I've been mostly lurking here and posting a little, but now the real reason I started reading MM has come to a head.
The short backstory is that mom is in serious need of insurance and her kids are going to end up covering it until the SSA thinks she's disabled or Obamacare kicks in and she will qualify for Medicaid. Trust me, no one wants the long backstory.
So we have looked at a bunch of insurance plans and narrowed things down to two options: the Red Plan and the Blue Plan. The Red plan has higher premiums, but lower deductibles & co-pays and OOP maximums. The bottom line looks like this:
The Red plan will cost $1900 more than the Blue plan over the 18 months until either SSA benefits or Obamacare kick in.
The plans are basically the same if there is something like an ER visit for a broken arm or minor surgery or something.
On the Blue plan, we think there is a 2-5% chance that something terrible and expensive will happen to mom (cancer diagnosis, other trauma) and the OOP maximum will be $5,000 higher on the Risky plan.
Kid A has enough e-fund savings that they could put a bunch money in a trust to cover the OOP costs in the event something bad happened. ETA: Kid B is in grad school and her H is in med school but on scholarship. The "plan" is for the kids to split things 50/50 but there will probably be lots of fuzzy math where Kid A ends up paying a bit more than half. That's fine with Kid A.
A poker player would take the Blue plan. Paying an extra $2000 on the Red plan to avoid a 2% chance or even 5% or 10% chance at losing $5000 is a bad bet. But life is not poker and the dealer is not going to give us a second hand. So WWMMD?
Also if anyone has any advice on tax-favored savings plans for situations like this I am all ears.
edited to rename the plans so that people don't read too much into the plan names
Post by littlemisssunshine on Jul 25, 2012 18:08:18 GMT -5
I'd say risky plan. You save money, and there's a low chance and a short time frame for something to go wrong. You also have the backup of Kid A paying the extra 5k. I don't see much risk with this choice.
Post by MixedBerryJam on Jul 26, 2012 0:04:27 GMT -5
How old is your mom? Where does that 2 - 5 % number come from? I am not an actuarial, but I would think the chances of my 60+yo mom having a substantial medical expense in the next 18 months would be greater than that. I can show you my 57yo husband's $45,000 1-day hospital bill for chemo if you're interested.
Edited for clarity: he had a 15$ copay on those $45k treatments.
How old is your mom? Where does that 2 - 5 % number come from? I am not an actuarial, but I would think the chances of my 60+yo mom having a substantial medical expense in the next 18 months would be greater than that. I can show you my 57yo husband's $45,000 1-day hospital bill for chemo if you're interested.
Edited for clarity: he had a 15$ copay on those $45k treatments.
With enough googling and patience it's possible to start working out the odds at least a little. SEER Cancer diagnosis incidence by Age and Race for women Long-Term Trends in Medicare Cost Concentration etc. etc. Even for diabetics Medicare benificiaries, the chance of being high cost in a given year is only about 10%. And mom is not in great health but she is not in the unhealthiest set of diabetic Medicare patients. So we guess her risk of having super-high medical expenses is somewhere around 5% in the worst case. Even if we take her chances at 10% the math on which plan is better stays about the same ... a poker player would still never take the Expensive plan, but the numbers start getting closer.
The Expensive plan is only better than the Risky Plan if mom ends up as one of these truly nightmare cases. Even with a $10,000 hospitalization the plans are about the same. It would take something that cost $30,000+ for the Expensive Plan to be a better deal. Cancer is obviously something that would cause that. So would certain diabetes complications, end-stage renal disease, etc.
If there were more time between today and Obamacare or the disability claim being processed then the Expensive plan might make more sense. But with only 18 months I feel like it would be unnecessarily risk averse to go with the Expensive plan. We've already rejected a different plan that was actuarially "better" because it had a higher OOP maximum.
How old is your mom? Where does that 2 - 5 % number come from? I am not an actuarial, but I would think the chances of my 60+yo mom having a substantial medical expense in the next 18 months would be greater than that. I can show you my 57yo husband's $45,000 1-day hospital bill for chemo if you're interested.
Edited for clarity: he had a 15$ copay on those $45k treatments.
With enough googling and patience it's possible to start working out the odds at least a little. SEER Cancer diagnosis incidence by Age and Race for women Long-Term Trends in Medicare Cost Concentration etc. etc. Even for diabetics Medicare benificiaries, the chance of being high cost in a given year is only about 10%. And mom is not in great health but she is not in the unhealthiest set of diabetic Medicare patients. So we guess her risk of having super-high medical expenses is somewhere around 5% in the worst case. Even if we take her chances at 10% the math on which plan is better stays about the same ... a poker player would still never take the Expensive plan, but the numbers start getting closer.
The Expensive plan is only better than the Risky Plan if mom ends up as one of these truly nightmare cases. Even with a $10,000 hospitalization the plans are about the same. It would take something that cost $30,000+ for the Expensive Plan to be a better deal. Cancer is obviously something that would cause that. So would certain diabetes complications, end-stage renal disease, etc.
If there were more time between today and Obamacare or the disability claim being processed then the Expensive plan might make more sense. But with only 18 months I feel like it would be unnecessarily risk averse to go with the Expensive plan. We've already rejected a different plan that was actuarially "better" because it had a higher OOP maximum.
Just realize that dollars add up very quick when it comes to hospitalizations. My appendectomy bill was about $15K and routine childbirth was about $25k. Your average hospitalization will be much more than $10k and 1 hospitalization may put you over the 30 K mark...
Does your mom have a risky lifestyle? Drinking? Smoking, Obesity? General lack of medical upkeep in previous years?
I would probably go with the risky plan because the worst case (extra $3k) is not really that bad assuming your mom has not had major medical issues previously.