I finally got a job that offers insurance! (yay!) but, I don’t know If I can afford it.
Their cheapest option is a $4500 deductible plan. Nothing is covered until I hit that deductible, so I’d be stuck with paying $900/month for my insulins PLUS $180/month for insurance that literally does nothing for the rest of the year. I’d only be making $13.50/hr so literally half of my paycheck would be going towards my healthcare every month.
And, since my employer technically offers “insurance” with premiums that are less than 9.7% of my total income, I’m going to lose my obamacare savings if I decide to stay with my marketplace plan instead. My plan that was $30/month would go up to $280/month even though my income would normally qualify for a cheaper rate.
I’m really confused at what I should do right now, but I have to get this paperwork signed within the next 2 days.
It sounds like they have other options? Can you give a summary as in the monthly premium, the deductible as well as the max out of pocket for both plans?
Also on your current plan for $30/month which you say would rise to $280/month, what are the deductibles and max out of pocket for those?
And the similar information for your current plan @ $30/month and the rise to $280/month ?
Also is the Max OoP a total of $4500 for plan 1 or is it $4500 on top of the initial 4500 deductible? Plans I am familiar with do not have deductible = max OoP which means as soon as you hit the deductible, insurance pays 100% of everything for the rest of the plan year.
The out of pocket is the same as the deductible. As soon as I hit $3000 or $4500 depending on the employer plan, everything will be paid 100%. Until then, there’s no prescription coverage. I’d be stuck paying $900+ a month until the deductible has been hit. I’d only be making $2300 or so a month so It would be a HUGE chunk of my income.
I believe Plan 2 would be the cheapest for you with the $3000 deductible when figured over the cost of the year.
Even if using Eddie’s approach, I would still opt for Plan #2. The difference in monthly premiums between Plan #1 and Plan #2 is not worth it.
Obviously the Current “Obama” plan @ $30/month is your cheapest. However the revised “Obama” plan @ $280/month would end up being the most expensive approach.
The thing with the Obama plans is at least I wouldn’t have to pay full price for insulin. It might be more expensive once my deductible is hit, but until then, I’m not sure if I can afford it.
Are there any additional medical costs over the cost of the year which should be factored in? If your medical costs go higher than Plan #2 with $3000 deductible would end up being cheapest over the course of the year and would average out to about $450 per month in total (premium and deductible over the year).
There’s a few things I’d like but could never afford with my current plan (such as a pump) If I were to meat my deductible with the $3000 plan, I’d potentially be able to get one finally.
Maybe. The only problem is if I were to get a CGM and pump, next year I’d have to pay even more than the $1000/month I’d have to pay now (until the deductible is met). I’d have to do some budgeting to make sure I could afford it.
You could try and time your reorders so you get your last pump and CGM supply order in mid-December. That would let you go longer into the new year before you needed to reorder supplies. We get 90 days of supplies at a time.
If you do this - Don’t try to time it too close to the end of the year. Definitely leave some cushion because the distributor billing departments have been known to muck up the order date by a few days which normally doesn’t matter but can be a big deal if it cross the year. Mid-December gives enough cushion that should not be an issue.
Anyway - even with a mid-December, for the year it all comes out in the wash but it would just (likely) spread the deductible across a few more months so it might not be a big monthly bill right in the beginning of the year.
It actually sounds like you have really good insurance choices. Good luck with your decision.
while less expensive they do not count toward satisfaction of the deductible. Look at Blink Health (not cheap but less) for a less expensive insulin option that will generally count toward the deductible.
Yes, debatable, and lots of discussion on this subject in other threads here. But imho, the value of a cgm is greater if you have to choose. I don’t have to choose and I still have only a cgm.
If you think you’re capable of saving the money, and you think the employer plan will be similar next fall- consider staying with your current plan now and saving as much as possible up for next year’s deductible.
Your employer plan sounds like my current Virginia ACA plan. Between insulin, pump supplies, and CGM supplies, I had hit the deductible by early spring. It sucked in the winter but has been a relief to just see $0 since then.
Sad to say, there’s never an easy choice regarding insurance. Good luck!
PS - if the work insurance company is the one I think it is, save all your receipts regarding medical spending and stay in network. This year has been ok for me with the billing department, but last year their billing was horrible… hours on the phone each month
By having insurance, even though you have not met the deductible for the insurance company to pay, you will only be charged the agreed upon amount for the drugs. Be sure you go to the pharmacy that is approved by your insurance company (in network one) to fill everything. And be sure they run it through your insurance. That way, you get the cheaper price, plus they are keeping track of your out-of-pocket for you and you are not having to keep the receipts. As an example, my deductible through Obamacare is $7,000 per year. I pay $236 a month for it and I get a credit of $314. If I didn’t get the credit my premium would be $550 a month. Nothing is covered until I pay the $7,000 and then it only pays 60%. I took a prescription to the pharmacy for an antibiodic and they filled it without running it and they told me it was $18. When I asked did she run it through my insurance, she told me no, and then ran it. The prescription was $5. They didn’t pay anything but by having the insurance I only had to pay $5. So the money on the front end you are spending will say you a little on the back end. Not much, but some. Same thing for your office visits, labs, tests etc.
Sounds like you have a copay coverage for RX, and not co-insurance. Often co-pays are not tied to the deductible being met, but can be limited to certain drugs. PPO plans often work this way.
My drug coverage insurance (not PPO), I pay the insurance approved amount 100% until my deductible is met.
