Increased insurance coverage

[BloomingLotus 179]

Through my company's health insurance open enrollment, I have the opportunity to "buy-up" to a higher coverage plan for the next year. My surgery will likely be in late January or early February so the plan would be active by then. It seems like considering all of the associated costs it would be a better option. Both plans cover bariatric surgery, but the higher plan has a lower deductible and much lower coinsurance rates for surgery and hospital stays. I'm trying to determine if the increased monthly cost for the year will be worth the hospital and follow-up savings.

Has anyone done this before? Was the decision to "buy-up" worth it in your opinion?

[ORsleeveMom 5]

Find out what the out of pocket max on each of the plans is and whether the deductible applies to the out of pocket max. I do cost estimates for a hospital and I have found that the majority of patients meet their out of pocket maximums with bariatric surgery. So it really just comes down to what that number is.

[BloomingLotus 179]

I already know that my deductible counts towards my out of pocket max. With the buy-up my deductible drops from 500 to 250, but the total out of pocket max is the same.

For coinsurance though: for inpatient surgery (I'm expected to stay one day):

High plan : $100 deductible stay/0% coninsurance and 0% coinsurance for physician/surgeon

Current plan: 20% coinsurance on both

My appointment co-pays and prescription co-pays will go down by $10 each.

Monthly, it's about $100 extra per month.

Realistically speaking, I *think* it makes sense for this year, knowing I will have surgery and plenty of follow up visits.

I hope in doing the math right!

[della street 213]

20% coinsurance on a hospital stay plus 20% coinsurance for physician/surgeon visits could be mucho bucks, potentially much more than the $1200/annual additional you'd be paying. Without knowing all the details, I'd go for the high plan - especially since if you need any follow-up hospitalizations (of course, hopefully not, but just in case...), the 20% could really start adding up big-time -- just my 2 cents )