Choosing between OAP and QCHP (and possibly CDHP)
I’m changing to a state job next month. Family situation: -Me (relatively healthy, unlikely to meet max OOP) -6 year old child (major health issues, will always hit annual max OOP) -Husband (moderate health issues, type 1 diabetic, may meet annual max OOP).
All of the plans require that each individual family member “has to meet their own OOP limits until the overall family OOP limit has been met.”
The OAP offered will cost $5232/year. It has no deductible, individual max OOP $3k, family max OOP $6k.
The CDHP premiums will costs $4,788/year. High deductible, but same max OOP as the OAP plan above.
For OOp maximums… in theory, my kid will his $3k OOP really quick, husband and I may or may not meeting $3k at any point. So if kid meets his OOP limit, but if neither husband nor I don’t reach $3k each, the $6k family limit never applies? So after $3k spent on kid, we won’t pay any more for him during the year. But if husband and I each accrue costs of say $2,999 each during the year, that’s it’s. We’ve essentially paid $8998 out of pocket that year, right? But if both husband and child reach $3k individual, and I’ve barely spent anything, then all three of us are paid out for the year.
Or am I misunderstanding something?
The third option is a QCHP. Premiums will be $6648/year. Individual max OOP is $1750 and family max OOP is $4375.
What should I do with each family member having unique needs? If it was an aggregate family OPP max it’d be an easy choice as my kid alone will hit the family max OOP every year. But since we all need to meet it… should I chose the OAP with no deductible since my healthcare is cheap and my husband’s is moderate? Or go with a high deductible CDHP (side note, I’m not sure if we could get an HSA, as my husband technically has healthcare through the VA which has been unhelpful, and kid has ChampVA)? Or go with the QCHP that has the lowest individual and family max OOP (even knowing I’m unlikely to meet the lower OOP max either, but husband is more likely to hit $1750 than $3k)?
For what it’s worth, it’s all run by Aetna and ALL of my child’s providers (he sees some locally as well as several in two different major cities) are “in network” with each plan. For husband and I, we can be flexible about who we see to stay in network, but I verified my kid’s providers because we’re very picky about his specialists.
Sorry this is so long… I’m just afraid of making a stupid decision.