🥺 Please help – Health Plan Coverage
TLWR: Can someone give me parental/big brother/sister opinions on if it is most smart to go with my current plan (MarketPlace – highest premium, lowest coverage, favorable mental benefits) instead of my employer plans (slightly lower but still high premiums, higher deductibles and unfavorable mental health benefits)? 🥺 Very neurodivergent and no support system.
I’m currently on a marketplace plan since I lost my job in June. I really like the plan- it has a higher base premium (before my tax credit) but a lot of low or $0 copays and low deductible. My weekly mental health visits are $0 copay which is my favorite benefit because it’s important to me to continue seeing my provider weekly.
I got a job but kept my market place insurance for the rest of the year. I make $49k a year and 8.39% of that would be about $342/month – anything more than that could be considered unaffordable (though my employer only has 12-15 employees so unsure if it adheres to the Monthly Minimum Standards that companies of 50+ employees adhere to). I am 100% responsible for the premium.
Could I still be eligible for a premium tax saving credit based on both of the employer plan monthly premiums being higher than $342/month? (Plan details below)
Plan 1) Premium: $349.07/month. Deductible: $3,000. Premium Annual: $4,188.84 (+$3,000 Deductible = $7,188)
Plan 2) Premium: $369.76/month. Deductible: $6,000. Premium Annual: $4437.12 (+$6,000 Deductible = $10,437.12)
Either way, I’m tempted to stay with my marketplace plan (whether I qualify for a tax credit or not) because the employer plans would have a $75/visit copay and I see my mental health provider once a week and this would make my visits unaffordable and needing to cut back a lot.
My thought is I’d rather pay a lot for my Healthcare .gov plan and get good benefits from my coverage instead of still paying a lot through my employer plans but with meh coverage and needing to pay $75/visit copay for mental health.
TLDR: Can someone give me parental/big brother/sister opinions of whether based on what I said I value most, if it is most smart to go with my current plan despite the highest premium? ��
Here are the plan summaries for more context. I calculate premium annual plus full deductible so get an ideal of the maximum coverage analysis. Besides the deductible and $20 premium difference, the coverage is the same … very confused why the lower premium, lower deductible is cheaper…knowing our system … I’m partially to believe there’s some gotcha or some corporate greed trick I don’t know about).
Company Plan Options:
Plan 1) Premium: $349.07/month. Deductible: $3,000. Premium Annual: $4,188.84 (+$3,000 Deductible = $7,188)
Plan 2) Premium: $369.76/month. Deductible: $6,000. Premium Annual: $4437.12 (+$6,000 Deductible = $10,437.12)
Both plans offer:
$25 PCP Copay
$75 Specialist Copay
$50 Urgent Care (Deductible does not apply)
40% Coinsurance Emergency Room Care
40% Diagnostic/Imagery (X-ray, blood work, CT/PET Scan, MRI)
$10 Medication Copay
$75 Mental Health visit (Deductible does not apply)
Current Plan) Premium: $467.32/month. Deductible: $1,500. Premium Annual: $5,607.84 (+$1,500 Deductible = $7,107.84) (This is w/o my tax credit)
My Plan offers:
$0 PCP Copay (Deductible does not apply)
$75 Specialist Copay (Deductible does not apply)
30% Diagnostic/Imagery (X-ray, blood work, CT/PET Scan, MRI)
30% Coinsurance Emergency Room Care
$0 Preferred Generic Medication
$15 Generic Medication
$0 Mental Health Visit (Deductible does not apply)
