Disney Information Station Logo

Go Back   The DIS Discussion Forums - DISboards.com > Just for Fun > Community Board
Find Hotel Specials & DIScounts
 
facebooktwitterpinterestgoogle plusyoutubeDIS UpdatesDIS email updates
Register Chat FAQ Tickers Search Today's Posts Mark Forums Read





Reply
 
Thread Tools Rate Thread Display Modes
Old 11-26-2012, 05:09 PM   #1
DVCLiz
That's me - proud defender of the Mega roll
click here to use the trolldar
We saw "I pooted" and thought it was a "New York" thing!
 
DVCLiz's Avatar
 
Join Date: Sep 2004
Location: North Carolina
Posts: 10,726

Health Insurance Question

Please don't make this political.

I am in the process of deciding next year's health insurance through BCBS. I have an individual policy and have recently added my DD19 to my policy.

If I stay with my current plan (which has a $250 deductible) my rate goes up the usual amount as it has for several years (this year it's about $80 a month more.). I can save myself about $550 per month by going to a plan with a higher deductible ($1000.)

Does anyone know - as much as we can right now - what I might risk losing if I change to a new plan, which would be considered a non-grandfathered status? I would love to save the $6000+ next year but not at the expense of being shut out of a better option in 2014.

Just curious if anyone has knowledge or experience they might be willing to share. I have until December 8 to make up my mind.
DVCLiz is offline   Reply With Quote
Old 11-26-2012, 05:18 PM   #2
sam_gordon
DIS Veteran
 
Join Date: Jun 2010
Posts: 10,089

Quote:
Originally Posted by DVCLiz View Post
Please don't make this political.

I am in the process of deciding next year's health insurance through BCBS. I have an individual policy and have recently added my DD19 to my policy.

If I stay with my current plan (which has a $250 deductible) my rate goes up the usual amount as it has for several years (this year it's about $80 a month more.). I can save myself about $550 per month by going to a plan with a higher deductible ($1000.)

Does anyone know - as much as we can right now - what I might risk losing if I change to a new plan, which would be considered a non-grandfathered status? I would love to save the $6000+ next year but not at the expense of being shut out of a better option in 2014.

Just curious if anyone has knowledge or experience they might be willing to share. I have until December 8 to make up my mind.
Check with BCBS or your HR coordinator. A couple years ago I also changed from a lower deductible to a lower premium plan. I never made the low deductible so it didn't make sense to pay the higher premium. The only difference in my case was the premium/deductible. All the coverage was the same.

If you're saving $550/month, that's over $6,000 per year! That's a LOT of money (to me). Put two months away and you've just covered your deductible. Make sure the new plan isn't an HSA, that it's the same coverage with a changing deductible.
__________________
Freedom W. Caribbean June 15 - June 22, 2014 Video
Oasis W. Caribbean June 8 - June 15, 2014 Review
Barcelo Maya Palace June 29-July 6, 2012
Bay Lake Towers, WDW June 1 - June 6, 2011
Polynesian, WDW Dec. 29, 2008 - Jan. 3, 2009
Wilderness Lodge, WDW, June 2005
Polynesian, WDW Sept. 7 - Sept. 14, 2001
Caribbean Beach, June 1993
sam_gordon is online now   Reply With Quote
|
The DIS
Register to remove

Join Date: 1997
Location: Orlando, FL
Posts: 1,000,000
Old 11-26-2012, 05:27 PM   #3
DVCLiz
That's me - proud defender of the Mega roll
click here to use the trolldar
We saw "I pooted" and thought it was a "New York" thing!
 
DVCLiz's Avatar
 
Join Date: Sep 2004
Location: North Carolina
Posts: 10,726

Quote:
Originally Posted by sam_gordon View Post
Check with BCBS or your HR coordinator. A couple years ago I also changed from a lower deductible to a lower premium plan. I never made the low deductible so it didn't make sense to pay the higher premium. The only difference in my case was the premium/deductible. All the coverage was the same.

If you're saving $550/month, that's over $6,000 per year! That's a LOT of money (to me). Put two months away and you've just covered your deductible. Make sure the new plan isn't an HSA, that it's the same coverage with a changing deductible.
Yes, it seems like a no brainer - it's just that I am curious if I make a change what I might be giving up in terms of being grandfathered for any new options for the new health care laws taking place in 2014.
DVCLiz is offline   Reply With Quote
Old 11-26-2012, 05:43 PM   #4
tvguy
Question anything the facts don't support.
 
