Please help me choose a medical insurance plan.

June 3, 2012 12:34 PM

Please help me choose an insurance plan.

I'm really dumb about these things and as a result we currently have shitty insurance coverage.

Us: 2 adults and a kid. 1 adult has chronic health problems. Multiple family members need mental health services. We have consistent prescription needs. Kid probably needs speech therapy.

I THINK that nearly every provider will be in-network, as these are the state provided plans. Mental health/speech may be exceptions though. Hard to say at this point. With a small kid, urgent care visits happen a few times a year. (Note that is is possible that 1 adult won't be on this family plan.)

I made a spreadsheet of what the member pays for each the plans and our projected costs for services (and this is the official information).

It seems the the annual cost and monthly cost on the plans isn't too different. The total cost of predicted health care is in the $400 range monthly for each plan.

But if some wiser MeFites can point out some flaws or perhaps say "OMG, choose X because of this little thing that you didn't notice," it would be greatly appreciated.

What am I missing here?

posted by k8t to Health & Fitness (4 answers total)

Given that "the total cost of predicted health care is in the $400 range monthly for each plan", you should probably go for the plan that offers the lowest deductible and out-of-pocket maximum to cover yourselves in case of unpredicted health problems. If I were in your family's shoes, I would not go for a plan with an HSA unless you feel confident that you can pile up enough money in it to cover the % co-pays. For example, with this plan, you pay 10% in- or 30% out-of network on a lot of stuff, and the predictable stuff is one thing, but what about the unexpected? Do you feel financially ready for the unexpected? I personally would feel a lot more comfortable paying more for a plan like this where your costs are fixed.
posted by ThePinkSuperhero at 1:04 PM on June 3, 2012

Speaking of the HSA, I don't see on your spreadsheet the amount you'll be contributing to it- if you haven't rolled that into your monthly plan cost, you'll want to do so.
posted by ThePinkSuperhero at 1:10 PM on June 3, 2012 [1 favorite]

All I can tell you is to look very, very carefully at your prescription benefits to make sure that any out-of-pocket limits are actual limits. Caremark, for instance, is blithely telling me that because I require a brand-name drug when a (vastly less effective) generic is available, I will be charged the difference between the two, limit be damned. This has been a very nasty surprise that I would hate to see anyone else have to go through.
posted by corey flood at 1:30 PM on June 3, 2012

On the off-chance you are talking about UW, I recently had a chat with an HR person there who basically indicated that their best plan was the Group Classic (if I understood correctly, he said something about UMP being imposed upon UW employees because the legislature thought that the university had 'gold-plated' insurance and that UMP was crap, to paraphrase).

He didn't have much to say about the CDHP stuff, as it's new, but it doesn't sound like a good match for your family given your higher use of medical services.

The one thing I noticed, when comparing UMP and Group Health on the PEBB website, was how astonishingly often Group Health would request a flat fee and UMP would ask for a percentage; when it comes to hospital visits, you're going to come out way ahead if you're paying a flat fee of $80 rather than 15% (for example)! Thus, were I a high utilizer of medical services I'd pay the extra premium for Group Health. FYI, as an insurance novice myself, I found this UW page to be a helpful breakdown of all the terms used.
posted by librarylis at 9:11 PM on June 5, 2012 [1 favorite]