Any Health Insurance Experts Here?

[GTaudiophile]

I am looking for a new health insurance plan:

1: $500 Deductible / 20% Coinsurance for $172.10 per month ($2065.20/year)
2: $1000 Deductible / 0% Coinsurance for $179.10 per month ($2149.20/year)

Plan 1 is provided by Blue Cross Blue Shield of GA. Plan 2 is provided by Celtic.

 

[alkemyst]

Originally posted by: GTaudiophile
I am looking for a new health insurance plan:

1: $500 Deductible / 20% Coinsurance for $172.10 per month ($2065.20/year)
2: $1000 Deductible / 0% Coinsurance for $179.10 per month ($2149.20/year)

Plan 1 is provided by Blue Cross Blue Shield of GA. Plan 2 is provided by Celtic.

no where near enough info provided.

 

[GTaudiophile]

Sorry, I can't link to plan information directly.

I am using E-Health-Insurance to research plans.

 

[sixone]

How is the higher deductible plan more expensive than the lower? Must be other differences besides cost.

Normally, it would depend on how much you and family? are likely to generate in claims. If you only have one or two visits, then you should go with a higher deductible plan and save yourself some money in premiums.

The Celtic plan I looked at included prescription coverage. You'll want to factor in the cost of any meds you are likely to need.

General rule: Annual premiums + likely out-of-pocket expenses = total annual cost. Figure this for both plans, and pick the one most likely to take the least amount out of your pocket.

 

[GTaudiophile]

My employer pays the vast majority of the premiums, so that is not the issue. The issue is: What if I get into a really bad car wreck and the hospital bill exceeds $60,000. Would having a lower deductible with 20% coinsurance be better in this situation or a higher deductible with 0% coinsurance?

 

[Uppsala9496]

Originally posted by: GTaudiophile
I am looking for a new health insurance plan:

1: $500 Deductible / 20% Coinsurance for $172.10 per month ($2065.20/year)
2: $1000 Deductible / 0% Coinsurance for $179.10 per month ($2149.20/year)

Plan 1 is provided by Blue Cross Blue Shield of GA. Plan 2 is provided by Celtic.

All depends on whether or not you think you are going to have some big claims.
Plan 1 looks to be the best option since the $500 deductible is easy to meet. The coinsurance shouldn't be a problem if you are just having normal office visits.
If you plan on having any surgery, you might want to consider plan 2 since there is only a $500 deductible difference. The 20% coinsurance difference could well exceed that $500. BCBS is however a better carrier than Celtic (even though BCBS' claims departments are a joke).
Let me know if you have any other specific questions. I used to underwrite health and life insurance (about 5 years ago).

 

[Dulanic]

Originally posted by: GTaudiophile
I am looking for a new health insurance plan:

1: $500 Deductible / 20% Coinsurance for $172.10 per month ($2065.20/year)
2: $1000 Deductible / 0% Coinsurance for $179.10 per month ($2149.20/year)

Plan 1 is provided by Blue Cross Blue Shield of GA. Plan 2 is provided by Celtic.

It really varies, if you only use the insurance a little in a year the first plan would be better. Otherwise #2 would be. But since you said plan #1 is Blue Cross, go 2, screw Blue Cross, they deny tons of stuff for no reason.

 

[spidey07]

Originally posted by: GTaudiophile
My employer pays the vast majority of the premiums, so that is not the issue. The issue is: What if I get into a really bad car wreck and the hospital bill exceeds $60,000. Would having a lower deductible with 20% coinsurance be better in this situation or a higher deductible with 0% coinsurance?

there is a thing called "out of pocket maximum"

There are a whole lot of factors in choosing your insurance so there is not enough information to assist.

 

[GTaudiophile]

Originally posted by: Uppsala9496

Originally posted by: GTaudiophile
I am looking for a new health insurance plan:

1: $500 Deductible / 20% Coinsurance for $172.10 per month ($2065.20/year)
2: $1000 Deductible / 0% Coinsurance for $179.10 per month ($2149.20/year)

Plan 1 is provided by Blue Cross Blue Shield of GA. Plan 2 is provided by Celtic.

All depends on whether or not you think you are going to have some big claims.
Plan 1 looks to be the best option since the $500 deductible is easy to meet. The coinsurance shouldn't be a problem if you are just having normal office visits.
If you plan on having any surgery, you might want to consider plan 2 since there is only a $500 deductible difference. The 20% coinsurance difference could well exceed that $500. BCBS is however a better carrier than Celtic (even though BCBS' claims departments are a joke).
Let me know if you have any other specific questions. I used to underwrite health and life insurance (about 5 years ago).

Thanks. I normally get one physical per year at the tune of around $600. That's not a problem. It's the catastrophic stuff that worries me.

 

[sixone]

Originally posted by: GTaudiophile
My employer pays the vast majority of the premiums, so that is not the issue. The issue is: What if I get into a really bad car wreck and the hospital bill exceeds $60,000. Would having a lower deductible with 20% coinsurance be better in this situation or a higher deductible with 0% coinsurance?