Join Date: Dec 2003
Location: Carmichael, California
Posts: 18,741

I think as long as you have no interuption in coverage withe them, they can't block you from switch plans in future years. That requirement has been around for decades.
__________________
tvguy is offline   Reply With Quote
Old 11-26-2012, 06:12 PM   #5
Miniefan
DIS Veteran
 
Miniefan's Avatar
 
Join Date: Apr 2004
Location: Orlando, FL
Posts: 1,785

As long as you are keeping a plan with BCBS then you would be ok. Usually the only thing BCBS requires when you obtain a policy with them is that you disclose any pre-existing conditions and release your medical records for the last few years, but since you are keeping the same ins carrier this should be fine too. I would check with your employer and find out more about the other plan. My dh's benefits changed also this year and offered a lot more plans with BCBS but the ones with lower deductibles were HSA plans. I would also find out what the maximum out of pocket expense for you is. I took the higher deductible plan this year, we don't usually spend a lot on healthcare each year, man I hope I don't have to eat these words. lol!!
__________________
Miniefan
Miniefan is offline   Reply With Quote
Old 11-26-2012, 06:34 PM   #6
DVCLiz
That's me - proud defender of the Mega roll
click here to use the trolldar
We saw "I pooted" and thought it was a "New York" thing!
 
DVCLiz's Avatar
 
Join Date: Sep 2004
Location: North Carolina
Posts: 10,726

I don't have an employer - I buy an individual policy.

I was just wondering if there are any benefits to keeping a plan that has definite grandfather status versus changing at all as it might impact the 2014 options for me. If anyone has any information about the new health care law and how it would affect a non-grandfathered plan I'd love to hear your thoughts.
DVCLiz is offline   Reply With Quote
Old 11-26-2012, 07:35 PM   #7
The Mystery Machine
DIS Veteran
 
Join Date: Jan 2001
Location: Missouri
Posts: 45,349

As long as you have 1000 to put toward the deductible at the beginning, go for it. 550 a month savings sounds wonderful!

I have no idea about the regs. That is a crumbshoot as far as I am concerned.
The Mystery Machine is offline   Reply With Quote
Old 11-26-2012, 07:50 PM   #8
jlewisinsyr
DIS Veteran
 
jlewisinsyr's Avatar
 
Join Date: Mar 2007
Location: Charlotte, NC
Posts: 6,539

Quote:
Originally Posted by sam_gordon View Post
If you're saving $550/month, that's over $6,000 per year! That's a LOT of money (to me). Put two months away and you've just covered your deductible. Make sure the new plan isn't an HSA, that it's the same coverage with a changing deductible.
Confused by this statement. A HSA (Healthcare Spending Account) is not a plan, it's a savings account and it is usually attached the HDHP (High Deductible Health Plan).

The HDHP has a deductible, but it's not a variable amount, it is set at plan enrollment based on your company's policies. The deductible can increase annually as announced by the IRS, but its usually pretty small; for 2013 the minimum deductible to qualify as HDHP was $1,250 for single and $2,000 for family, annually. Annual deductibles have been on the rise an many types of plans, or there is usually large jumps in premiums to retain the current deductible.

HDHP are great options, they provide all the same coverage as a normal plan, just with higher deductibles, but the higher deductibles are offset by lower planned premiums and that you can invest into a HSA pretax, and a HSA can carry over every year.

I've used a HDHP for the past 4 years, and love it and think many people discount them far too quickly. It really puts the choices of your medical expenses into your own hands.
__________________
: (34) : (36)
jlewisinsyr is offline   Reply With Quote
Old 11-26-2012, 08:16 PM   #9
sam_gordon
DIS Veteran
 
Join Date: Jun 2010
Posts: 10,089

Quote:
Originally Posted by jlewisinsyr View Post
Confused by this statement. A HSA (Healthcare Spending Account) is not a plan, it's a savings account and it is usually attached the HDHP (High Deductible Health Plan).
OK. If you want to get technical, yes, an HSA isn't a "plan". But, as you mentioned, it's generally tied to a Health Plan.

Quote:
The HDHP has a deductible, but it's not a variable amount, it is set at plan enrollment based on your company's policies. The deductible can increase annually as announced by the IRS, but its usually pretty small; for 2013 the minimum deductible to qualify as HDHP was $1,250 for single and $2,000 for family, annually. Annual deductibles have been on the rise an many types of plans, or there is usually large jumps in premiums to retain the current deductible.

HDHP are great options, they provide all the same coverage as a normal plan, just with higher deductibles, but the higher deductibles are offset by lower planned premiums and that you can invest into a HSA pretax, and a HSA can carry over every year.

