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Which health plan would you choose?

November 7th, 2016 at 06:09 am

I was nervously waiting to receive the details of next year's health insurance rates from my former employer's Cigna plan thru COBRA.

Right now, I'm paying $513/mth with a $500 deductible.

Next year, the same plan is just $520 a month with same deductible. I breathed a sigh of relief at that as I've been hearing so much about how high Affordable Care Act rates are rising.

Still, $520/mth is not great when you're not working. I do have an option of going with the other plan my former employer offers, a high deductible HSA plan where you pay $460/mth but have a $1500 deductible.

I think I've decided against the high deductible plan becus i'd rather not have that large upfront deductible facing me every time I think I should see a doctor about something. The savings difference if I went with that plan instead of sticking with my current plan would be about $720. But another reason not to go with that plan is because I believe the company contributes something to your health savings account, but as an ex-employee, I wouldn't get that.

I also looked at my options on my state's healthcare exchange. The choices have narrowed. For next year, there are only 7 silver plans to choose from and they are all with ONE insurer, Connecticare, a company that gets only a 2 star rating from the state and my neurologist is not in their network. Also, the deductibles associated with these 7 plans range from $1,000 to $5300 altho the monthly premiums range from $325 to $425.

As a reminder, if I found a f/t job next year that paid anything remotely decent, I'd have to pay back whatever subsidies I had received up to that point (they estimate subsidies to be $532/mth!!), making these plans not so affordable should I find steady work.

Finally, I need to carefully look at prescription costs, as my one ongoing prescription is considered a "specialty" drug. Although the pharma company will pick up 100% of my copay cost regardless of what health plan I'm on, they do have an annual cap on what they pay. I can't remember what it is but if I look at the one ACA silver plan I'd consider, one with a $1,000 deductible, I see that plan pays 50% of specialty drugs and requires I pay "no less than $65 or greater than than $500 per prescription."

I get this med mail order and becus of its high price, i guess, you can only get 1 month at a time. So that means I'd be charged $500/mth just for this one prescription. Again, the pharma company picks up the copay but I could bump up against their annual maximum. Compare that to my current Cigna plan where the max I would be charged is $250 per prescription.

I doublechecked with cigna and as an ex-employee I won't qualify for the wellness incentive program, where you can earn up to $250 a year in gift cards just for getting a physical or a mammogram, for instance. Frown

So by sticking with my current plan, at least I can count on the same coverage I've been getting with a pretty low $500 annual deductible. I'll also know my med co-pays are still 100% covered. My doctors are part of the network.

With the lower monthly premium ACA plans, yeah, I could save $720 over the course of the year, but if I find any kind of steady job, chances are I'll have to pay back the subsidies, which as noted above, aren't cheap. If you factor in this payback, these plans are definitely not affordable.

Of course, I can only stay on COBRA through the end of next year; at which time i'd have to go on an ACA plan or the plan of some future employer.

5 Responses to “Which health plan would you choose?”

  1. LuckyRobin Says:

    What we did was plug all the numbers into a spreadsheet, estimating how much we would spend with each plan over all. Then we considered how much out of pocket it would be each month with our set medical expenses. In the end we went with the cheaper to us plan overall because with no income coming at all, we have to rely only on our savings for this. You will have sporadic income with your patchwork jobs you always put together, so that could factor into your choices as well, if you are trying to live off of that without dipping into savings.

    Is your medication one that you can get through the Walgreens discount prescription program? We get one of our medications that way. We just don't run them through insurance at all. We get a $350 medication our insurance doesn't cover for $15 that way. Not every state has it, but I think they said something like 40 do. We found out about it when we had no insurance and they said we could still use it for that drug when we got insurance again since it wasn't covered. I think other big name pharmacies have something similar as well. It would pay for you to investigate.

  2. PatientSaver Says:

    LuckyRobin, thanks for the info about Walgreens. They are my pharmacy but i didn't know about the plan. I will try using the card there next time I have a need, but for purposes of my Copaxone, I can't use it for that becus with the Copaxone, they require you to order it by mail, and the Walgreens card is only good at participating pharmacies. But still good to have, so thanks again.

    I am so leery of changing health plans due to very negative past experiences doing 5 years ago. At one point, becus my income had dropped, I had to go on my state's Husky program, which is basically Medicaid and it was hellish trying to find in-network doctors; I had to travel way out of my way just to see one. The coverage really stank.

  3. Jenn Says:

    Based on your situation, it sounds like sticking with your current coverage is likely the best approach. Peace of mind counts for something too so even if it's a little more expensive, it might still be worth it to you.

    But running the numbers as LR suggests is a good idea so you're as informed as possible. The high deductible plans seemed scary to me at first, but our family is coming out ahead. Our healthcare costs have been less than the amount my employer contributes to the HSA and the HSA savings continue to grow tax-free.

  4. Carol Says:

    I think you might be smart to stay with your current plan just for peace of mind. That might be worth the maybe $720 over the year. After all you may have to change 'cuz you get a job, or worse case, you have to change again next year.

  5. CB in the City Says:

    I'd stick with the current plan. It's not that much more expensive, and you will be spared the risk of lost paperwork, etc.

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