Health Insurance?

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Joined: 02/14/12
Posts: 47
Health Insurance?

I checked into my insurance here at work. I currently pay 150 a month for a plan that has a 200 deductible and pays 100 in network after copay.

Adding baby to that plan will change my payment to 587/month.

Um.... I can't afford that.

The only other option is this new high deductible HSA plan. Which is - $5000.00 deductible, after which insurance pays 90%. There is a small monthly payment (20.00) and then you're supposed to put money into a health savings account to pay your medical bills.

Which to me seems as good as not having any insurance at all, except for a catastrophe. Even just the ankle arthroscopic surgery I may need in the next few years would leave me owing at least 5k.

Maybe some BTDT moms can tell me what medical costs for baby are like in the first year??? i.e. - baby check ups, shots, etc?

I looked into individual plans, but the rates weren't much better and most times didn't include prescriptions and labwork, etc.

It's so annoying. I really don't believe that baby should cost an extra 435/month to cover!!!

KatherineD's picture
Joined: 10/03/06
Posts: 217

Eek! Wow, I can't believe it's that big of a jump from single to family. We pay biweekly for insurance and I can't remember what it is off the top of my head, but I know it's less than that. My husband works for the Department of Defense as a firefighter, so we have Blue Cross Blue Shield Federal Employees. It covers any sort of well visit (baby check ups, shots, my check ups, child check ups). Any sort of preventative check up is covered for free. Sick visits are a $20 copay, specialists are a $30copay (like when I broke my foot and needed to see an orthopedic doc). My oldest has chronic UTI's and usually our first lab visit of the year ends up costing us around $230. I will say, your deductible is fabulous!! Ours is $350 per individual and $700 for family and then $5000 for catastrophic coverage.

lemonlemon's picture
Joined: 12/30/07
Posts: 1904

I'm not much help, brody has his dads insurance which is regence/blue cross.. and we normally pay like a 15-25 dollar copay (i swear it always changes) and then it covers each well child checkup- someitmes we have to pay like 15 dollars out of pocket for flouride treatment...

I dont have ANY insurance at the moment so i have to pay 100% out of pocket, so it's really stressing me out!

Is there any state or program you can get that would cover the baby?

Joined: 09/02/05
Posts: 994

:lurk:
That is quite a jump for sure. The coverage sounds pretty good though. We currently pay about $486/mo for medical, dental, and vision. Medical sounds similar to pp--$450 deductible per individual and $1000 for the family. Preventative care is free as are well-child check ups (which there are a bunch of for baby in the first year). We have a $25 copay for regualar visits and $35 for specialists and then it is 85/15.

Good luck with this!

ambie719's picture
Joined: 10/03/07
Posts: 811

:bigarmhug: All I have to offer are hugs. I'm Canadian so all doctors appt/bloodwork/ultrasounds are covered, and DH is military so his prescriptions/dental/vision are all 100% covered, and me and the kids have a small deductible and are covered 80% I believe.

regdahl's picture
Joined: 05/05/07
Posts: 777

That is an ENORMOUS jump! Wow!! We have an HSA account. The money you put in is pretax so you save that money and then once you reach your deductible/maximum out of pocket everything is covered at 100%. So actually they are good for years you know you'll have a major health expense. Like this year we'll easily reach our max with the baby so everything else we have will be covered at 100%. We'll pay a maximum out of pocket $5,000 - all other medical expenses will cost us nothing for the year.

Joined: 02/14/12
Posts: 47

I'll have to check to see if the well baby appointments are covered or seperate. It seems like my OB is all lumped into one, because at my second appointment they said I didn't have a copay.

The vision and dental insurances are seperate. I'm not sure what the family deductible is on the medical - maybe its 200/person?

i'm hoping that the baby's 'father' will come out of hiding/ignoring and maybe his insurance wouldn't cost anything to add baby... but I can't count on that...

Joined: 08/20/11
Posts: 137

That seems crazy for that big of a jump. We have have regence blue shield and it is only $312 a month for my dh, me and our son. After the baby is born, I will go on my own insurance (still through regence because me and dh work for the same company) and for me and 1 kid its $120 a month and for dh and 2nd kid it will be $120 also so it will be $240 a month for all 4 of us. That covers medical, dental and vision. We all have a $400 deductible and insurance covers 90% percent after that I believe. Good luck!!

Joined: 02/14/12
Posts: 47

"regdahl" wrote:

That is an ENORMOUS jump! Wow!! We have an HSA account. The money you put in is pretax so you save that money and then once you reach your deductible/maximum out of pocket everything is covered at 100%. So actually they are good for years you know you'll have a major health expense. Like this year we'll easily reach our max with the baby so everything else we have will be covered at 100%. We'll pay a maximum out of pocket $5,000 - all other medical expenses will cost us nothing for the year.

