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Old 12-06-2017, 04:51 PM   #1
Join Date: Sep 2001
Location: Houston TX
Posts: 1,837
Our new insurance

I am on my wife's insurance policy offered by her employer. Every year the insurance renews on December 1st and there are usually a few changes to consider. This year the changes were large; the company has new ownership and this year they offered 2 different plans which was nice as it gave us a bit more choice. The problem is that the company is small and the employees are either older like my wife or young and with families, both drive up the costs.

Plan 1 or the Gold Plan was not too different from what we have had in the past. My wife would pay about $1000 per month, the company also kicks in about that much and that covers her and me. The deductible is $1200 per person and they offered an 80/20 copay on procedures, lab work and hospitalization. The doctors copays are $35 for a GP and $55 for a specialist and the drug tiers were $15/$35/$55/$105. We take mostly Tier 1 and 2 but I do have 1 Tier 3 asthma drug. While the month to month costs are not too bad in the event of a major hospitalization we would still end up having to pay the 20%. When my wife had her stroke the bills were over $40,000 but luckily that year her insurance paid 100% after meeting the deductible which they don't offer now.

Plan 2 or the Silver Plan was more of a high deductible PPO. Her company would pay all the premiums for us so no paycheck deduction which is good but the deductible is $5000 per person which could be bad. But they offer an HSA with this and due to an IRS rule that because we are moving to this plan in December we can fully fund the HSA this month and get the tax benefit which we really need due to all the bonus and stock money we got this year. I think she can put in $7750 this month. Then each month next year she will put in around $645 per month to fully fund it again which is less than her old insurance premium was. They company will also give $500 towards the HSA. There are no drug tiers or Dr. copays until you reach your deductible, then everything is paid 100% as well as hospitalization and procedures and lab work.

Also offered is a fairly good plan for dental and vision which is cheaper than in past years. They are offering an FSA plan that can only be used for dental and vision but at least we can put pretax money into that and use it for procedures. I think the FSA can only carry over $500 per year so we are funding that a bit more carefully but we do plan to try to get some needed dental work done before she retires and looses that benefit.

She did the homework, several spreadsheets based on past years medical expenses and decide Plan 2 was the better one for us. This was mainly due to the HSA which will save us on taxes and that instead of paying $1000 monthly premiums we are instead building a health savings account which can be used for all medical expenses towards our deductible and is ours to keep. The other thing is with this plan, doctors visits, procedures, etc. are at an agreed rate within the network so the cost is not like if you had no insurance. Today I paid $180 to see the orthopedic Dr. and with the other plan it would have been $55. But that will come out of my HSA. If it weren't for the HSA and the fact that we are in a financial position to fully fund it for this year in one month we probably would have picked the other plan. My wife things her 2 paychecks for December will amount to less than $800! But it's only one month.

My wife is eligible for Medicare but the company insurance is better since we are both covered. She plans to work until the end of the year she turns 70 and then switch to Medicare with a supplemental plan. I will be 64 so will only have to find coverage for a year until I am eligible. Hopefully by then the Republicans won't have destroyed Medicare.

The crime is that we have to do all this shit and it still costs so much. My family and friends in Australia, Canada and the UK will admit that their National Health has it's limitations but is no where near as costly. We are the only first world nation that still uses an outdated model where employers provide insurance.
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