Insurance advice

[Jess55 97]

It's open enrollment at my job, so we have to pick our insurance plan for the next year. I plan on revising from the lap band to gastric sleeve shortly after the switch, I am confused on which plan to choose. Which would give me the best way of paying less out of pocket, for my surgery. So can I have some advice from someone who is knowledgeable in these matters.

With my current plan - which is the middle tier, I pay $338 per month and it has a $1000 deductable, and it says for a hospitalization it says 90% after deductible. Does that mean I pay 10% of the total bill after my deductible?

The highest plan is $539 per month has no deductible and $500 hospitalization inpatient and $150 out patient.

The difference would be paying $200 per month, which would be $2400 more per year. But the lower plan would be $1000 plus 10% of the bill if I'm understanding correctly.

Do you think it would be about even in the end? Does anyone have any idea what the gastric sleeve surgery costs with the one night hospital stay? If it is about even, I'll probably keep the middle plan and just pay off the other part.

Any advice would be great! I have to choose by May 1st.

Thanks!

[Sharon1964 2,530]

With my current plan - which is the middle tier, I pay $338 per month and it has a $1000 deductable, and it says for a hospitalization it says 90% after deductible. Does that mean I pay 10% of the total bill after my deductible?

Yes, that's what it means.

One of the things you didn't list was the amount of your maximum out of pocket per year. If a plan has a $5,000 max out of pocket, for example, then you will never pay more than that for the year in expenses (not including premiums). So while you have to pay 1000 for your deductible then 10% after that, if that 10% is more than $4000 (using our example), you won't have to pay anything more than $4000.

Also, make sure all of the plans will cover the procedure that you want to have done.

Edited April 27, 2015 by Sharon1964

[Jess55 97]

The out of pocket max is $3500 an the lower, $2500 on the higher. Leaning more towards the higher one now, because not expecting it to, but what if something goes wrong and I need something additional?

[Sharon1964 2,530]

Now you have the key information - your out of pocket max, and your premiums. There is one more thing to check on, and that is, do your copays and deductibles count towards your out of pocket max? If they do, then here's the breakdown:

Plan A

Premium $6468/year

Max Out of Pocket $2500

Total max expenditure per year $8968

Plan B

Premium $4056/year

Max Out of Pocket $3500

Total max expenditure per year $7556

***IF*** the deductible does NOT count for the out of pocket max, then your max expenditure will be $8556/year

I would not normally recommend this method of figuring out which plan to choose, but things are different when you're planning surgery. You KNOW the total is going to be more than your max out of pocket, while in a "normal" year it might not. Once you've met your max out of pocket, and your plan is covering everything, you can have whatever you need to have done, that you might have put off otherwise (since your plan will pay 100%).

Before taking anything I say as advice, please, PLEASE always check with your plan documents and/or HR and/or insurance professional.

[Jess55 97]

I appreciate your advice. I was trying to descretely ask the head of HR today, how much more would seemingly be taken out of my check if I chose the higher plan, and he was saying he'd only choose it if I were to see a doctor often, while he knows I have lap band, I'm not ready to tell him of my plan for revision (even though we're friends and I've known him for the past 11 years)

I think I'm going to keep the middle plan and just hope the hospital will come up with a payment plan to work with me.

Thank you again

[naenae85 1]

Pretend you are already paying for the higher and save that$200 starting now. Then you will have a head start towards the bills.