I've decided this year to do a real analysis of which option (of the ~15 I can choose from) is the best from my wife and I from a risk/cost perspective. However, reading through 160 pages per plan is fucking ridiculous (lulz private industry rules right?).

I'm curious what went in to your decision making process if you had more than 1 option to choose from. There are so many damn things to place emphasis on from doctor availability, to deductibles, to copays, to cost that this is a task that could consume many many hours.

11/29/2011 5:07:29 PM

my company has an online evaluator thing where you put in how many prescriptions, doctor visits, etc you usually have in a year and then it gives you the yearly total out-of-pocket, the total yearly premiums, and the total actual cost to you.

i chose a high-deductible health plan with an HSA. i rarely go to the doctor.

11/29/2011 5:33:52 PM

Yeah, without doing the analysis yet I pretty much assume that is where we'll end up. I haven't been to a primary doctor in 4 years.

11/29/2011 5:36:04 PM

I'm about to go away from the PPO this year. Probably just do a HSA.

11/29/2011 5:49:05 PM

the HDHP seemed like a no-brainer for me. wife has her own coverage through her employer, no kids, no prescriptions, good health (knock on wood). i still get free check-ups and i never lose the money in the HSA, it just rolls over. last year i was on a plan with pretty much the best coverage my employer offers, but with the highest premiums. i didn't feel like i got my money's worth, but the peace of mind was nice. as long as you have enough on-hand to cover your deductible at all times (which should be easy for anyone not living paycheck to paycheck), then the peace of mind factor is the same.

[Edited on November 29, 2011 at 6:07 PM. Reason : i do wish i had waited until after my vasectomy to switch ]

11/29/2011 6:05:46 PM

The only thing that makes me a bit weary of switching to strictly a HSA plan is catastrophic injury. I shudder to think how much debt I'd have wracked up if I didn't have the coverage I had when i destroyed my shoulder.

I don't have a whole lot of other expenses, so the $100/month I pay isn't that big a deal.

11/29/2011 6:12:42 PM

^It's not as bad as you think depending on what your company's HSA plan is. I think the OOP maximum (after the deductible and a percentage covered beyond that) for the HSA plan through my work is like $5,000 or something for a single person (I knew all of this really well a month or two ago when I did all the research and made my spreadsheets to compare ). I mean that sucks, but that pricetag is not catastrophic at all. Plus my company is paying us $500 to use the HSA plan this year.

In fact, now that my wife and I work at the same company, by switching from my wife and I both being on my basic (high premiums - low deductible) plan to each of us separate on our own HSA plans through our work, we will save about $2500 a year in premiums. Yes we are less covered for a catastrophic incident, but the majority of our deductible the first year is already recouped in savings with the premiums and the OOP max is far from a debt burden.

our analysis and decision was pretty much the same as what NeuseRvrRat summed up ^^

[Edited on November 29, 2011 at 6:55 PM. Reason : ]

11/29/2011 6:54:00 PM

yep, my company gives $500 seed money for single person coverage

[Edited on November 29, 2011 at 7:40 PM. Reason : just a one-time thing for when you first sign up for the HSA]

11/29/2011 7:39:40 PM

****************** BUMP ******************

My insurance plan is being cancelled. Any suggestions on new insurance company? I don't go to the doctor much at all. I currently have a HDHP and don't mind continuing that.

Health insurance companies in NC:

Insurance Company
Website

Aetna Life Insurance Company
http://www.aetna.com
Blue Cross and Blue Shield of NC
http://www.bcbsnc.com
Celtic Insurance Company
http://www.celtic-net.com
CIGNA Health and Life Insurance Company
http://www.cigna.com
Coventry Health Care of the Carolinas
http://www.coventryhealthcare.com
Humana Insurance Company
http://www.humana.com
John Alden Life Insurance Company
http://www.assuranthealth.com/corp/ah/Agents/NorthStarMarketing.htm

Mega Life and Health Insurance Company
http://www.megainsurance.com
Time Insurance Company
http://www.assuranthealth.com/corp/ah/Agents/TimeInsurance.htm

11/19/2013 4:30:28 PM

If you qualify for subsidies, then you should stick to the two providers that offer subsidy eligible plans, namely BCBS and Coventry.

11/19/2013 5:55:55 PM

I made a spreadsheet plotting total out of pocket costs (premium + coinsurance) under an increasing amount of total medical bills to evaluate my wife's enrollment options through her employer based on her likely usage. In her case the lower premium plan actually resulted in a lower aggregate costs for all but a couple thousand dollar sweet spot, given the lower up front cost, and the fact the deductible was higher but the out of pocket maximum would kick in sooner (premiums don't count against the out of pocket max). However, for this comparison the conditions covered were essentially the same even if coinsurance rates were different.

My own known medical costs are very low, so I generally just go for a lower premium plan that still limits my financial exposure with a manageable deductible and out of pocket maximum. The main drivers of premiums are 1) paying for medical services you may or may not use (impacts covered services, copay and coinsurance rates) and 2) risk/exposure (deductible and out of pocket maximum)

One way to look at a lot of comparisons is that higher premium plans essentially mean you are prepaying for medical services. Just make sure the out of pocket maximum meets your budgetary needs, and you have the fiscal discipline to cover increased patient responsibility (coinsurance or copays) if you opt for the lower monthly premium plan. Covered services may be different, so you still need to ensure they meet your needs...but many of those plan differences are smoothed out for better or worse under the ACA.

[Edited on November 19, 2013 at 6:53 PM. Reason : .]

11/19/2013 6:45:10 PM

Quote :

"If you qualify for subsidies, then you should stick to the two providers that offer subsidy eligible plans, namely BCBS and Coventry."

that's not necessarily true. you can be at the high end of the range and have a subsidy small enough that the savings for a plan outside of the exchange more than offset the loss of subsidy.

11/19/2013 7:29:33 PM

^ Quite true. Thank you for the correction.

11/19/2013 9:44:27 PM

Why did they name the new law the "AFFORDABLE CARE ACT" when the plans all cost more?


Even a fucking kindergartner could tell you if something costs more its not more affordable.

11/20/2013 12:37:02 PM

ACA sucks for young people, especially young males. My company had to scrap their HDHP which was great for young, healthy people. I'm going to be paying more next year for less coverage. Hope some of you people keep this shit in mind when you vote in 2014 and 2016.

11/20/2013 2:16:59 PM

I'm currently wrestling with a subsidy question. My employer's updated plan is quite reasonable to cover myself (less than $100/month contribution) but would be cost-prohibitive to cover my wife (depending on the option chosen, $600+/month for her coverage. Thanks, Obama.) As she is a grad student and, as such, earns a salary of $0 currently, based on combined household income for a 2 person household she would probably also qualify for a subsidy on the income metric.

However, the language around subsidies and employer plans is basically "if an employer-provided plan is available to you, you are ineligible for subsidies unless the plan costs more than 9.5% of your income". As the cost to add her to the plan is above that threshhold, I'm wondering if she'd be eligible for a subsidy? Or since I'm the primary on the employer plan and coverage for just me is under the limit, are we screwed?

If there is no subsidy available, I'm still sure I can do much better than $600/mo on the private market.

11/20/2013 2:18:03 PM

I believe she would do well on the exchange and get subsidies, as she has no employer. She should do that.

That said, while the subsidies are received directly to the insurer, they are ultimately justified or lost on your tax return the following year (April 2015). As such, your wife has the option of filling separately and whatever is available to you will be irrelevant to her credits/etc. However, seeing as North Carolina did not expand medicaid, having an income of zero makes her ineligible for anything but paying her own full fare way.

11/20/2013 3:09:35 PM