I Need Help Understanding My Health Insurance Choices

[DayTimer]

So here are the three plans I have to choose from for 2020 given that my kids' Doctors are "in-network" with this carrier:

Coinsurance (percentage of costs the plan pays after you meet your deductible)
Plan A 80%
Plan B 80%
Plan C 90%

Annual Deductible (what you must pay before the plan begins to pay benefits)
Plan A : $4,000 individual $8,000 family*
Plan B: $3,000 individual $6,000 family*
Plan C $2,000 individual $4,000 family*

Annual Out-of-Pocket Maximum (the most you will pay in a single plan year)
Plan A: $5,000 individual $10,000 family
Plan B $4,000 individual $8,000 family
Plan C $3,500 individual $7,000 family

Cost:

Plan A: $917/month
Plan B: $1066/month
Plan C: $1375/ month

So I was going to go with plan C for $1375/month because I'd rather be stuck paying 10% of the bill than 20% of the bill if we got hit with a big problem. But I may have misunderstood the Max out of pocket. For plan A, for example, does the max out of pocket of $10,000 mean that the insurer will pay 100% of the covered costs once I hit that $10,000 out of pocket expenses?

Does this mean that plan A Premium + max out of pocket would be $21,004 vs $23,500 for plan C?

Thanks

 

[Chazm]

Might wanna move this out of senior section but I’ll bet someone will chime in anywho

 

[DayTimer]

I’ll bet someone will chime in anywho

I'm hoping.

 

[StephanieCJ]

If you take premium x 12 and add back Family moop (to get worst case catastrophic scenario

Plan A=21,004/year
Plan B=20,792/year
Plan C=23,000/year

I would go with Plan A, because worst case scenario is only $212 more on A than B, but you save premium over all. Put the difference in a separate checking account to be used only to pay medical bills that way it doesn’t hurt so much if/when something does happen. Just my two cents...may not be worth anything

 

[leevena]

Difficult to give you an answer because all the benefit info is not provided and we do not know what type of utilization you expect to have next year. By way of example, I expect to have my yearly cardiologist visit (had a heart attack few years), one doctor/urgent care visit, and my 3 Rx per month. While I have a large deductible and OOP, I have a $40 office visit copay, $60 Urgent Care, and my scripts cost less than $15 per month. No reason to expect any other expenses.

 

[DayTimer]

If you take premium x 12 and add back Family moop (to get worst case catastrophic scenario

Plan A=21,004/year
Plan B=20,792/year
Plan C=23,000/year

I would go with Plan A, because worst case scenario is only $212 more on A than B, but you save premium over all. Put the difference in a separate checking account to be used only to pay medical bills that way it doesn’t hurt so much if/when something does happen. Just my two cents...may not be worth anything

Thank you. Your 2 cents are much appreciated and worth a great deal. I appreciate you taking the time to help me with this.

 

[StephanieCJ]

I’m stuck having to do a buy up plan because of health issues for my daughter and myself and when MOOP is figured in, it comes out better. Sucks, because we never know when a surgery is going to be needed for her but we could save a ton of money if it weren’t a consideration....I must really like this kid, because she is expensive.

 

[DayTimer]

Difficult to give you an answer because all the benefit info is not provided and we do not know what type of utilization you expect to have next year.

My main concern was minimizing my max cost in the case of a catastrophe and in order to figure that out I needed to confirm I understood "max out of pocket" correctly.

 

[vic120]

Mine I have Xerelto and sleep machine and I have an autistic child that goes through half the deductable in feb

so for me its simple premium plus max out of pocket

I don't know your situation if paying a copay and not paying as much towards deductible factors in

 

[DayTimer]

so for me its simple premium plus max out of pocket

I don't know your situation if paying a copay and not paying as much towards deductible factors in

"knock on wood" we are a healthy bunch thus far. The prescription plan is $10 generic, $30 formulary brand, and $60 non-formulary across all three choices. We typically only have a few prescriptions in the house each year, e.g. antibiotics.

My concern is minimizing max oop should one or more of us be severely injured or develop a critical illness.

Our biggest health care cost year to year is the health insurance premiums.