Help Choosing Insurance Plan Between Spouses
I started a new job after a gap in employment and my spouse and I can now analyze which coverage option is best for us and our child.
Our employers do not have restrictions on insuring a spouse who is eligible for insurance through their own employer, so both of us are free to insure the entire family if that is the best choice.
Spouse and I typically only go to the doctor for preventable care. Our child is three and goes for wellness visits and will likely go for the various illnesses toddlers are prone to get.
Any help in determining who should insure our child, if one or the other should insure the entire family, or if we should insure ourselves, and which plan to select considering those insuring options. I realize this is a ton of variables, but any help is appreciated.
My insurance options:
Gold Plan Overview Monthly Premium: Employee Only $71.50 monthly; Family $228.80 monthly Deductible (Single/Family): $1,000 / $3,000 OOP Max Including Deductible (Single/Family): $3,000 / $9,000 Coinsurance: 10% after deductible Office Visit Copay (Primary Care Provider and Specialist): $30 / $40 Emergency Room: 10% after deductible Outpatient Surgery: 10% after deductible Inpatient Stay: 10% after deductible RX (Retail): $10-55
Coverage of all preventive care services at 100%. The emergency room benefit is the same in-network and out-of-network. Deductible, coinsurance, and all copays are applied toward the out-of-pocket maximum.
For a family, once three individuals in the family meet the annual deductible ($1,000 each) in a plan year, the deductible is satisfied for the entire family. At that point, the plan will pay for 90% of eligible services for the remainder of the plan year for all family members.
Once three individuals in the family meet the out-of-pocket maximum ($3,000 each) in a plan year, the plan will pay for 100% of eligible services for the entire family.
Silver Plan Overview Monthly Premium: Employee Only $12.12 monthly; Family $38.80 monthly HSA Contribution: $500 Deductible (Single/Family): $3,000 / $4,400 OOP Max Including Deductible (Single/Family): $4,500 / $9,000 Coinsurance: 20% after deductible (for all medical visits and all RX)
Coverage of preventive care services at 100%. The emergency room benefit is the same in-network and out-of-network. Deductible, coinsurance, and all copays are applied toward the out-of-pocket maximum.
For a family, no one member exceeds $3,000 in a year. Once a combination of all members reaches $4,400, the deductible is satisfied for the entire family. At that point, the plan will pay for 80% of eligible services for the remainder of the plan year.
Once two individuals in the family meet the out-of-pocket maximum ($4,500 each) in a plan year, the plan will pay for 100% of eligible services for the entire family.
Spouse Insurance Options:
Spouse Premiums: Employee Only: $45.44 monthly Employee+Child: $169.96 monthly Family: $299.08 monthly
Numbers are based on staying in network.
Deductible (individual/family): $600/$1,200 OOP: $6,600/$13,200 Preventative: covered 100% Primary care: $40 copay (primary-virtual covered 100%); $80 copay (specialist); $60 copay (urgent care) Hospital care: $750 copay (inpatient child) 35% after deductible (inpatient/outpatient adults); $350 copay (outpatient child); $1,500 copay maternity labor and delivery Emergency room: $100 copay (child); 35% after deductible (adult) Diagnostics: 20% RX: copay based between $15-$90
submitted by /u/colkaivcyp
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