A car wreck would be covered by car insurance. Most health insurance plans will not pay anything for injuries resulting from a car accident.

If you find you have to use it, the higher coinsurance would be the better choice. But how likely are you to need it? You may get to the end of the plan year, only to discover that you paid $xxx, but have nothing to show for it.

In my formula above, you should be using the annual premiums YOU pay for the coverage. Anything paid by your employer is irrelevant to your choice.

 

[Uppsala9496]

If you are concerned with large claims, go with option 2 then. Just for the peace of mind if nothing else.

 

[Bryophyte]

How old are you? Just you covered or do you have family covered as well? If more than one, does the deductible cover you all or is it per person? Any health problems (IOW, are you likely to use the insurance more than the deductibles?) Planning on having any kids in the near future? You need to look at the provider directory (if they limit who you can go see, you need to make sure there are enough doctors in your immediate area to choose from.)

If you will probably need a fair amount of medical care (in excess of $3000), you ought to go with the higher out-of-pocket one (1000 dollar deductible plan). If you're a young, healthy, single male with no family history of major health problems, the other plan would probably be fine.

 

[GTaudiophile]

Originally posted by: Bryophyte
How old are you? Just you covered or do you have family covered as well? If more than one, does the deductible cover you all or is it per person? Any health problems (IOW, are you likely to use the insurance more than the deductibles?) Planning on having any kids in the near future? You need to look at the provider directory (if they limit who you can go see, you need to make sure there are enough doctors in your immediate area to choose from.)

If you will probably need a fair amount of medical care (in excess of $3000), you ought to go with the higher out-of-pocket one (1000 dollar deductible plan). If you're a young, healthy, single male with no family history of major health problems, the other plan would probably be fine.

Age: 25
Marital Status: Single
Children: None
Health: Not superb, but fine.
Smoker: No

 

[Bryophyte]

What's the total annual out-of-pocket maximum for plan one?

 

[The Stigenator]

first off your out of pocket max per year is 1000 for #1 and 2000 for #2..

Second I would avoid Blue cross.. I had them for a few years and they kept raising my PPO rates even though i was hardly ever using them. ANd then their precription coverage was horrid. PPO's have advantage that you can go see a doctor as soon as possible without waiting for a HMO system to 'schedule' you in.

I have the value basic whatever Health net one and I am happy for what coverage i get. I would avoid blue cross at all costs. If you want good care for that price you can get an awesome Kaiser HMO plan.

 

[GTaudiophile]

Originally posted by: Bryophyte
What's the total annual out-of-pocket maximum for plan one?

PLAN 1:

Out-of-Pocket Limit: $2,000 per individual.
Lifetime Maximum: $5,000,000

PLAN 2:

Out-of-Pocket Limit: $1,000 Single.
Lifetime Maximum: $5,000,000

 

[GTaudiophile]

Originally posted by: TheGoodGuy
first off your out of pocket max per year is 1000 for #1 and 2000 for #2..

Second I would avoid Blue cross.. I had them for a few years and they kept raising my PPO rates even though i was hardly ever using them. ANd then their precription coverage was horrid. PPO's have advantage that you can go see a doctor as soon as possible without waiting for a HMO system to 'schedule' you in.

I have the value basic whatever Health net one and I am happy for what coverage i get. I would avoid blue cross at all costs. If you want good care for that price you can get an awesome Kaiser HMO plan.

Everyone around here has BCBS, but you're right. My monthly premium has gone from $70/month to $170.00/month from December 2002 to October 2005. I have only been to the Dr. once in that time, last year, for a physical. Their billing department is horrid. I pay for 6 months at a time, and getting them to send a statement at the end of those 6 months is near impossible.

 

[Bryophyte]

Prescription coverage for each plan?

 

[sixone]

Originally posted by: GTaudiophile

Originally posted by: TheGoodGuy
first off your out of pocket max per year is 1000 for #1 and 2000 for #2..

Second I would avoid Blue cross.. I had them for a few years and they kept raising my PPO rates even though i was hardly ever using them. ANd then their precription coverage was horrid. PPO's have advantage that you can go see a doctor as soon as possible without waiting for a HMO system to 'schedule' you in.

I have the value basic whatever Health net one and I am happy for what coverage i get. I would avoid blue cross at all costs. If you want good care for that price you can get an awesome Kaiser HMO plan.

Everyone around here has BCBS, but you're right. My monthly premium has gone from $70/month to $170.00/month from December 2002 to October 2005. I have only been to the Dr. once in that time, last year, for a physical. Their billing department is horrid. I pay for 6 months at a time, and getting them to send a statement at the end of those 6 months is near impossible.

Those increases are happening with all plans, not just BC/BS. I work for a TPA, and we're seeing increases across the board.

 

[GTaudiophile]

Originally posted by: Bryophyte
Prescription coverage for each plan?

