Wednesday, December 21, 2016

Medical insurance


While annually there have been changes in coverage, deductibles and cost, I have never felt that our medical insurance was outrageous. I currently pay:

$4152 premium cost
$6000 max OOP deductible cost

$10,152/year maximum  for our family medical coverage.  This expense has always come out of my check as a pretax deduction, and I have always based my budget on my actual take home pay. I  will stick with this figure as we typically max out our deductible. So far this new plan year, we've met the first $4000 deductible and are working on the second one, which has a different formulation than previous years, so it will take longer to eat it down. Once we do, as long as we remain in plan, we will not incur any costs beyond the aforementioned $10,152. I budget in anticipation of the worse case scenario. Currently, I have a HSA plan, which I fully fund, based upon the deductible we have to meet, so that I have the pretax funds available to meet the full $6000 in this year's case. This translates into no impact upon my monthly budget. I have been intentionally prepaying for the full plan year as March 1 remains my retirement date, and I wanted not to have any additional obligations. I have been living on projected retirement earnings, before adding additional income streams. I continue to live purposefully, prudently.

While we will have this coverage through the end of August, I remain concerned about what our next insurance coverage will be. I anticipate significant change.

Plan A: I find a full-time position with benefits before Sept 1, coverage/cost to be determined.
Plan B: I go on a state of CT sponsored health insurance.
Plan C: I go on an alternative medical plan that has just been presented to me.

Plan B:
Employee only:
$5,988.24 premium cost for the cheapest option
$5685.00 deductible
$11,673.24 But once again, I would be hit with a co-pay until an additional $865 was incurred
$12,538.24 Far from great but do-able.

If I wanted a family coverage plan:
$15,583.44 premium cost for the cheapest option
$11,370.00 deductible
$26,953.44 Again, there would be additional co-pays until I hit the max OOP. I didn't bother to look. I simply can't afford this.

I am in the process of doing my homework, as medical insurance goes. Plan C is part of a recent income stream; I was unaware that I'd be offered medical coverage. Great! I initially thought, until I got the forms in the mail. The cheapest option would be:

Plan C employee only:
$4388.40 premium cost for the cheapest option
$6500.00 deductible
$10,888.40 BUT even once the deductible is met, there is a 40% copay up to an additional $1000
$11,888.40 do-able as well

If I wanted a family coverage plan:
$56,128.92 premium cost (no, I am NOT kidding)for the cheapest option
$13,000.00 deductible
$70,128.92 BUT even once the deductible is met, there is a 40% copay up to an additional $1000


So, for now, I am focusing on finishing my course work, getting all of my paperwork in to start volunteering at the local hospital, and applying everywhere for a full-time position with benefits as an administrative position in the medical field. I started this journey, fully knowing that my new career will have me working just to cover insurance. There are other perks, however! : )

Worse case scenario: I only insure myself under plan C and the kids will have to look elsewhere for coverage: Ds #2 already told me that he can go on the plan at work (an expense that would be new to him), I am already looking into Medicaid for special needs son, leaving DD and DS # 3 (both work P/T, but do not get benefits) to go onto their father's plan at work, assuming that he agrees, if not also putting the other 2 onto his coverage. Note: I have always held the medical insurance coverage the entire 25 years that we were married. 

This is simply awful.

Anyone else go through this nightmare?


Kathy said...

I feel your pain with medical insurance. I don't know how people will manage. Healthcare costs are insane, and it keeps getting worse.
we are paying more and more in premiums for less and less of coverage.

Marcia in rural WNY said...

My daughter goes through this yearly. She is on SS disability, her husband is permanently on Workman's Comp, and their 24 year old has no benefits through work, is on extended Medicaid through the New York State health registry. She has to figure 3 separate budgets as a family policy isn't possible for reasons she understands and I don't. It's actually costing them less now than when her husband was still working--then they were paying even more money for less coverage. One year all three of them had surgery--none of it planned. Nightmare time.

Liz Bernard said...

Good luck finding a solution Carol. I find those figures shocking (I live in the U.K.).

saraband said...

The complexities of all this make me VERY thankful for the UK's National Health Service. As pensioners we get free prescriptions and my husband has free hearing aids. Eye tests are free but we pay for glasses (Specsavers). We also pay for dentistry but are registered with an NHS dentist which is cheaper than going private.

meme said...

I am on the state sponsored insurance for Massachusetts - because I am self employed. I have a Tufts plan - 15 dollar co-pays, 100 for a visit to the ER, 25 to see a specialist. There are no deductibles to meet - and prescriptions are 12.50. I like the plan and my premium is 100 dollars per month. IT is just for myself - my husband is on Medicare as he is disabled.

I know some people who have health insurance thru their jobs....180 dollars a week for a family plan !!!! who can afford that??? so expensive.

Meg B. said...

I am so thankful. Dh is retired, and on Medicare, but kids and I still on his plan. It USED to he $120(ish, we added "extras, including maternity)/month for all of us, 100% of sick care paid, including prescriptions 40% copay,office visits/well care, with a huge deductible, to which things like physicals didn't apply. It was a great plan, but we had caps of 1 million per person. (Those have now been deemed illegal, but, we were allowed to buy extras, ie:maternity cover when I was having all those babies)
NOW, we pay $380/ month, well visits 100 percent covered, low deductible, ($450 family) BUT, we have the privilege of paying 20% of everything else. This change came just in time for a $40,000 emergency surgery for my 11 year old daughter. You do the math.
I need more of your meal posts to calm me down now.

Hawaii Planner said...

I'm so sorry - health care shouldn't be that expensive for families, as it means many go uninsured & puts their health at risk.

Your plan sounds as reasonable as it can possibly be. I'm currently under my own insurance, and also cover both kids. My husband has his own policy via his work. We're on a high deductible plan, but our employer puts a lump sum in our health savings account at the beginning of the year. Despite my health complications (lupus), we've only had one year in recent memory where we had to go beyond our employer contributions. At that point, I tapped my health savings account from another employer.

Fingers crossed that you find a great job with full health benefits for you & your family.

Aunty Bee said...

I am grateful for our Health system in New Zealand, we pay for GP visits $46.00 @ visit, prescriptions vary but the highest is about $35.00, (my husband, has heart disease and a lung condition.Our prescriptions start at the beginning of each year, and we are considered High Prescription Users so by September our meds are no charge. He works full-time, and I work 4 days a week, our son at home is a Uni student and use the Uni's med centre, for free. He gets subsidized dental costs, we pay full. All hospital visits and admissions are free, people do have medical insurance, and get immediate attention, or operations for their needs. Ironically from many of the same specialists who work in the state system. Emergency clinics often staffed by GP's on a rota systems, are expensive but available for after hours emergencies, you are encouraged to go there, not the main hospital's A&E.
This system works, some things like MRI's and CT scans have a waiting list, but overall everyone I know are happy with our system.