What would you do?

[golfnut]

Presently, we have retiree medical coverage for a family of three thru UHC. Annual cost is $10,800 per year (note this is net of a $533 monthly employer subsidy). Deductible is $4,000 per individual / $8,000 max out of pocket per year. There is also 20% coinsurance.

Met with a HC agent who gave us a quote for an association plan (FACT) thru UHC for an annual premium of $7,200. Deductible is $10,000 and no coinsurance.

Not 100% sure what to do here because:

- Not sure what my previous employer will do with the retiree plan once the Obama plan goes into effect on 1/1/2014. Will they discontinue to offer the retiree plan and continue (or not) the $533 retiree subsidy?

Just curious of people's thoughts here? What would you do?

Thanks,
Golfnut

 

[Moemg]

I would get the booklets for both plans and check them line by line . Does the second policy have a maxium out of pocket ?

 

[bbbamI]

Do you have pre-existing conditions? Will the second plan cover them?

We have retiree med bennies through Mega Corp. We don't know what/if anything will happen with those bennies on down the line, but since DH was diagnosed with cancer last year, we won't be making any changes.

Well...not at least until we have to...

 

[golfnut]

I would get the booklets for both plans and check them line by line . Does the second policy have a maxium out of pocket ?

Yes, max out of pocket is $10,000.

 

[golfnut]

Do you have pre-existing conditions? Will the second plan cover them?


We have no pre-existing conditions.

 

[MichaelB]

Presently, we have retiree medical coverage for a family of three thru UHC. Annual cost is $10,800 per year (note this is net of a $533 monthly employer subsidy). Deductible is $4,000 per individual / $8,000 max out of pocket per year. There is also 20% coinsurance.

Met with a HC agent who gave us a quote for an association plan (FACT) thru UHC for an annual premium of $7,200. Deductible is $10,000 and no coinsurance.

Not 100% sure what to do here because:

- Not sure what my previous employer will do with the retiree plan once the Obama plan goes into effect on 1/1/2014. Will they discontinue to offer the retiree plan and continue (or not) the $533 retiree subsidy?

Just curious of people's thoughts here? What would you do?

Thanks,
Golfnut

Whatever happens in 2014 is going to affect all plans, not just your current plan.

In addition to differences in premium / deductible / copay / total OOP, I would look at

potential for price increases
guaranteed continued access and availability of the plan
the size and accessibility of the network

premiums can change because of coverage, also because of group size (smaller groups pay higher premiums for similar coverage and are subject to higher price increases)

When it comes to health care insurance, the biggest challenge for middle aged people is continued coverage, then cost. Large group coverage is generally safer, so if you do decide to change policies, you should make sure the group that enables the policy is going to be around and eligible.

 

[Moemg]

Since the co-insurance would go towards your deductible it's kind of a wash .

 

[dgoldenz]

The policy he's showing you is the HSA 100 it sounds like. Good plan and for $3600/year savings I'd definitely consider it if I were in your position. Your current policy has a $16k family max out of pocket while the HSA plan would be $10k max out of pocket and a $3600/year lower premium. The real question is whether you can qualify for the rates the agent quoted and if there will be any medical exclusion riders. United will rider just about everything other than high blood pressure and cholesterol and if you have any riders, you likely won't qualify for a preferred rate. Hopefully your agent is independent and offers coverage from more than one company.

 

[Texas Proud]

Yes, max out of pocket is $10,000.

Is that per person or in total for the family?

 

[dgoldenz]

Is that per person or in total for the family?

Family. HSA out of pocket maximums can't exceed $11,900.

 

[golfnut]

The policy he's showing you is the HSA 100 it sounds like. Good plan and for $3600/year savings I'd definitely consider it if I were in your position. Your current policy has a $16k family max out of pocket while the HSA plan would be $10k max out of pocket and a $3600/year lower premium. The real question is whether you can qualify for the rates the agent quoted and if there will be any medical exclusion riders. United will rider just about everything other than high blood pressure and cholesterol and if you have any riders, you likely won't qualify for a preferred rate. Hopefully your agent is independent and offers coverage from more than one company.

Note the family max is $8,000.

 

[golfnut]

Is that per person or in total for the family?

The $10,000 is the family max.

 

[dgoldenz]

Note the family max is $8,000.

The first post says this:

Deductible is $4,000 per individual / $8,000 max out of pocket per year. There is also 20% coinsurance.

Is this an HSA plan with a combined family deductible? It states that the individual deductible is $4k + 20% co-insurance with an $8k OOP max, so what is the family deductible and OOP max?

 

[golfnut]

The first post says this:


Is this an HSA plan with a combined family deductible? It states that the individual deductible is $4k + 20% co-insurance with an $8k OOP max, so what is the family deductible and OOP max?

Apologize for the confusion.

The individual deductible is $4,000 and the family OOP is $8,000. There are two individual deductibles of $4,000 each.

 

[golfnut]

The first post says this:


Is this an HSA plan with a combined family deductible? what is the family

Yes it is.