This sounds like what my other option is. I guess what i'm worried about is that 5k is kind of a lot. Most years I think I wouldn't come close to 5k in health care costs, but I can think of 1 or 2 surgeries I may need in the coming years, and 5k would be an awful lot for me to pay off.

I guess if the HSA differs from flex medical ( and I seem to remember them saying it does...) then you can roll over your HSA from year to year, so if, for example one year I put in 200/month into HSA totalling 2400 for a year, and don't spend much of that, and then the next year I have a surgery or something, then I have that money there...

I just hate to 'gamble' with health stuff. You just never know what's gonna happen. I mean, it's nice to know 5k would be the absolute worst, but 5k is still a lot to pay.

regdahl's picture
Joined: 05/05/07
Posts: 777

"kal301" wrote:

This sounds like what my other option is. I guess what i'm worried about is that 5k is kind of a lot. Most years I think I wouldn't come close to 5k in health care costs, but I can think of 1 or 2 surgeries I may need in the coming years, and 5k would be an awful lot for me to pay off.

I guess if the HSA differs from flex medical ( and I seem to remember them saying it does...) then you can roll over your HSA from year to year, so if, for example one year I put in 200/month into HSA totalling 2400 for a year, and don't spend much of that, and then the next year I have a surgery or something, then I have that money there...

I just hate to 'gamble' with health stuff. You just never know what's gonna happen. I mean, it's nice to know 5k would be the absolute worst, but 5k is still a lot to pay.

Yes, Flex spending expires at the end of the year but the HSA is your money and it rolls over from year to year. They are both pre tax dollars though so you aren't paying taxes on the money you put into your HSA.

I would do some figuring though because honestly HSA accounts are supposed to be more economical for those with high medical bills. Because if you figure what you spend on your premium (monthly cost), deductibles and copays - that could easily exceed the $5,000 especially if you know you're going to have surgeries coming up. It often just sounds like more because you're hearing that one big number. With the other plan you're hearing percentages and smaller copay amounts. Those all add up quickly though.

Oh - and usually if you have an HSA the hospital/clinic will allow you make monthly payments. That's what we're doing right now. Our ob clinic requires you pay a portion of your bill up front. With my DS we had to write them one time check but this time we have an HSA and since we contribute monthly to it they allow us to make monthly payments for about $100 rather than the one time payment of $1000.

**Tiffany**'s picture
Joined: 11/21/03
Posts: 1230

I agree that's a big jump. However it is sort of similar at the school district my dh works at. Our insurance isn't bad but it's not cheap for the family either and dental insurance isn't included it's separate. For a single person the rate is quite low then it jumps significantly for a couple and even more for family. Our insurance raises every year too while the single plan stays mostly the same. I think our total monthly payment is $500 for both medical/dental we don't get vision. RXs are $10 for generic $20 for name brand. Our deductible is $5000 and co pay is $15 excepting well baby visits and shots.

We have programs in Iowa that will pay some towards your insurance or pay what your insurance doesn't. You have to qualify financially though I am not sure what the limitations are.

Joined: 12/01/05
Posts: 1000

If you do the math (575 - 20 X 12 months), you find that you are paying $6660 more per year for the "low deductible" plan than the high deductible plan, and that's not even including the deductible (I forgot how much that was) and the co-pays after the deductible.

Joined: 02/14/12
Posts: 47

"regdahl" wrote:

Yes, Flex spending expires at the end of the year but the HSA is your money and it rolls over from year to year. They are both pre tax dollars though so you aren't paying taxes on the money you put into your HSA.

I would do some figuring though because honestly HSA accounts are supposed to be more economical for those with high medical bills. Because if you figure what you spend on your premium (monthly cost), deductibles and copays - that could easily exceed the $5,000 especially if you know you're going to have surgeries coming up. It often just sounds like more because you're hearing that one big number. With the other plan you're hearing percentages and smaller copay amounts. Those all add up quickly though.

Oh - and usually if you have an HSA the hospital/clinic will allow you make monthly payments. That's what we're doing right now. Our ob clinic requires you pay a portion of your bill up front. With my DS we had to write them one time check but this time we have an HSA and since we contribute monthly to it they allow us to make monthly payments for about $100 rather than the one time payment of $1000.

This makes sense - 587/month for the premium for the 100/50 plan comes out to over 7k. So, the 5 k would be cheaper, probably. My only reservation is that once I hit 5k, the insurance only pays 90%, so I'd still owe 10% - which, if something really awful happened, like a big trauma accident/long hospitalization, or G-d forbid, cancer treatment, could still be a lot. But it may be a better option for me.

