How important is health insurance lifetime max benefit?

[yoopermom]

I just got a new job, and have to decide whether or not to switch from DH's health insurance to mine. I have a few chronic conditions (and may need a major surgery down the road), and he has a million dollar lifetime max for the entire family on his. Mine would be two million. I've heard nightmare stories about how fast a million max can be exceeded, and then what? So if you would like to share, how important do you think it is, and what level would you be comfortable at?

TIA!
Terri

 

[scrdofbugs]

The lifetime max is very important if you have chronic health conditions that require expensive treatments or frequent hospital stays. They will add up fast. It is important to everyone else as well because if we are diagnosed with cancer, MS, your monthly medicine could be in the thousands. I see hundreds of insurance benefits through my work. Most plans has a 1 or 2 million limit. I think that is the norm.

 

[Mommee]

I think the lifetime max was something that was going away under the new laws.

 

[Colinsmom]

$1 million lifetime max for the whole family combined? Or $1 million per person? My DH's leukemia treatment plus bone marrow transplant 15 years ago ran about half a million (who knows what it would be in today's medical dollars). All else equal, I'd certainly choose a $2 million limit over $1 million.

 

[yoopermom]

I thought it was a million each, but upon rereading, it's a million for the family. Doesn't seem like much to me ?

Terri

 

[Disneefun]

I much prefer plans that have "per incident limits." For example, say your incident limit is $500,000. That means that if you get cancer, you get a half million for that. Then if, on top of that, you get something like MS, you get another half million. Then if you get into a car accident and break bones, you get another half million. Each incident isn't eating into the available money for the others and there's no lifetime cap on how many incidents you can have.

Some employers have a "buy up" option that lets you pay extra for incident limits instead of lifetime limits. If you can get it, it's worth the extra money. Otherwise, go for the highest limit you can get, in your case the 2 million. With costs skyrocketing, you need to get as much coverage as you can b/c one big problem can quickly eat up that million or two. Then you're cut off and any other problems will have to be covered out of your own pocket.

 

[seasheller]

I think the lifetime max was something that was going away under the new laws.

I agree, this is one of the benefits of the new health insurance laws.

 

[3boymthr]

The no lifetime maximum goes into effect for all plans in 2011 (this will be a roll out - plan limits will change to unlimited as the plan renews). This is a benefit change that affects both fully insured and self funded plans. Grandfathered plans are not exempt from this change.

ETA - that said, the likelihood of you hitting a million dollar maximum between now and then is slim. You would need to have what is called a catastrophic illness for this to happen between now and then and even with a catastrophic illness most people will not hit a $1M max. Catastrophic illnesses include such diseases as Hemophilia; Stage 4 cancer that has matastasized and involves a bone marrow transplant, a heart/lung transplant (a heart transplant will come close but not hit); Goucher's Syndrome and some other extreme illnesses. It is much easier to hit a million dollar maximum if you have a major medical plan over an HMO or PPO (where discounts will bring the million dollars in charges down to about half a million). Can you tell I evaluate large claim risks as part of my job?

 

[DISdreamin']

We have a $2M lifetime max for each person covered on the plan, and I really wish there were an alternative. We used to have an option with no lifetime max (it was about 4x the money, but I would have happily paid it to maintain that). I keep hoping my employer will redo the plan once the new health care laws are in place so we have no limit once again.

In the meantime, I am seriously considering adding a major medical policy just in case something catastrophic happens - $2M just isn't enough if it's something really bad.

 

[luvdzny]

I much prefer plans that have "per incident limits." For example, say your incident limit is $500,000. That means that if you get cancer, you get a half million for that. Then if, on top of that, you get something like MS, you get another half million. Then if you get into a car accident and break bones, you get another half million. Each incident isn't eating into the available money for the others and there's no lifetime cap on how many incidents you can have.

I am not sure about that, 500,000 is not a lot for a lifetime when a person has cancer. DH has gone through cancer treatments 3 times in the past 20 years, and 500,000 is already gone.

