Open Season Health Insurance

[Anonymous]

I hate that I have to shop for insurance....

Right now we are on BCBS as a family and the premiums are high. $770 a month. DH wants to switch to MHBP (Aetna) which is $472 a month. We rarely go to the doctor, just annuals and I have a few specialists. We rarely go to Urgent Care even. The copayments are the same for Urgent Care, Specialist and PCP. All of our doctors are under both plans. The deductible for BCBS is $0 and MCPH is $700. What worries me is the copayment for a hospital visit. BCBS is $350 and MHBP is $200+10% of services. So if someone needs surgery and it costs $100,000, we're out $10,200.

Am I wrong? Any opinions or experiences?

[Anonymous]

What’s the out of pocket max?

[Anonymous]

Just that $770/month for a family is amazing - our family pays $2514/month.

And, because you are rarely sick, doesn't mean you will always be rarely sick. Over the years our kids have had broken bones, sprains, eye injuries, and I have a teenage nephew with lymphoma who was an incredibly healthy athlete, until he wasn't.

I would stick with BC/BS

[Anonymous]

well, if no one needs surgery, in 33 months you've saved $10,000.

So one thing you could do is put 300/mo in a separate high yield account and have that be your emergency fund for medical expenses?

[Anonymous]

It’s 10% of the allowable costs, so if the surgery “costs” 100k but the negotiated price for insurance companies is $35k then your share is $3500, which is basically the difference in premiums between BCBS and MHBP anyway.

But yes that is the downside. It is limited by the out of pocket max though.

[Anonymous]

Anonymous wrote:It’s 10% of the allowable costs, so if the surgery “costs” 100k but the negotiated price for insurance companies is $35k then your share is $3500, which is basically the difference in premiums between BCBS and MHBP anyway.

But yes that is the downside. It is limited by the out of pocket max though.

OOO thank you, it says

Standard Option
• $6,000 for Self Only enrollment ($12,000 for Self Plus One or Self and Family enrollment)
for covered services and drugs from Network providers/facilities and pharmacies, combined.
Only eligible expenses for Network providers/facilities and pharmacies count toward this
limit.