I've used a HDHP for the past 4 years, and love it and think many people discount them far too quickly. It really puts the choices of your medical expenses into your own hands.
We've had HDHP/HSA's offered for the last 3-4 years. The first it was offered, I crunched the numbers. It wasn't worth it. I crunched the numbers again this year. It wasn't worth it.

From the way I understand our plan... you pay 100% of your medical bills (using the plan's discounted rate) until you reach your maximum out of pocket (whatever that might be based on the plan). After that, that's it, you don't have to pay anything the rest of the year. To offset that cost, you can deduct pre-tax dollars into the HSA. You use that money to pay for medical costs. However, you are limited in how much you can put into an HSA in a given year. Did I summarize that fairly well?

After I crunched our numbers (based on what we actually paid medically last year), HDHP's seem great if you a) have very little medical expenses or b) have a lot of medical expenses. If you're "in the middle", I don't think they make sense.

ETA: With the OP posting it could be a $550/month saving, it could be an HDHP... not that there's anything wrong with that, but you need to know what you're getting in for.
__________________
Freedom W. Caribbean June 15 - June 22, 2014 Video
Oasis W. Caribbean June 8 - June 15, 2014 Review
Barcelo Maya Palace June 29-July 6, 2012
Bay Lake Towers, WDW June 1 - June 6, 2011
Polynesian, WDW Dec. 29, 2008 - Jan. 3, 2009
Wilderness Lodge, WDW, June 2005
Polynesian, WDW Sept. 7 - Sept. 14, 2001
Caribbean Beach, June 1993
sam_gordon is online now   Reply With Quote
Old 11-26-2012, 08:29 PM   #10
jlewisinsyr
DIS Veteran
 
jlewisinsyr's Avatar
 
Join Date: Mar 2007
Location: Charlotte, NC
Posts: 6,539

Quote:
Originally Posted by sam_gordon View Post
From the way I understand our plan... you pay 100% of your medical bills (using the plan's discounted rate) until you reach your maximum out of pocket (whatever that might be based on the plan). After that, that's it, you don't have to pay anything the rest of the year. To offset that cost, you can deduct pre-tax dollars into the HSA. You use that money to pay for medical costs. However, you are limited in how much you can put into an HSA in a given year. Did I summarize that fairly well?
Semi-well, the HDHP has two dollar limits, the first is the deductible; the deductible is what you pay out of pocket the second is the maximum out of pocket which is the worst case scenario per year, but the amount between deductible and max out of pocket is subject to co-insurance, usually 70% - 90% depending on the plan.

The co-insurance of say 90% means that if you have a deductible of $1,500 and a max out of pocket of $3,000, and you exceeded your deductible and had a new medical expense of $1,000, you would pay $100, the insurance company would pay $900. So for me, my deductible is $1,500 per year, max out of pocket of $3,000 and a coinsurnace of 90%. To reach the maximum out of pocket, I'd have to have medical expenses of $16,500 in a calendar year ($1,500 + $15,000 X 10%).

Deductibles are also a bit different with HDHP, as you don't have co-pays, so think of a standard health plan with a $500 or $1,000 deductible. Your co-pay doesn't count, so if you have a $35 co-pay on a $500 deductible plan and you go to the doctors for a routine cold, you'd pay $35, the insurance company would pay the doctor's the balance of say $65. Then your medicine has a $35 co-pay and the insurance company say picks-up another $30. In total you are out of pocket $70, but only $90 qualified to your deductible. All medical costs you pay of out pocket are qualified to your deductible with a HDHP plan.
__________________
: (34) : (36)
jlewisinsyr is offline   Reply With Quote
Old 11-26-2012, 08:39 PM   #11
sam_gordon
DIS Veteran
 
Join Date: Jun 2010
Posts: 10,089

Quote:
Originally Posted by jlewisinsyr View Post
Semi-well, the HDHP has two dollar limits, the first is the deductible; the deductible is what you pay out of pocket the second is the maximum out of pocket which is the worst case scenario per year, but the amount between deductible and max out of pocket is subject to co-insurance, usually 70% - 90% depending on the plan.

The co-insurance of say 90% means that if you have a deductible of $1,500 and a max out of pocket of $3,000, and you exceeded your deductible and had a new medical expense of $1,000, you would pay $100, the insurance company would pay $900. So for me, my deductible is $1,500 per year, max out of pocket of $3,000 and a coinsurnace of 90%. To reach the maximum out of pocket, I'd have to have medical expenses of $16,500 in a calendar year ($1,500 + $15,000 X 10%).
I don't remember them discussing the difference between the deductible and the max out of pocket. Doesn't mean they didn't, but I either missed it somewhere or we don't have a a deductible and just have the max out of pocket.