Thank you!

Joined: 02/14/12
Posts: 47

"2sonsplus1" wrote:

If you do the math (575 - 20 X 12 months), you find that you are paying $6660 more per year for the "low deductible" plan than the high deductible plan, and that's not even including the deductible (I forgot how much that was) and the co-pays after the deductible.

Yea, I just worked it out - 587 a month would be over 7k a year, and then I'd still have a 25.00 copay for each visit, including, it seems, each well baby visit.

with the high deductible, I'd pay everything up to 5k, after 5k I'd pay 10%. My monthly premium would be 50.00 (I thought 20, but I was looking at the wrong income bracket).

If I go the high deductible route, and put, let's say 200/month into the HSA, I'd be paying about 250 a month/100 a month more than I currently am, and would have 2400 a year into the HSA. Which I hope would be enough for a 'typical' year. If it works under the same rules as the flex med, I can also use that money for some over the counter things and even massages at Massage Envy.

And the fact that it rolls over year to year is good. I'm going to try to work out what's the max I'm comfortable putting in each month. I know the guidelines on OTC stuff changed a bit, so I'm going to look at those and then see.

Thanks for your advice ladies. I'm feelin a little better now. I like having a plan!

Gabsma03's picture
Joined: 07/23/08
Posts: 178

My insurance costs me $5.00 a week if I work 12 hours a week. If I wanted to add a family I would need to work 28 hours and it would cost $15.00 a week. ( one of the great perks of my job) . However since I only work 16 I only cover myself. DD is covered on her dad's( court ordered along with child support) and Dh covers himself and ds, the price is gonna jump dramatically now that he will go from individual + 1 dependant to a family plan. Not sure the cost, it really kills me to see the cost of insurance. I would maybe try to go after ( Baby's father) here its court ordered the day must provide heath insurance(if avail ) and pay Child support if you go that route. If not we have the no kid left behind plan where the state give thier insurance. I had to use that for dd since I could put her on my plan and (ex wasn't working at that time).It wasn't exactly what I wanted but I couldn't afford the 300.00 a moth premium it costs at that time.

Joined: 12/01/05
Posts: 1000

I think I'd try to pay the difference between what you would pay to the other plan into the HSA at first and try to get as close to the $5 as quickly as possible. You don't want to be stuck with a big bill you can't pay. Anything can happen with baby during the first few months, and one hospitalization would eat through that deductible pretty quickly. If you don't use it, you can roll it over to next year and stop paying in so much, and then you will really notice the increase in take home pay.

My kids are all on the State CHIP program, and it's way better insurance for a lot less money than it would cost to get it through DH's work. Have you looked into your state's S-CHIP program?

Joined: 02/14/12
Posts: 47

"2sonsplus1" wrote:

I think I'd try to pay the difference between what you would pay to the other plan into the HSA at first and try to get as close to the $5 as quickly as possible. You don't want to be stuck with a big bill you can't pay. Anything can happen with baby during the first few months, and one hospitalization would eat through that deductible pretty quickly. If you don't use it, you can roll it over to next year and stop paying in so much, and then you will really notice the increase in take home pay.

My kids are all on the State CHIP program, and it's way better insurance for a lot less money than it would cost to get it through DH's work. Have you looked into your state's S-CHIP program?

I think the State things all have low income requirements, so I wouldn't qualify. I make a decent income, I've just filled it all up with a mortgage and car payment and all that other stuff.

I really can't afford 600 a month (a 440 increase) to pay into an HSA... if I could, I think id rather do the 100/50 plan, because at least I know that after the deductible (400.00 a year) everything would be paid 100%. With the high deductible plan, I'll still have 10% to pay after I pay the 5000.00 deductible... which, in the event of a hospitalization, could bankrupt me.

also, I'll have daycare costs to try and figure out... and the expensive stuff I'm not used to for babies... I really don't have much extra right now, and it's just me. I feel like I"m going to have to get a second job or find things to do at home to make extra money to pay for a baby that I'll never see because I'm always working.

I don't have to decide until about insurance until baby is here... so, for example, if baby is early and needs NICU, I'd have to choose the 587 a month plan. I couldn't pay 5000.00 plus 10% of a NICU stay, I"m sure.

Joined: 12/01/05
Posts: 1000

I don't know about your state, but in my state, if you make a higher income you can still get S-Chip, but with co-payments and a minimal monthly premium. It might be worth checking into. I didn't realize that your insurance covers 100% after the deductible. That's amazing. Ours, you pay everything out of pocket until you meet the deductible, which is $750, then after the deductible, you still pay 10% or 20% depending whether it's in or out of network. You pay those until you reach the out of pocket maximum, which I think is $5000, but don't quote me on that.

