this again. The CDHP also comes with a Health Savings Account (HSA). This is similar to a Flexible Spending Account (FSA) except that it's not a use it or lose it plan like the FSA; it goes into a savings account and can be carried over from year to year forever to pay for medical expenses if you don't spend it.

Migraines and not spend money on my health? Not anytime soon for me which means with the CDHP, I would most likely pay the $3800 plus premiums before I have any health coverage. I could use the HSA toward the $3800, but that would still come out of my paycheck. So isn’t the $3800 deductible like a premium payment if you’re pretty sure you’re going to hit it? Even if it does include prescriptions toward the deductible, no prescriptions are covered until the deductible is met; you have to pay 100% prescriptions until that time.

Let’s see, guaranteed 305% premiums increase with the same medical coverage or pay $3800 plus premium before any health is covered? Migraines. Migraine Specialist. Additional Migraine tests. Another ultrasound needed. Who knows what new treatments are to come? All of this doesn’t include the other members of my family and their expenses.

I’m so glad my health benefits are ‘improving’ next year! Are your benefits getting better too?



jasminepw said...

A good person to run these choices by is Jennifer Jaff, Executive Director of the Advocacy for Patients with Chronic Illness http://www.advocacyforpatients.org
email: patient_advocate(at)sbcglobal.net

Our health benefits diminished when my husband's employer changed our Aetna PPO coverage to Choice II POS. I went from the allowed 60 Physical Therapy visits per year down to 25, and then was denied PT visits all together (deemed medically unnecessary).

The worst part was the increased out-of-pocket costs we started seeing after the switch. Because of them we depleted what little savings we had, and we're now in foreclosure. Hard to believe this happens to people WITH insurance, but it's a sad truth.

I wish you the best, and I hope whichever way you go, it allows you the coverage you need.

MigrainePuppet said...

That looks like a really good website. Thank you for the link!

I don't understand how the insurance companies can play doctor and either limit the medications they'll cover or not cover something that your doctor deems necessary. I don't know how people manage without any insurance.

I know there are times I question whether or not I should have a test done that my doctor wants because of the out of pocket costs. It's tough weighing all of the options.

I hope everything works out for you and will keep you in my thoughts and prayers. Thank you for your best wishes Jasmine.

PPLIC said...

Bril­liant! Great talk that was extremely insightful and very enter­taining. It’s given me loads to think about.