Just relocated to NYC and need to choose United health care plan.
September 22, 2014 7:43 AM Subscribe
My wife and I were relocated to NYC a month ago and we need to decide by the end of the month, which medical insurance plan we should sign up for.
Hi Metafilter, i have been and avid reader for more than 10 years, this is my 1st ask.
My wife and I were relocated to NYC a month ago and we need to decide by the end of the month, which medical insurance plan we should sign up for.
The options we got from her HR company are all UHC group coverage.
We are finding it hard to decide which plan to get as we are trying to get pregnant and so far no luck.
We are normally in great shape taking no meds, but we are in our late 30s and mid 40s.
The $940 premium plan is way over our budget, so we need to decide between the Standard ($0) and Enhanced (~$540) which we could squeeze in to our budget but will eat into our savings.
We are clueless about the US health system so please keep it as easy to understand as possible.
Any help will be much appreciated.
Thanks!
Hi Metafilter, i have been and avid reader for more than 10 years, this is my 1st ask.
My wife and I were relocated to NYC a month ago and we need to decide by the end of the month, which medical insurance plan we should sign up for.
The options we got from her HR company are all UHC group coverage.
We are finding it hard to decide which plan to get as we are trying to get pregnant and so far no luck.
We are normally in great shape taking no meds, but we are in our late 30s and mid 40s.
The $940 premium plan is way over our budget, so we need to decide between the Standard ($0) and Enhanced (~$540) which we could squeeze in to our budget but will eat into our savings.
We are clueless about the US health system so please keep it as easy to understand as possible.
Any help will be much appreciated.
Thanks!
Usually HR will have some kind of a worksheet that you can work through to figure out the total annual cost to you to of the various plans. I would ask about that.
However, looking at those plans, as long as you are going to be sticking with in-network providers there is NO REASON AT ALL to go with the Enhanced or Premium plans. For in-network care, the only thing you save is $5-$10 co-pay per doctor visit, and even if you go to (say) 2 dr visits every week for an entire year, that is still only $1000 savings for the ENTIRE year. You'll be paying almost that much PER MONTH in additional premiums, so that is very much not worth it at all.
The only reason for the Enhanced & Premium options that I can see, is that if you are choosing a substantial part of your healthcare from non-network providers, there is a pretty substantial difference in the amount of deductible and co-insurance. If you were going regularly to a non-network doctor you might save some money by going with the Enhanced or Premium plans. That is probably the reason they offer those plans--because some employees want the option to go to non-network providers for whatever reason, and these plans might help those employees reduce their costs. Some people prefer to go that way because they have an established relationship with an out-of-network doctor or perhaps just for philosophical reasons, they want to keep the non-network option open. These plans are designed to allow for that choice, but you pay a LARGE premium for it.
As a new employee without any established doctors or hospitals you prefer, I would just choose the standard plans and then plan to use ONLY in-network providers.
Before you do that, you'll want to talk to your HR and get a list of providers in the area (it will probably be available online on a web site), check the specialties you are interested in, such as gynecology, and just make sure that in-network providers are going to work for you. But in general, United Healthcare is a large company, they will have many in-network providers everywhere, and especially that will be so in New York City. You shouldn't have any problem at all sticking with in-network providers.
When calling for an appointment with a new doctor or hospital, your standard question will be 'are you in-network for United Healthcare?' If they say yes, you're golden. If they say no, just choose another provider.
TL;DR: Choose standard plan, always use in-network providers.
Additional thought: Ask HR about opening a healthcare spending account and put some amount in it - $200, $300, $400/month, somewhere in that ballpark. (Your HR might have a worksheet for this, too--the idea would be to put exactly enough into this account annually to pay your actual annual medical-related expenses not covered by your insurance plan.) You can use this pre-tax money to pay for any medical expense not covered by the insurance--co-pays, hospital admission, prescriptions, etc. This would be a far more profitable way to spend extra dollars every month than paying the higher insurance premiums.
posted by flug at 8:50 AM on September 22, 2014
However, looking at those plans, as long as you are going to be sticking with in-network providers there is NO REASON AT ALL to go with the Enhanced or Premium plans. For in-network care, the only thing you save is $5-$10 co-pay per doctor visit, and even if you go to (say) 2 dr visits every week for an entire year, that is still only $1000 savings for the ENTIRE year. You'll be paying almost that much PER MONTH in additional premiums, so that is very much not worth it at all.