 

[sookie]

I think this is going away under the health reform laws! Thank god.
I am a pretty healthy young lady, but had surgery last fall (routine) and then had major complications - the 8 days in the hospital was approximately 200k!! was supposed to be an overnight thing - max! i have a great insurance plan so my out of pocket was minimal - but what if six months from now, something ELSE happens?! if 8 days eats up 200k - a major long term illness would meet that 1 million max pretty darn quickly!
if you have a choice, and total cost / benefits are the same - i'd go with the 2 mil. but if the other plan is better, cheaper, and since this cap will go away in the next few years - i'd stick with the old one! usually employer sponsored coverage is a lot cheaper than being covered as a spouse under a family plan - unless you have a good situation like a fed employee. so look at total cost and the bennies (for instance, deductibles and copays - and other stuff that some plans will pay for while others won't such as allergy testing and specialists...).
there is so much to look at! but don't let the cap be the determining factor if everything else is in your favor because that should be going away.

 

[3boymthr]

I think this is going away under the health reform laws! Thank god.
I am a pretty healthy young lady, but had surgery last fall (routine) and then had major complications - the 8 days in the hospital was approximately 200k!! was supposed to be an overnight thing - max! i have a great insurance plan so my out of pocket was minimal - but what if six months from now, something ELSE happens?! if 8 days eats up 200k - a major long term illness would meet that 1 million max pretty darn quickly!
if you have a choice, and total cost / benefits are the same - i'd go with the 2 mil. but if the other plan is better, cheaper, and since this cap will go away in the next few years - i'd stick with the old one! usually employer sponsored coverage is a lot cheaper than being covered as a spouse under a family plan - unless you have a good situation like a fed employee. so look at total cost and the bennies (for instance, deductibles and copays - and other stuff that some plans will pay for while others won't such as allergy testing and specialists...).
there is so much to look at! but don't let the cap be the determining factor if everything else is in your favor because that should be going away.

Unless the republicans get in an throw away the current laws the maximum is definitely going away. There will be a roll-out for plans with the maximum going away when the plans renew. Plans have no choice in this. This change applies to all plans regardless of type - individual, group, fully/self insured. It even applies to government and union sponsored plans.

 

[sookie]

maybe if republicans get in they can fix the mess the dems have made of our flex spending accounts.....

 

[yoopermom]

OP here, thanks for all the great info and PLEASE let's not let this get political! I've never had a thread locked, and I'd prefer not to start now.

Ok, so from what I understand, this should not be a deciding factor. The two just happen to be through the same company, his pays 85% on most things (after deductible and copays), mine would pay 100%. Problem is that I'm only 1/2 time, so payment would eat up most of my salary. However, 15% of any serious illness/accident would be very serious for us financially. Sigh. Decisions...

Terri

 

[Where'sPiglet?]

OP here, thanks for all the great info and PLEASE let's not let this get political! I've never had a thread locked, and I'd prefer not to start now.

Ok, so from what I understand, this should not be a deciding factor. The two just happen to be through the same company, his pays 85% on most things (after deductible and copays), mine would pay 100%. Problem is that I'm only 1/2 time, so payment would eat up most of my salary. However, 15% of any serious illness/accident would be very serious for us financially. Sigh. Decisions...

Terri

It might eat up most of your salary, but wouldn't your DH get more take home pay after the health benefit is not included in his salary? So, basically, your joint salary would be roughly equal whether you pay the health or he does?

 

[quentina]

It might eat up most of your salary, but wouldn't your DH get more take home pay after the health benefit is not included in his salary? So, basically, your joint salary would be roughly equal whether you pay the health or he does?

Make sure your plan does not have a working spouse fee....these can add up also.

 

[yoopermom]

No working spouse fee, hurray. I would get an extra 50 bucks a month if I don't take mine. BUT no open enrollment plan for mine ever, so it would take a major family change in order to ever be able to pick it up if I don't take it now. Urgh...

Terri

 

[wdwfan16]

The no lifetime maximum goes into effect for all plans in 2011 (this will be a roll out - plan limits will change to unlimited as the plan renews). This is a benefit change that affects both fully insured and self funded plans. Grandfathered plans are not exempt from this change.

ETA - that said, the likelihood of you hitting a million dollar maximum between now and then is slim. You would need to have what is called a catastrophic illness for this to happen between now and then and even with a catastrophic illness most people will not hit a $1M max. Catastrophic illnesses include such diseases as Hemophilia; Stage 4 cancer that has matastasized and involves a bone marrow transplant, a heart/lung transplant (a heart transplant will come close but not hit); Goucher's Syndrome and some other extreme illnesses. It is much easier to hit a million dollar maximum if you have a major medical plan over an HMO or PPO (where discounts will bring the million dollars in charges down to about half a million). Can you tell I evaluate large claim risks as part of my job?

I thought it went into effect 6 months after the bill was signed. That should be August.