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Health plan advice needed; Kincaid, are you out there?
Topic Started: Nov 30 2009, 07:46 PM (196 Views)
1hp
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Fulla-Carp

It's open enrollment time through my wifes work. Options are:

1. Healthnet - cost $6,042/year with out of pocket maximum of $1,500/individual

2. Kaiser - cost $1,250/year with out of pocket maximum of $1,500/individual

3. PPO option 1 - cost $4,460/year with out of pocket maximum of $1,250/individual; emergency room and hospital plan only really pays 85% of costs.

4. PPO option 2 - cost $1,800/year with out of pocket maximum of $2,500/individual; emergency room and hospital plan only really pays 80% of costs.

The copays, and deductibles look to be more of a distraction unless you go to the doctor's office once a week.

I'm not 100% conversant in the language - does out of pocket maximum imply that for numbers 3 and 4, I would only pay the 15% or 20% for emergency room until I had reached the out of pocket maximum, then the plan pays 100% after that?

Only likely scenario that would put us all in the hospital is a car crash (four out of pocket maximums adds up fast), but I believe my auto insurance medical would pick up the stuff not fully covered (ie auto insurance would be secondary medical insurance) - does that sound right?

Any other comments? I'm actually thinking of going for PPO option 2, though I have started looking at the local Kaiser facilities.

There are 10 kinds of people in this world, those that understand binary and................
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apple
one of the angels
it would be nice if you could talk a good insurance agent... could you be referred to your wife's work's agent?... for questions?

ours is invaluable.. he suggests new companies if one is better.. he explains how the plans work.. our costs are the same.

we found the best in the area by word of mouth.

Most plans specify whether they are an 80/20, a 70/30 or 100% of all costs after the copay (and deductible is met)... you really have to read the fine print.. can you get copies of the plans?

Edited by apple, Nov 30 2009, 07:53 PM.
it behooves me to behold
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1hp
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Fulla-Carp

I don't have details, just plan summary tables. I'm guessing from what you are saying, and re-reading the tables that PPO option 1 is an 85/15 plan, and Option 2 is an 80/20 plan. It states that the plan only pays 85% (or 80% for the option 2) after deductible is met - what's confusing is that at the beginning it talks about an out of pocket maximum - I'm guessing from what you wrote that the 80/20 doesn't get affected by the out of pocket maximum?

Don't think we have access to my wife's company's agent, but she will ask - that was a good suggestion.
There are 10 kinds of people in this world, those that understand binary and................
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Jolly
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Geaux Tigers!
<BUMP>
The main obstacle to a stable and just world order is the United States.- George Soros
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Kincaid
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HOLY CARP!!!
I'm in claims (and liability at that), so I have about as much knowledge anyone off the street regarding health plans. The HR person should be able to answer your question.

Two things though:

1. We have Kaiser and love it.

2. I checked with a neighbor that sells life insurance (I know, it's maybe not exactly the same as health insurance) and she did not even bother giving me a quote, just saying that nothing anyone can offer can even come close to an employer health plan for overall cost.
Kincaid - disgusted Republican Partisan since 2006.
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1hp
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Fulla-Carp

The only issue is that I will have a daughter leaving for college next September, and after looking at the Kaiser website, it is unlikely there will be any Kaiser facility close to where she ends up. Have you ever used Kaiser in a part of the country that has no Kaiser facilities?

Believe my wife is leaning towards PPO option 2 - that way we can keep our current doctors.

Yeah, the cost is ok. A colleague who is unemployed and has to buy his own health insurance told me he is paying $900 a month for him, his wife, and baby.
Edited by 1hp, Dec 1 2009, 03:07 PM.
There are 10 kinds of people in this world, those that understand binary and................
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Jolly
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Geaux Tigers!
Make sure the PPO has a major medical provision.

100 grand is not hard to do with a CABG or other major surgery...
The main obstacle to a stable and just world order is the United States.- George Soros
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Rainman
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Quote:
 
1hp:
emergency room and hospital plan only really pays 80% of costs.


WARNING WILL ROBINSON!!!!!!!
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Kincaid
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HOLY CARP!!!
We've never had to confront medical treatment out of the area. Crossed fingers.
Kincaid - disgusted Republican Partisan since 2006.
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