Health Insurance Questions.

[Tacori E-ring]

DH and I are both self-employed which is great except for one major thing...we have to buy our own health insurance (which can get expensive). It is very good insurance but we can only change our coverage once a year

so we are going to go ahead and add maternity now. My question is what seems like a good/common deductable? Also is it worth it to pay a little extra and get 100% coinsurance vs. 80%. Any advice would be so great since we only have the end of this month to make a decision. Yeah! Sometimes being a grown-up is hard

 

[chrono]

Well, it depends on how much extra a month you have to pay. If you are sure about gettting pregnant and having a baby in 2007, it is usually better to be covered 100% because there is the OB visits, physical therapist (if needed), lots of bloodwork and tests, hospital charges, delivery charges, well baby visits and immunizations, etc. The cost can add up, especially considering 80% vs 100% and the bills can add up to the thousands. What does your maternity cover? Is it 80% too?

My insurance is 90%/10% and I've already had to fork out $320 on my own for the OB visits, and probably a couple hundred for the PT too. I'm sure the hospital and delivery bill might be close to $1000. I wish my hubby's plan would have kicked in sooner. His plan covers 100% with only a $10 copay and it worked out that his is cheaper, (and his monthly cost was cheaper too

).

If you both are healthy and forsee no major surgery/illness, then usually the 80%/20% is sufficient.

 

[eks6426]

I would look to see what your out of pocket maximum is. My insurance is 80/20 but I have an out of pocket max of $1200. So after $1200 I would be covered at 100%. In your case since you would hit the out of pocket max with a baby you''d want to calculate whether paying for the 100% coverage or the out of pocket max is cheaper.

Also, can you do a healthcare flexible spending account so you can set money aside for medical expenses pre-tax? It''s a use it or loose it thing so calculate carefully. If your future child will be in daycare, you can do a dependent care account too...up to $5000 per year.

 

[Tacori E-ring]

Thank so much for both of your replies!

Chrono: I like to think of myself as healthy. I have had a lot of ovian cysts but besides that I have never been in the hospital (except for well visits of course) but I guess you never really know huh?

IS: We are planning on not doing daycare (since we are both self-employed it shouldn''t be a problem). Also we can write off all the money (including monthly payments) anyways since we are SE so I am not sure a HSA would be worth it. I really have no idea though.

To add maternity is an *extra* $300-$400 a MONTH. Think of all that bling

. I was thinking of a $1000 deductable with 80% coinsurance and $15/$30 for drs visits. According to them all I would pay is the drs co-pay, deductable, and then 20% To change the exact plan to 100% is an extra $60 a month. We go want to get preggo sometime in 2007 so maybe it is worth it to go $60 a month more and pay less in the end. Of course to lower my deductable to $500 is only $20 more than the last plan, $80 more than the first. See how confused I am!

 

[chrono]

Wow, the added maternity option is sure expensive!

$1000 deductable means you will pay 100% until you hit the $1k mark, then the insurance will cover 80% of the medical bills. Does the $15/$30 co-pay count towards the deductable? What is your Out-of-Pocket max? If it is low, that''s fine. If it is in the thousands, it isn''t worth it.

Wow, it sure isn''t much to go upgrade to the 100% coverage. Is this $60/month figure in addition to the $400/month maternity option? I guess everything depends on your Out-of-Pocket max. If the amount is high, then the obvious choice is to go with the 100% coverage.

 

[Tacori E-ring]

I am not sure what my out of pocket max is. Is that the same as the deductable?

 

[chrono]

No, the deductable is different from the out-of pocket max.

Let's take a look at this health plan A as an example.
$0 deductable: pay nothing extra for the insured 80% coverage to kick in right away
80% covered: Plan pays 80%, I pay the remaining 20%
$1K Out of pocket max: Once my total out of pocket (20% I've been paying) hits $1K, the insurance company will pay 100% of the remaining bills.

Let's take a look at this health plan B as an example.
$500 deductable: I am required to pay 100% of all medical bills up to a total of $500 before the insured 80% coverage applies
80% covered: Plan pays 80%, I pay the remaining 20% after the deductable is met.
$1K Out of pocket max: Once my total out of pocket (20% I've been paying) hits $1K, the insurance company will pay 100% of the remaining bills.