PLAN 1:

$200 annual Rx deductible; $15 generic; $30 brand ; $45 non-formulary. Deductibles apply to each covered member.

PLAN 2:

Rx discount card, average 15% discount. 0% after deductible. Drug card optional.

 

[Dulanic]

Originally posted by: TheGoodGuy
first off your out of pocket max per year is 1000 for #1 and 2000 for #2..

Second I would avoid Blue cross.. I had them for a few years and they kept raising my PPO rates even though i was hardly ever using them. ANd then their precription coverage was horrid. PPO's have advantage that you can go see a doctor as soon as possible without waiting for a HMO system to 'schedule' you in.

I have the value basic whatever Health net one and I am happy for what coverage i get. I would avoid blue cross at all costs. If you want good care for that price you can get an awesome Kaiser HMO plan.

Hell yes, I hate blue cross. Ok first off for the past few years my benefits have gotten worse and worse every year, higher out of pocket, higher co pay etc...

But what really pissed me off is when I was in the hospital, they refused to pay the last 3 days saying it was not medically necessary. Lets see I cant eat or drink and have't in a week, cant walk, and the doctors can't figure out what was wrong with me, but yaaaa not medically necessary. Even my doctor just laughed, because they called and asked him before they did this, and he said it was very much so medically necessary.

Had to fight it for a while, but they finally paid.

 

[GTaudiophile]

Originally posted by: Dulanic

Originally posted by: TheGoodGuy
first off your out of pocket max per year is 1000 for #1 and 2000 for #2..

Second I would avoid Blue cross.. I had them for a few years and they kept raising my PPO rates even though i was hardly ever using them. ANd then their precription coverage was horrid. PPO's have advantage that you can go see a doctor as soon as possible without waiting for a HMO system to 'schedule' you in.

I have the value basic whatever Health net one and I am happy for what coverage i get. I would avoid blue cross at all costs. If you want good care for that price you can get an awesome Kaiser HMO plan.

Hell yes, I hate blue cross. Ok first off for the past few years my benefits have gotten worse and worse every year, higher out of pocket, higher co pay etc...

But what really pissed me off is when I was in the hospital, they refused to pay the last 3 days saying it was not medically necessary. Lets see I cant eat or drink and have't in a week, cant walk, and the doctors can't figure out what was wrong with me, but yaaaa not medically necessary. Even my doctor just laughed, because they called and asked him before they did this, and he said it was very much so medically necessary.

Had to fight it for a while, but they finally paid.

So who do you use now instead of BCBS?

 

[alkemyst]

Originally posted by: GTaudiophile

Originally posted by: Bryophyte
How old are you? Just you covered or do you have family covered as well? If more than one, does the deductible cover you all or is it per person? Any health problems (IOW, are you likely to use the insurance more than the deductibles?) Planning on having any kids in the near future? You need to look at the provider directory (if they limit who you can go see, you need to make sure there are enough doctors in your immediate area to choose from.)

If you will probably need a fair amount of medical care (in excess of $3000), you ought to go with the higher out-of-pocket one (1000 dollar deductible plan). If you're a young, healthy, single male with no family history of major health problems, the other plan would probably be fine.

Age: 25
Marital Status: Single
Children: None
Health: Not superb, but fine.
Smoker: No

You are spending $600 on a yearly physical?

 

[alkemyst]

Originally posted by: GTaudiophile

Originally posted by: Dulanic

Originally posted by: TheGoodGuy
first off your out of pocket max per year is 1000 for #1 and 2000 for #2..

Second I would avoid Blue cross.. I had them for a few years and they kept raising my PPO rates even though i was hardly ever using them. ANd then their precription coverage was horrid. PPO's have advantage that you can go see a doctor as soon as possible without waiting for a HMO system to 'schedule' you in.

I have the value basic whatever Health net one and I am happy for what coverage i get. I would avoid blue cross at all costs. If you want good care for that price you can get an awesome Kaiser HMO plan.

Hell yes, I hate blue cross. Ok first off for the past few years my benefits have gotten worse and worse every year, higher out of pocket, higher co pay etc...

But what really pissed me off is when I was in the hospital, they refused to pay the last 3 days saying it was not medically necessary. Lets see I cant eat or drink and have't in a week, cant walk, and the doctors can't figure out what was wrong with me, but yaaaa not medically necessary. Even my doctor just laughed, because they called and asked him before they did this, and he said it was very much so medically necessary.

Had to fight it for a while, but they finally paid.

So who do you use now instead of BCBS?

I am on Aetna...our company is self-insured through the providers, BCBS used to be our agent. They kept denying claims our own HR departments approved (keep in mind we self-insure, all insurance claims are paid by us....BCBS was just managing it).

We gave them a while to fix the problems and they didn't...we are on Aetna now.

I look at insurance for a couple factors:

I want a catastrophe covered.

I want easy co-pays and a managable deductable. I want some of the 'basics' wrapped in.

I want it easy to find treatment from any physician *I* choose.

I am paying about $100 a month. Company picks up more than half I believe.