The only reason for the Enhanced & Premium options that I can see, is that if you are choosing a substantial part of your healthcare from non-network providers, there is a pretty substantial difference in the amount of deductible and co-insurance. If you were going regularly to a non-network doctor you might save some money by going with the Enhanced or Premium plans. That is probably the reason they offer those plans--because some employees want the option to go to non-network providers for whatever reason, and these plans might help those employees reduce their costs. Some people prefer to go that way because they have an established relationship with an out-of-network doctor or perhaps just for philosophical reasons, they want to keep the non-network option open. These plans are designed to allow for that choice, but you pay a LARGE premium for it.
As a new employee without any established doctors or hospitals you prefer, I would just choose the standard plans and then plan to use ONLY in-network providers.
Before you do that, you'll want to talk to your HR and get a list of providers in the area (it will probably be available online on a web site), check the specialties you are interested in, such as gynecology, and just make sure that in-network providers are going to work for you. But in general, United Healthcare is a large company, they will have many in-network providers everywhere, and especially that will be so in New York City. You shouldn't have any problem at all sticking with in-network providers.
When calling for an appointment with a new doctor or hospital, your standard question will be 'are you in-network for United Healthcare?' If they say yes, you're golden. If they say no, just choose another provider.
TL;DR: Choose standard plan, always use in-network providers.
Additional thought: Ask HR about opening a healthcare spending account and put some amount in it - $200, $300, $400/month, somewhere in that ballpark. (Your HR might have a worksheet for this, too--the idea would be to put exactly enough into this account annually to pay your actual annual medical-related expenses not covered by your insurance plan.) You can use this pre-tax money to pay for any medical expense not covered by the insurance--co-pays, hospital admission, prescriptions, etc. This would be a far more profitable way to spend extra dollars every month than paying the higher insurance premiums.
posted by flug at 8:50 AM on September 22, 2014
If you're confused about how the U.S. health insurance system works--which you probably very much are!--you might look at some resources like these:
posted by flug at 8:59 AM on September 22, 2014 [1 favorite]
- How does health insurance work
- Video explanation
- Good basic article
- Search for more similar resources
posted by flug at 8:59 AM on September 22, 2014 [1 favorite]
I agree with doing the standard plan for now. The only real benefits to the more expensive plans are for out-of-network providers, and a TON of doctors take United Healthcare here in NYC. (Out-of-network is just a fancy way of saying that the doctor does not accept that insurance, and you have to submit paperwork to be reimbursed if you go to a provider that doesn't accept it.)
United Healthcare also has a pretty decent website search for finding doctors. If you need personal recommendations for a GP, an excellent OBGYN practice, etc. please feel free to MeMail me.
posted by bedhead at 9:14 AM on September 22, 2014
United Healthcare also has a pretty decent website search for finding doctors. If you need personal recommendations for a GP, an excellent OBGYN practice, etc. please feel free to MeMail me.
posted by bedhead at 9:14 AM on September 22, 2014
The other thing to know, re the US system, is that companies typically have an open enrollment period once a year where you can make changes or switch to another plan. Check with your HR to find out when this is. So worst case, if you go with the standard and don't like it, you can switch to another one in a year or less. You can also make changes with a qualifying event, like having a new baby (adopting or giving birth) or if your spouse loses coverage through their own employer.
But the big unknown here is your fertility efforts. Any pregnancy/delivery stuff will be covered under your plan, but health insurance typically does not cover infertility treatments (though it might cover diagnosis), or has only limited coverage. You need to read your plan to see what they will offer you. If you go for infertility treatments you might be paying a lot out of pocket in any case. If your out-of-network coverage on the fancier plans would include infertility treatment in some fashion, then it might really be worth it to go that route.
posted by handful of rain at 9:22 AM on September 22, 2014 [1 favorite]
But the big unknown here is your fertility efforts. Any pregnancy/delivery stuff will be covered under your plan, but health insurance typically does not cover infertility treatments (though it might cover diagnosis), or has only limited coverage. You need to read your plan to see what they will offer you. If you go for infertility treatments you might be paying a lot out of pocket in any case. If your out-of-network coverage on the fancier plans would include infertility treatment in some fashion, then it might really be worth it to go that route.
posted by handful of rain at 9:22 AM on September 22, 2014 [1 favorite]
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