High plan or low plan on Health choice insurance

[Tigger1]

I have until Tuesday to make insurance changes for next year. In the years past I have been on the low plan but I might have a surgery next year. We are typically a healthy family, going to the dr. mainly for check-ups
It will be just myself and one daughter this year.
Here are my choices.

High plan
I pay $50.00 co-payment for each visit to the doctor.

I pay First $500 deductable on anything thats not an office visit,
(hospital, blood work, x-rays, ect.).

Then I pay 20% of everything until I have paid a max of $2,900 + $50 copay each office visit.

Low Plan
I pay nothing for the first $500
Then I pay all of next $500
After that I pay 50% of next 10,000
So the most I pay is $5,500 per year

The High plan is also about $50 per month more than the low plan.
What would you do?

 

[mikehn]

The quick answer is, I would go with the high plan.

 

[golfgal]

Your fixed out of pocket costs are about $2000 different between the plans with the high plan coming out less expensive unless you anticipate over 40 office visits next year.

The most you will pay on the high plan is the $2900 + $600 more over the year for premiums--not including any office visits.

If you have surgery next year you will most likely have more than $10,000 in bills so you can plan on paying the full $5500.

The low plan will save you money IF you don't have any major medical expenses and only each go to the dr once or twice so you don't go over your $500/deductible. Considering a standard sick child visit to the dr is about $300 if they do say a strep-test just 4 visits/year between the 2 of you could mean paying more on the low plan then you would on the high plan.

If it were me I would take the high plan with the assumption that you are having surgery. Does the plan say anything about preventative care being covered at any %? If your preventative care (physicals, well child checks, cancer screening, etc.) is covered at 100%, which is typical with policies in our state, then I will reevaluate my answer.

 

[Tigger1]

Going to th Dr twice a year is about tops for us. Last year I did go 4 times plus about 8 visits to the Chiropractor. With x-rays of my back and Thyroid xrays I did have over $500 out of pocket expenses but still saved over high plan. My Daughter went to the Dr several times and went a little over also. We did come out ahead with the low plan. I am considering the high plan because of the surgery. If I do not get the high plan, I will likely put of the surgery (fibroid removal). If I go with the high plan I might still not get the surgery.

I figure the difference in the 2 plans if I have surgery as follows
high plan
$2900 deductable + $600 increase a yr in insurance = $3500 + copay * # of visits

Low plan = $5,500 max

Low plan also costly for unexpected minor cost such as my sons blood test to see if he carries cysic fibrosis

The hospital billed us $2400 with low plan
High plan would have been about $1,300

(The original bill was nearly $7000, but allowed charges were around $4400.)

 

[golfgal]

Going to th Dr twice a year is about tops for us. Last year I did go 4 times plus about 8 visits to the Chiropractor. With x-rays of my back and Thyroid xrays I did have over $500 out of pocket expenses but still saved over high plan. My Daughter went to the Dr several times and went a little over also. We did come out ahead with the low plan. I am considering the high plan because of the surgery. If I do not get the high plan, I will likely put of the surgery (fibroid removal). If I go with the high plan I might still not get the surgery.

I figure the difference in the 2 plans if I have surgery as follows
high plan
$2900 deductable + $600 increase a yr in insurance = $3500 + copay * # of visits

Low plan = $5,500 max

Low plan also costly for unexpected minor cost such as my sons blood test to see if he carries cysic fibrosis

The hospital billed us $2400 with low plan
High plan would have been about $1,300

(The original bill was nearly $7000, but allowed charges were around $4400.)

If you have the surgery the high plan still saves you about $2000-co-pays--how many office visits did your DD have last year? Your office visits would have been $600 in co-pays so you are still $1400 ahead but if your DD went in more then 28 times then the low plan is less expensive. Now, if you have more then one major medical expense, say you AND your DD have surgery, the low plan is a better deal. It's confusing. Do you have any other choices??

Based on the numbers you provided-did you go over the $5500 this year so you now have 100% coverage--if so, do the surgery NOW and get the low plan again next year.

 

[Tigger1]

I am not sure what I paid this year but its the first time I have had to pay anything being on the low plan. Between my children and I we have spent just over $1000 out of pocket + $2400 pending on a blood test.

We have just been very lucky not to get very sick. I do not go to the dr unless necessary. My son went to the dr this year for the first time in many years. When he was in school I think he went from 5th to 11th or 12th with no absents at school.
My other son (age 26) tried to get an appointment with our family dr about a year ago for a boil on his lower back. He could not get in as they could not find his records and would have to set up a first time seen appt.

So its hard to pay out over $400 a month for insurance (just for the 2 children at home ( one might have to be taken off for age limits this year), my ins is paid threw work) and then pay $50 each visit +.
Its alot of $$$ for a single parent.

I think I will go for the high plan this year, maybe go back to the other plan next year.

This next coming year I can also have a few things checked during the high year plan, like my hearing, allergys, bone density, ect.

One other thing I should consider in the cost difference is the difference is tax deductable.