Is my explaination clear? I'm not very good at writing down my thoughts.

 

[Tacori E-ring]

Okay I just talked to an insurance broker. He suggest instead of adding a traditional maternity policy which is $$$$, a supplimental policy that will cover labor & delivery (basically it covers hospital stays) It is only $70 a month but we would have to cover all x-rays, sonagrams (sp?) basically everything except the labor. He said we would save money in the long run for sure but insurance is about peace of mind and there is no right or wrong way. Is this something that is worth it? How many sonagrams do you have? I guess I have to find out how much out of pocket they are.

 

[movie zombie]

please don''t forget that things don''t always go according to plan and there can be complications that increase the costs. if anything could go wrong, it did go wrong when i was pregnant many years ago.....and i shutter to think what out of pocket expenses would have come to.

movie zombie

 

[sevens one]

Date: 11/13/2006 7:48:31 PM
Author: movie zombie
please don't forget that things don't always go according to plan and there can be complications that increase the costs. if anything could go wrong, it did go wrong when i was pregnant many years ago.....and i shutter to think what out of pocket expenses would have come to.

movie zombie

Amen to that!

Get as much coverage as you can with the least out of pocket expense for dr/hosp bills. When I had Angello- that little guy racked up the bills. Every time he went through the hosp doors it cost me $500. So needless to say- it got pretty ugly.
He was hospitalized for six weeks after he was born = $460,000 (yikes) Can you imagine forking over 20% of that?
and that was only the first of many hospital stays.

I call him my million dollar baby.

I don't want to be a downer but you just never know how things will turn out. It's so much better to be covered.
The last thing you want to worry about when a loved one is sick is "how are we going to pay for all this?"

 

[Tacori E-ring]

Thanks for all the advice. After talking to BOTH sets of parents we have decided to go the traditional route (adding maternity) Yes it will be a big expense per month but like you both mentioned things don''t always go according to plan. My younger brother was 3 months early, had to have blood, surgery, and was in the ICU for three months. Very few people could afford that w/o proper insurance. Plus my mom said I would be pissed I was gaining weight, pissed my ankles were getting puffy, pissed I would be feeling bad, ex...the last thing I will need was being worried when the Dr wanted an extra blood test or sonagram. Not worth losing sleep over. So I think I have decided on a policy that has $1,000 deductible/100%/and $15/$30 Dr co-pays. I could drop the deductible to $250 with 80% coverage for $5 difference a month but I think I rather know what I am going to pay upfront (like sevens mentioned)

 

[:)]

Hi Tacori - a thought for you - if you already know the OB that you want, make sure the plan you select includes that OB on it. This is probably a good way for you to select a plan - pick the doc first, then evaluate the plans which include the doc.

 

[Tacori E-ring]

Date: 11/13/2006 9:42:08 PM
Author:
Hi Tacori - a thought for you - if you already know the OB that you want, make sure the plan you select includes that OB on it. This is probably a good way for you to select a plan - pick the doc first, then evaluate the plans which include the doc.

Luckily the health insurance I have doesn''t have a "network." I can go to any doctor but that is very good advice.

 

[:)]

Oh, good! As much as it sucks to have to pay so much, it is probably worth it in the long run to have peace of mind if anything happens to your little Tacori-ette in utero or during delivery (or after it for that matter) that it will all be taken care of. Also probably good peace of mind for your husband to know that you will be well cared for too!

 

[Tacori E-ring]

Date: 11/13/2006 10:01:50 PM
Author:
Oh, good! As much as it sucks to have to pay so much, it is probably worth it in the long run to have peace of mind if anything happens to your little Tacori-ette in utero or during delivery (or after it for that matter) that it will all be taken care of. Also probably good peace of mind for your husband to know that you will be well cared for too!

Oh a little Tacori-ette....so cute. I am glad I looked into my options though. Now I feel much better about our decision. DH is confident we can swing it. At least it is a tax write-off!