Major medical decision - & 1 hour to make it!
OhioGuy
and we only have 2 hours to make it.
Long story short, the union where she works voted to approve a new
insurance plan for the next year. They had provided us with insurance info
that was "tentative" and still being negotiated. As such, the numbers were
not finalized, and I told my wife that until we got the final numbers for
the different plans being offered, we couldn't do a real comparison.
Well, yesterday the employees voted to approve the plan, and today they
told my wife she had to fill out and submit all the paperwork forms by 4 PM
TODAY - yes - TODAY - if we wanted to remain on the old traditional PPO
(Blue Cross/Blue Shield) insurance.
The board where she works has pretty much decided that everybody should
automatically be switched over to a new Core PPO/HRA plan, unless they opt
out.
The main difference: employee share for traditional PPO plan more than
doubles - increases from $206 a month (family coverage) to $471 a month.
My wife has a number of health issues, and I think we spend just over
$3K - maybe $3,500 a year, when I look at the amount the insurance actually
paid the doctors and such.
The traditional PPO plan covers everything except a $10 to $20 copay we
paid for meds, and $20 copay we paid for Dr. visits.
New high deductible plan they want to "sweep" everybody into covers the
first $1,000 annually, but leaves us to pay all medical costs from $1,000 to
$3,000 - in other words $2k out of pocket if we spend $3,000 annually. Then
it will cover everything over that.
Considering our average annual health costs, this means that if we have
about $3,500 in spending next year, here is what we would spend under the
two plans:
Traditional PPO: $471 a month out of pocket, or $5,652 out of pocket a year
in premiums to have everything but copays covered. If we have $3,500 in
expenses, this means we pay $5,652 to get $3,500 back this year. Last year
it would have cost us only $2,424 in premiums to get this same coverage. (so
it was like getting a $1,000 return on our "investment") This year, it
would be like losing $2,100 on a $5,652 investment, unless our costs were
significantly higher - which has happened in the past.
High Deductible HRA/PPO: $206 a month out of pocket, or $2,472 a year. It
seems much more complicated. If we have the same expenses as last year,
they would pay the first thousand, we would pay the next $2,000, and they
would pay the next $500. (out of $3,500) So our total out of pocket
expenses for the care would be $4,472. For that "investment", we would be
reimbursed for the first $1,000 in expenses, plus $500, for a total of
$1,500 we would get back
Last year, the traditional PPO was an obvious good choice. We paid about
$2,400 and got about $3,500 worth of medical bills paid.
This year, that looks like a bad investment: we'd spend about $5,600 to
get the same $3,500 in medical bills paid.
The high deductible plan appears to be a mixed bag, though, and I'm not
sure exactly how to calculate the results. It looks like we would spend
about $4,500 to get the same $3,500 in medical bills paid.
When you look at it as a return on investment:
Last year trad PPO: 45% return on investment
This year trad PPO: - 37% return on investment
This year high deductible: -22% return on investment
So we're looking at a negative return on our investment either way! It
seems that we have only 2 choices - a bad choice, and an even worse choice
for our family.
Part of this issue, according to her employer, is because the employee
pool where she works uses much more medical than most groups. As such, when
they tried to shop around, they were completely turned down by many
providers, who would not even provide a quote.
I'm almost convinced that we should drop the insurance she gets through
work and go out on the open market. The only thing that tells me that would
be a bad choice is the fact that her employer says they are paying 80% of
the premiums.
According to them, traditional PPO family coverage for each family costs
$1,300 per month, of which they are willing to pay $825. The new high
deductible HRA costs $1,031 a month, of which they are willing to pay $825
worth. You can see that they are offering 80% if we will switch over to the
high deductible plan, but only 63% if we stick with the old plan.
Anyone have any ideas on this? What really 'sticks in my craw' is that
they just voted on whether to approve these numbers yesterday. (my wife
voted no - she agreed that the union needed to try to get better terms)
Then when she came in to work this morning, they told her she not only had
to make a decision between the two plans, but also fill out several forms
and get them in by 4 today! I find that unreasonable, and here I am at home
crunching numbers on it, only to find out that both options are rather bad
for us!