Quote:
Deductibles are also a bit different with HDHP, as you don't have co-pays, so think of a standard health plan with a $500 or $1,000 deductible. Your co-pay doesn't count, so if you have a $35 co-pay on a $500 deductible plan and you go to the doctors for a routine cold, you'd pay $35, the insurance company would pay the doctor's the balance of say $65. Then your medicine has a $35 co-pay and the insurance company say picks-up another $30. In total you are out of pocket $70, but only $90 qualified to your deductible. All medical costs you pay of out pocket are qualified to your deductible with a HDHP plan.
Our copay is $25 for dr's, and the med's depend... could be free, could be $4, $10, or $60. Now, granted, our typical strep throat, etc (most of our doctor visits with kids) runs us $35 at most. Add on another $100 for the insurance portion, and now I'm out $135. Again, the premium difference is $30/month, so it's going to take me three months just to "make up" the extra I have to pay for that ONE visit. Three kids plus DW, and I, none of which would have met the individual deductible, or the family deductible, would have given us a big hit in the pocket book.

Don't get me wrong. I do think HDHP have a place. It's just not for everyone. You (general you) need to look at what you would pay (premiums as well as deductibles & co-pays).
__________________
Freedom W. Caribbean June 15 - June 22, 2014 Video
Oasis W. Caribbean June 8 - June 15, 2014 Review
Barcelo Maya Palace June 29-July 6, 2012
Bay Lake Towers, WDW June 1 - June 6, 2011
Polynesian, WDW Dec. 29, 2008 - Jan. 3, 2009
Wilderness Lodge, WDW, June 2005
Polynesian, WDW Sept. 7 - Sept. 14, 2001
Caribbean Beach, June 1993
sam_gordon is online now   Reply With Quote
Old 11-26-2012, 08:57 PM   #12
jlewisinsyr
DIS Veteran
 
jlewisinsyr's Avatar
 
Join Date: Mar 2007
Location: Charlotte, NC
Posts: 6,539

Quote:
Originally Posted by sam_gordon View Post
I don't remember them discussing the difference between the deductible and the max out of pocket. Doesn't mean they didn't, but I either missed it somewhere or we don't have a a deductible and just have the max out of pocket.
There should be a difference between the two; the minimum deductible for 2013 is $1,250, max out of pocket is $6,250. Note, very rarely do companies hit the lower or upper limits when designing their plans; but almost always there is a difference in the values.
__________________
: (34) : (36)
jlewisinsyr is offline   Reply With Quote
Old 11-27-2012, 06:58 AM   #13
sam_gordon
DIS Veteran
 
Join Date: Jun 2010
Posts: 10,089

Quote:
Originally Posted by jlewisinsyr View Post
There should be a difference between the two; the minimum deductible for 2013 is $1,250, max out of pocket is $6,250. Note, very rarely do companies hit the lower or upper limits when designing their plans; but almost always there is a difference in the values.
I got out my form to double check.
In Network
Individual Deductible: $3500
Family Deductible: $7000

Individual OOP Limit: $3500
Family OOP Limit: $7,000

There is a difference for out of network providers. Once you hit the deductible for out of network, you pay 30% until you hit the OOP max.

In my case for the two years that I've checked, family spending would have been $3K-4K (well under the family deductible & OOP limit) compared to the <$2K we actually had to pay. That "savings" doesn't justify the (slightly) lower premiums.

If someone wants to use a HDHP, more power to them. It just doesn't make sense for us. I simply recommend anybody considering one do their research before jumping in.
__________________
Freedom W. Caribbean June 15 - June 22, 2014 Video
Oasis W. Caribbean June 8 - June 15, 2014 Review
Barcelo Maya Palace June 29-July 6, 2012
Bay Lake Towers, WDW June 1 - June 6, 2011
Polynesian, WDW Dec. 29, 2008 - Jan. 3, 2009
Wilderness Lodge, WDW, June 2005
Polynesian, WDW Sept. 7 - Sept. 14, 2001
Caribbean Beach, June 1993
sam_gordon is online now   Reply With Quote
Reply



Thread Tools
Display Modes Rate This Thread
Rate This Thread:

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off

Forum Jump

facebooktwitterpinterestgoogle plusyoutubeDIS Updates
GET OUR DIS UPDATES DELIVERED BY EMAIL



All times are GMT -5. The time now is 12:52 PM.

Powered by vBulletin® Version 3.8.4
Copyright ©2000 - 2014, Jelsoft Enterprises Ltd.

Copyright © 1997-2014, Werner Technologies, LLC. All Rights Reserved.