med/dent/vision benefits experts?

[georgeharrison]

My husband is changing jobs soon and we are trying to figure out if it makes more sense for us to all be on my work's plan, his work's plan, or separate.  Is anyone on this board good with figuring this stuff out?  I have so many #s and "if this, then that" going on and my mind is overloaded.

[waverly]

I don't know if I am good at figuring it out, but feel free to post Q's. My decision is fairly straightforward. Many of his jobs have a small penalty if I am on theirs instead of my own. Mine is not expensive, has good coverage, plus he has been laid off 3 times and switches jobs a lot, so it is nice to have mine when his is not available.

Mine charges full price for adding any additional people which is kind of crappy, so kids go under his which again is not great because of all his lay offs, but ultimately way cheaper.

[georgeharrison]

Thanks waverly . My H's medical is currently amazing, so it's going to be a big adjustment. The basic #s are below. It looks like it is better to either all be on my work's or separate. Some things to consider:

My H is one year in remission from colon cancer. He has to have CTs and colonoscopies a couple times/year and blood work and meeting with his oncologist several times/year. He's also kind of prone to ailments: had to go to the ER for a huge cut in December, needed a huge hernia repair surgery the next day, had appendicitis a couple months ago. We will at minimum meet his deductible every year for a while, if not the whole OOP Max.

My kid is a teen and sees his primary probably 3x/year for med checks. He sees a counselor every other week as well. He is very healthy. He will probably meet or come close to the deductible for at least the next year or so. It is unlikely that he will hit the OOP Max (knock on wood).

In general, I am the healthiest person you will ever meet. I go to the doc a few times/year because I am on anxiety meds and she likes to check in. That's about it (again, knock on wood). I don't remember ever hitting my deductible and certainly not OOP max.

The two things that I'm really getting hung up on is the deductible and the OOP Max. If we are all on my plan, the family deductible is only $2700. My H's OOP max if he is on his work's plan is only $2500.

If you see anything that is obviously "you should go with this one" or something I haven't thought of, I'd love a new perspective.

Attachments:

[waverly]

Just a quick glance, the numbers look better for the premiums separately. If he had insurance before shouldn't be an issue, but pre-existing conditions could be a concern if there were a lapse in insurance and new insurance company wanted to be a jerk about the cancer. How did his insurance handle the cancer before? Did you have to pay a lot OOP, or were you happy with it?

Since you and child go to the doctor far less frequently a larger deductible doesn't bother me. I would check on if regular doctor visits are covered with just a co-pay. For example, I think my regular doctor has no-copay totally covered doesn't go towards my deductible, and a specialist is $20. I find for those infrequent doctor visits, it is nice to just pay the $20 co-pay type thing rather than owe $250 towards my deductible every time I see someone. If I can see a regular doctor through out the year without really tapping into that deductible then it makes it far more affordable then a plan where everything is subject to the deductible. Not sure if I am explaining that well.

[bullygirl979]

Would your son's visits be a co-pay or 100% until you hit the deductible?

[georgeharrison]

Oct 11, 2019 14:24:04 GMT -5 bullygirl979 said:

Would your son's visits be a co-pay or 100% until you hit the deductible?

they are co-pay:  $20 for office visits, 20% for his counseling (usually about $40) 

[bullygirl979]

Personally, I would split it. Given your H's medical care, it doesn't make much sense for him to go on your plan. And, given it would be $600 more a month for you and your son to go on his, that doesn't make much sense either. I would backroll that $600 and use it in case you hit your deductible or OOP max.

[goldengirlz]

Do the numbers change if you put your kid on your H’s plan and you take an individual plan? The OOP max on your plan for a family is pretty steep.

Otherwise, it actually seems like you get the best “value” from your family plan because the OOP max and deductible stay the same even by adding your H and your premiums only increase slightly (well, more than slightly, but I’d rather take the hit on premiums than deductibles.)