 

[dgoldenz]

Apologize for the confusion.

The individual deductible is $4,000 and the family OOP is $8,000. There are two individual deductibles of $4,000 each.

If the deductibles are $4k per person and there is a 20% co-insurance after the deductible, where does the $8k OOP max come from? If the max OOP was $8k for the family and the deductible was $4k each, that would mean there is 0% co-insurance (i.e. insurance company pays 100%). An HSA plan should also have a single combined family deductible, not be per person...

 

[golfnut]

If the deductibles are $4k per person and there is a 20% co-insurance after the deductible, where does the $8k OOP max come from? If the max OOP was $8k for the family and the deductible was $4k each, that would mean there is 0% co-insurance (i.e. insurance company pays 100%). An HSA plan should also have a single combined family deductible, not be per person...

The 20% coinsurance is not x/s of the OOP max of $8,000.

 

[dgoldenz]

The 20% coinsurance is not x/s of the OOP max of $8,000.

Maybe I'm missing something. If you have a $4,000 per person deductible and $8k OOP max with 20% co-insurance, then what is the family deductible? $4k times two people would be $8k and there would be nowhere to fit in the 20% co-insurance When the deductibles are applied individually, there is usually a max of two deductibles per family.

 

[golfnut]

Maybe I'm missing something. If you have a $4,000 per person deductible and $8k OOP max with 20% co-insurance, then what is the family deductible? $4k times two people would be $8k and there would be nowhere to fit in the 20% co-insurance When the deductibles are applied individually, there is usually a max of two deductibles per family.

In our plan, there is a max of 2 deductibles per family ($4,000 times 2) which equals the $8,000 family OOP of $8,000.

Regarding the coinsurance, it is 80%, not 20% (my mistake) and it reads as follows:

In-Network Plan Level Coinsurance-

80% of eligible expenses after satisfying the deductible until Out-of-Pocket is reached.

 

[dgoldenz]

In our plan, there is a max of 2 deductibles per family ($4,000 times 2) which equals the $8,000 family OOP of $8,000.

Regarding the coinsurance, it is 80%, not 20% (my mistake) and it reads as follows:

In-Network Plan Level Coinsurance-

80% of eligible expenses after satisfying the deductible until Out-of-Pocket is reached.

I think you may have a higher deductible and OOP max than you think you have. If the deductible is $4k and they pay 80% after that and your max OOP is $8k, that would apply to only one person. The family maximum would be two deductibles and two OOP maximums which would be a total of $8k and $16k.

If the deductible was $4k per person and the family maximum OOP was $8k total, that would mean there would be no co-insurance to pay. Since the policy clearly has a co-insurance percentage of 80/20, the OOP max must be higher.

 

[golfnut]

I think you may have a higher deductible and OOP max than you think you have. If the deductible is $4k and they pay 80% after that and your max OOP is $8k, that would apply to only one person. The family maximum would be two deductibles and two OOP maximums which would be a total of $8k and $16k.

If the deductible was $4k per person and the family maximum OOP was $8k total, that would mean there would be no co-insurance to pay. Since the policy clearly has a co-insurance percentage of 80/20, the OOP max must be higher.

Note the following from our plan:
For single coverage, the Out-of-Pocket Maximum is
$4,000 per Covered Person per calendar year.

If more than one person in a family is covered under the Policy, the single coverage Out-of-Pocket Maximum stated above does not apply. For family coverage, the family Out-of-Pocket Maximum is
$8,000 per calendar year.

 

[dgoldenz]

Note the following from our plan:
For single coverage, the Out-of-Pocket Maximum is
$4,000 per Covered Person per calendar year.

If more than one person in a family is covered under the Policy, the single coverage Out-of-Pocket Maximum stated above does not apply. For family coverage, the family Out-of-Pocket Maximum is
$8,000 per calendar year.

That doesn't make any sense if the deductible is equal to the OOP max and there is 80/20% co-insurance after the deductible. Are you sure the deductible isn't a lower amount?

 

[golfnut]

That doesn't make any sense if the deductible is equal to the OOP max and there is 80/20% co-insurance after the deductible. Are you sure the deductible isn't a lower amount?

Yes, I am sure.

 

[dgoldenz]

Yes, I am sure.

Alright, don't know what to say about that then...

 

[golfnut]

Alright, don't know what to say about that then...

Thanks for the interchange here. After reading other posts from you, I know this is a subject matter i.e. health plans you are an expert in.

I still need to get a formal quote from UHC thru our agent and , if you wouldn't mind, I'll be back at you with any questions I may have.

Something I've been wondering about is what my former employer will do come 1/1/14. The way I see it the possibilities are as follows:

- continue the retiree plan for retirees only.

- discontinue the plan but offer the $533 monthly stipend to all present retirees.

- discontinue everything and wish us good luck in finding a plan thru the exchanges or individual plans.

Again, thanks for the feedback.

Golfnut