I particularly don't like how the new plan could stick us with an
unplanned $2K in medical expenses, while this was never a possibility under
the old plan.
While under the new plan the library still "appears" to be paying 80%, the
fact that they offload $2k in costs to us really means they aren't. I'm not
sure what it would bring the percentage down to, but it's probably more in
line with the 63% they are paying with the traditional plan.
I'm so confused at this point, I really don't know which way we should go,
and we need to make a decision in the next hour or so. Help!
AllEmailDeletedImmediately
"OhioGuy" <no...@none.net> wrote in message news:fq9dv4$n5h$1...@aioe.org...
> My wife and I are facing a HUGE insurance decision to make for our
> family, and we only have 2 hours to make it.
>
how likely is your wife to have complications, etc? since it's obvious
that the company wants you in the other plan, maybe refuse to screw them?
that should give you enough time (1yr?) to decide if you want to switch next
yr. or just decide to go with the new plan, stick the 2k in the bank and
leave it. will you be able to switch back to the old plan if you do that?
dh's company doesn't give us much time to make decisions either. i have a
feeling that crap is really going to change this yr.
hchi...@hotmail.com
New plan. Deal with the $2K.
Same thing I've said before, get a plan on your own when young and
healthy, stick with it, and don't fool with insurance from the
employers.
SpammersDie
> $2,400 and got about $3,500 worth of medical bills paid.
>
> This year, that looks like a bad investment: we'd spend about $5,600 to
> get the same $3,500 in medical bills paid.
>
> The high deductible plan appears to be a mixed bag, though, and I'm not
> sure exactly how to calculate the results. It looks like we would spend
> about $4,500 to get the same $3,500 in medical bills paid.
>
> When you look at it as a return on investment:
>
> Last year trad PPO: 45% return on investment
>
> This year trad PPO: - 37% return on investment
>
> This year high deductible: -22% return on investment
>
>
> So we're looking at a negative return on our investment either way! It
> seems that we have only 2 choices - a bad choice, and an even worse choice
> for our family.
>
> Part of this issue, according to her employer, is because the employee
> pool where she works uses much more medical than most groups. As such,
> when they tried to shop around, they were completely turned down by many
> providers, who would not even provide a quote.
>
> I'm almost convinced that we should drop the insurance she gets through
> work and go out on the open market.
If those health issues were expected to continue generating a "positive ROI"
on your um, "investment", you'd be wise to stay off the open market. The
nice thing about group insurance is that you get the less risky members of
the group to subsidize you and your individual circumstances won't get
looked at too closely. On the open market, the insurer (who is the real
investor here) will evaluate the risk based on your individual circumstances
and rest assured, insurers are in business so *they* make the positive ROI,
not you.
(The flip side is, of course, that your employer may eventually decide that
you represent a negative ROI for them.)
Al Bundy
My guess is that if you select or get sweeped into the new plan, you
(wife) will somehow find a way not to see the doctor quite as much.
When it's your nickel, I can almost guaranteeeee you will tighten up
your game.
AllEmailDeletedImmediately
"Al Bundy" <MSfo...@mcpmail.com> wrote in message
news:beb6f599-1bf8-470f...@s13g2000prd.googlegroups.com...
>snip
> My guess is that if you select or get sweeped into the new plan, you
> (wife) will somehow find a way not to see the doctor quite as much.
> When it's your nickel, I can almost guaranteeeee you will tighten up
> your game.
which may or may not be a good thing, depending upon her existing problem.
Shawn Hirn
>
> I particularly don't like how the new plan could stick us with an
> unplanned $2K in medical expenses, while this was never a possibility under
> the old plan.
>
> While under the new plan the library still "appears" to be paying 80%, the
> fact that they offload $2k in costs to us really means they aren't. I'm not
> sure what it would bring the percentage down to, but it's probably more in
> line with the 63% they are paying with the traditional plan.
>
> I'm so confused at this point, I really don't know which way we should go,
> and we need to make a decision in the next hour or so. Help!
Considering that your wife has a pre-existing medical condition, you
ought to jump at one of her employer's plans. If you go out to buy a
private policy, you'll be reamed six ways to Sunday, and may not even
find coverage at all due to your wife's medical problem.