Need help choosing a plan as my medical needs will change drastically in the new year
What is potentially the most financially advantageous plan for my family?
My company offers a LOT of different health plans (for my purpose they're all UHC) and it's super confusing. I could use some help choosing one because my needs have changed.
Family of 4 in WI. Sole provider, paid 26x a year (bi-weekly). Medical needs are as follows:
Me: Surgery ($10k pre-insurance), mental health: flat $600/year, one non-covered prescription $30/month via good rx, autoimmune disease that requires blood work a couple times a year.
Spouse: Surgery ($1k pre-insurance), mental health: flat $1,200/year, 2 covered prescriptions $50 and $280 pre-insurance.
Dependents: one will need physical therapy for a joint condition as well as mental health services at a flat $600/year, the other is healthy and only goes for covered wellness visits.
I have the means to max out the HSA if I choose one of the HSA plans. I also have a healthy emergency fund that exceeds the full OOP Max on any of the 4 plans. The surgeries are not emergencies and can be scheduled at any point in the year if that makes any difference.
We had plan 3 this year and as of today have spent $400/$800 for my deductible ($1,072 OOP), $225/800 for my spouse's deductible ($977 OOP) and pretty much nothing on the kids ($200 oop between the 2 of them).
The providers would be in network and the coverage/costs are as follows:
Plan 1 Plan 2 Plan 3 Plan 4 Cost per pay period $67.95 $110.77 $338.51 $537.33 Deductible (Individual) $800 $250 Deductible (Family) $4,900 $3,200 $1,600 $500 OOP Max (Individual) $3,600 $2,300 OOP Max (Family) $7,800 $7,600 $7,200 $4,600 Coinsurance (Insurance Pays) 75% 75% 75% 85% HSA Yes Yes No No Annual Premium Cost $1,766.70 $2,880.02 $8,801.26 $13,970.58 DETAILS ABOUT COVERAGE Preventive Coverage Free Free Free Free Prescriptions (Tier 1 / 2 / 3) 75% After Deductible 75% After Deductible $10/$40/$60 $8/$30/$50 Out Of Network Coverage yes yes yes check with carrier
Plans 1 and 2: Coinsurance will not begin for any family member until the family deductible is met. The entire family out-of-pocket maximum must be met before your insurance will pay the full cost of covered charges for any covered family member. All medical and prescription drug amounts you pay will count toward the out-of-pocket maximum.
Plans 3 and 4: Coinsurance begins for each covered person after his/her individual deductible is met. Additionally, coinsurance starts for any covered family member once the combined family deductible amount is met. Once a covered family member meets the individual out-of-pocket maximum, your insurance will pay the full cost of covered charges for that family member. Medical and prescription drug copays and amounts you pay as coinsurance will count toward the out-of-pocket maximum.
submitted by /u/ShesAPlantEater
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