When my husband switched to a corporate job, we gained the option of a corporate health insurance plan. Now, we currently have an individual HMO plan (we shall call it plan A) that was paid through the store we had partnership in. Since the partnership has been disbanded, we would now have to pay the premium ourselves. I have spent the better part of the day trying to decipher which plan is better for us in terms of the next 4 months. We shall call the corporate option Plan B.
Premium: for Plan A, if we were to continue coverage for me and Ben, the premium stays at 759.11 a month, for a total of 3036.44 for 4 months. I know, ouch. If we were to switch to Plan B, the premium is 164.00 a month (656.00 for 4 months). If we were to drop Ben from our current plan A, the premium for just me would be 379.55 a month, and insure Ben on the plan B it would be 82.00 a month (total for 4 =1846.20).
HRA: Plan B offers a Health Reimbursement Account, in which they essentially give you money toward you deductible. For a family it is $600 each each, which is $50 a month. Any amount you don't use carries over to the next year. Plan A has no such offereing
Deductible: Plan A has no deductible. Plan B has a $2,500 per family deductible, which translates into $1,900 after the HRA is used up.
Out of Pocket Maximum and Co-insurance: Plan A has an OPM of $2,500 and Co-insurance of 20%. Plan B has an OPM of $8,500 including the deductible, so $6,000 and Co-insurance of 20%.
So here is my dilemma. My current OB is covered under both plans as in-network, as is my hospital (sigh of relief...I really didn't want to switch at this point). Plan A will cover 100% of my labor and delivery, and I will only be billed for 20% of the hospital stay (which is currently planned at 2 days) and lab fees up to $2,500. So with my current plan, to just insure me, it seems the most I would pay to have this baby would be $4,018.20, assuming that it cost $12,500 for a normal 2 day hospital stay. It would also cost $328 for Ben's insurance. That is a grand total of 4,346.20 for 4 months.
With Plan B, it seems it would cost the $656.00 to insure us both, the $1,900 for the deductible, and then we would start in on the OPM. I do not know if labor and delivery is covered 100%, but from the looks of the website, it is not. There is something called in-patient services that cost $350 but that doesn't seem like it is it. I used a website to estimate the cost of total maternity care for a normal pregnancy and it gives me a generious $13,000.00 price tag (I don't think this is the contracted rate, just a generous estimate). With my co-insurance, it would cost me $2,600.00, making the total cost $5,156.00 for 4 months.
Now, here's a couple catches. I don't know how quickly a $1,900 deductible would be met in the 2 months leading up to the delivery. Probably not very quickly. Assuming I have one doctors appointment a week for the last 4 weeks, that could be about $500 right there. That leaves a $1,400 carryover for the delivery. I would also not meet the deductible for this year, so I would be paying for the labwork in November and two monthly appointments. I am going to grossly estimate this at $1,000.
Another catch: I don't know when we would be able to enroll me and the baby in Plan B if we don't do it immediately. I am pretty sure the child can be added whenever, but I don't know about me. If I would have to wait until June, that would be another $1,500 to keep my current insurance. That assumes that they don't raise it again, which is very doubtful as they raised it twice last year. I could always decrease my coverage I guess.
I would be able to make a better decision if the people from Insurance Plan B would call me back or answer their phones. I need some more specifics on their plan.
Why does health insurance have to be such a headache? I have been dealing with this all day, and just have a bunch of numbers floating before my eyes. :( All I want is a healthy, safely delivered baby boy!