Help! What Insurance to Get for Someone with Large Medical Bills

Dec 18, 2015

  1. InsuranceDude-ins007

    InsuranceDude-ins007 New Member

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    My wife and I are retired with 2 children still in school. Since we do not work, we purchase individual health insurance. We do not qualify for subsidy under ACA. We reside in WA. Every Dec, we have a hard time deciding which health plan to purchase. I hope the experts out there can advise us on the type of insurance plans to get.

    One of us has very high medical and prescription bills every year. It has been so high that each year the bills exceed the out of pocket max for this individual. The other 3 of us have relatively low medical bills: average about 2 simple doctor visits per year per person.

    What I have done is that I purchase 2 policies: one policy for the one with high medical needs and another policy for the other 3 people. The rationale for this strategy is so that the person with the high medical needs has a lower deductible and max-out-of-pocket. If I were to purchase 1 policy for all 4 people, then there will be a much higher family deductible and much higher family max-out-pocket. Does this strategy make sense to you?

    Almost all health insurance articles I have read suggest that someone with high medical needs should get cadillac, high premium, high coverage, low deductible plans. According to my analysis, I think it would be better to save significantly on the premium and get a Bronze or Silver insurance with high deductible. My rationale is that if the bills are high enough to surpass the max-out-of-pocket anyway, why not save big time on the premium and pay a lot for medical bills until the max-out-of-pocket is reached? From what I've seen, the max-out-of-pocket for most plans are pretty much in the same ballpark. Does this sound like a sound strategy?

    In summary, I am considering 2 Bronze or Silver HSA policies: one for the high medical bills individual and another for the other 3. Is this a sound decision? If you have any opinion on this matter, please advise. Thank you very much.
  2. TampaHound

    TampaHound Guru

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    You stated you were retired? Are you over or under the age of 65? That's a good starting point right there.

    How old are the kids?
  3. russelltw

    russelltw Guru

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  4. FLM2

    FLM2 Guru

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    It's a very simple formula: for your family member who meets the annual maximum, add the annual premium to the Max OOP, whichever comes out the lowest total cost is the right plan-if you are considering an HSA you also need to consider the tax benefits for a family contribution that can pay the full Max OOP for the one likely to meet it.

    The only issue you have with two separate plans is that it raises the Max OOP for the whole family, if you have one plan it will be lower, you should also take that into consideration and good luck.
    FLM2, Dec 18, 2015
  5. kstein

    kstein Guru

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    I agree with FML, although more often than not the Bronze plans end up cheapest overall anyways, so you might find that you should all be on the same bronze plan.
    kstein, Dec 18, 2015