Joined: 02/14/12
Posts: 47

"2sonsplus1" wrote:

I don't know about your state, but in my state, if you make a higher income you can still get S-Chip, but with co-payments and a minimal monthly premium. It might be worth checking into. I didn't realize that your insurance covers 100% after the deductible. That's amazing. Ours, you pay everything out of pocket until you meet the deductible, which is $750, then after the deductible, you still pay 10% or 20% depending whether it's in or out of network. You pay those until you reach the out of pocket maximum, which I think is $5000, but don't quote me on that.

Yea, the 100/50 plan will cover 100% after deductible. ( I think I still have copays, but that's 25.00). The high deductible plan, after paying the 5000.00 deductible, will still cost me 10%, so that's whats scary. If it was 5k and done - covered at 100% after that, it would be so much better.

I'll check into the state thing. I'm in Maryland.

regdahl's picture
Joined: 05/05/07
Posts: 777

"kal301" wrote:

Yea, the 100/50 plan will cover 100% after deductible. ( I think I still have copays, but that's 25.00). The high deductible plan, after paying the 5000.00 deductible, will still cost me 10%, so that's whats scary. If it was 5k and done - covered at 100% after that, it would be so much better.

I'll check into the state thing. I'm in Maryland.

This surprises me. It seems backward from any other health plans I've ever heard of. Usually the high deductible plans go to a 100% coverage and the others still have 10-20% you pay. Not saying it's not right - just surprised since I've only ever seen it the opposite way.

Joined: 12/01/05
Posts: 1000

If you think about a $25 copay for an office visit, that's probably a lot more than 10%, but if it's a $25 copay for an ER visit or hospital stay, it's a lot less.

In Maryland, you can get your kids free coverage if you make 200% or less of poverty and coverage with a premium if you make 300% or less of poverty. Also, if you're pregnant, you can get yourself covered if you make 250% or less. When looking up the amounts, remember that you count as 2 people (you and the baby), so you would be a household of 2 (unless you live with someone else).

lemonlemon's picture
Joined: 12/30/07
Posts: 1904

I was going to add, if you dont qualify for the state, then maybe you could qualify for a bridge assistance type thing.
For example, we have to meet income requirements to get state insurance here, which since I live with Kevin, and pregnant with one kid already, we count as a family of four, and i have to give his income, which puts us too high to get state, however they have a bridge assistance, where you not only show how much you make, but show thema ll of your bills/savings/checking accounts and then they cover unpaid bills.
Unfortnately kevin is really good with money and so i dont want to show them our banka ccounts- even though a baby, out of pocket, is super super expensive.

BUT, Im going to try to go on my own, figure something out, because I make a looot less then him, so if somehow i can get it w/o showing his income I think i'd be ok. if not, off to the alter I go early haha.

I would definately check the baby daddy insurance- if he has insurance then im sure child support/dna test will make him cover the baby.
And check the income requirements for state, its amazing how some states cover a lot more if your pregnant. It seems like everyone I know around here who applies for state gets it, and one friend even owns two businesses!! its just weird how the #'s work!! especially if you live alone and are pregnant!!

Joined: 12/01/05
Posts: 1000

I was thinking the same thing about child support. He should have to provide insurance from a legal standpoint.

Joined: 02/14/12
Posts: 47

Yea, I checked out the Maryland stuff, I don't qualify. I really make a good salary (I work as a legal secretary in Washington DC)... I just don't have 600/month extra (not to mention the extra I need to find for daycare, etc).

The baby's father is ignoring me, currently. So while I hope to explore that as an option - he is in a union and I'm thinkin it's pretty likely he could add baby with little or no cost to him -- i'm trying to get things set in case there is a big fight. When adding a new baby, you have to do it within the first month after birth, or you have to wait an entire year until the open enrollment comes around (ours in November yearly) so I may have to do something myself if there is a court/mediation fight. But maybe he will come around and be an adult and have a discussion with me about it. We'll see.... just tryin to plan ahead!

Alikat30's picture
Joined: 02/19/08
Posts: 229

*Lurker*
Ugh. I feel your pain. I pay $900 out of pocket each month to cover DD and DH and myself. But this is also for a copay/100% covered plan. I pay more each month so I don't have to have the risk of huge bills for an accident/hospital stay. It's my safety net, although I know I could be more risky and pay less. I'm just not willing to take the risk. Our only saving grace with this LO is that employee/family is as many kids as you want so it won't increase any more due to more family members. (Oh and I'm union too, but that doesn't always guarantee good benefits)