Reply to High Deductible Health Insurance Plan

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[quote=Anonymous]First of all, Basic is one of the best health plans out there, well, after Standard. They are expensive for a reason. You have excellent coverage and you pay little during DR visits. Surgeries and such are also covered quite quell. In the same boat, so totally understand what it means to leave such a plan. Sorry you have to go through this.

If you know your medical services utilizations then it is easier to do the math about high-deductible plans. Say for Basic you pay 500 premiums per month. Then 6K per year. There is still some out-of-pocket, but a dr visit is 20 or 30 for specialist vs. paying the full price - 150-400 per visit depending on the type of specialist. So let's say you pay 1000 extra out of pocket for annual medical services for the Basic - it comes to about 7K total out of pocket.

High-Deductible Plan would be say 200 per month. So 2400 per year. But you have 4000 deductible. This means, you will be paying 4000 out of pocket (excluding any preventative services). Since Obamacare, all preventative is FREE for high-deductible plans. Annual Physical is free, but the blood work you will have to pay out of pocket - some blood works go 500-600 out of pocket. Especially watch out these Vitamin D tests. So, if you manage to spend up to 4000 out of pocket for the year, and then 2400 cost, you are 6400 vs. 7000 for the Basic. If you spend more than 4000, then you get lower costs - you will be paying typically only 30-40% of the service fee. So office visit is 80 and not 200 after you hit deductible. Companies have all sorts of hoops what qualifiers against deductible. Especially under a Family Plan. You have to make sure 4000 deductible is for the full family and not for a single member on the plan.

Biggest issue is paying upfront and full price until you reach the deductible. If you have kids then a visit to PM Pediatrics for example is 140 on a high-deductible plan vs. 25 on Basic. However, if you are relatively health and do not use medical services, high-deductible plans work well. You pay for what you use and pay a much lower monthly premium. I am not 100% sure how high-deductible will work if you need surgeries and hospitalizations. You will need to read all brochures and details.

In short, when you decide, try to make annual out of pocket comparisons to the best of your knowledge. Most plans have in-network and out-of-network coverage. When I was on a BCBS high-deductible plans, network was the same as on an older PPO plan. You can check networks on each company website - use the Find a Doctor search usually. [/quote]

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