We have health insurance through my work. Right now it is a PPO but starting 2008 they are switching to the HD plan. From what I have read and heard it sounds like a rip off and I am not happy. Do any of you know much about the HD plans, do you like them, have you spent a lot more since the switch. We can get a PPO insurance through my dh's work but my job is more stable. Please let me know your opinions. TIA!

What sort of a high deductible plan? Do you have to meet your deductible first before any bills are paid?

We personally have sort of a hybrid plan. We pay a $30 co-pay on doctor's office visits and do not need a referral to a specialist. For all labwork, we pay 20%. These two things are exempt from the deductible. In other words, we pay only the co-pay of either $30 or 20% from day one. These two things are outside the deductible net.

The deductibles are for major medical. We have $1500 per person. Things like my yearly mammogram, surgery, etc. go towards the major medical deductible.

We have separate pharmacy/prescription coverage that was an add-on to the medical insurance policy. We pay $15 for generic, $25 for name brand drugs on their preferred list, and $40 for all other drugs. If the prescription is less than $15, we pay the actual lower amount. It was about $110 a month for this, but for our needs, it is worth it.

It works for us, but I would like a lower deductible. However, the other employees can't afford a lower deductible plan and all employees must have the same coverage on this group employers plan. The insurance company is Lifewise. They pay bills timely.

We have a high deductible plan, and I will talk about it in just a moment.. but I wanted to first say that it was my understanding that anytime there is a change in jobs with either spouse the other's company is required to allow you to switch to their plan. This is how my previous employer's HR person explained it to me: If you husband looses his job his employer is required to continue to keep your insurance going until the end of the month. Assuming you let us know about the loss of job ASAP we should be able to start up your insurance (with us) on the first of the month following the insurance company's receipt of the new enrollment application (eg: Job was lost in September, if everything is processed quick enough new insurance goes into effect October 1st). I was able to find out more information about this by looking at our current plan's benefit booklet.. Please look at your coverage booklets & talk to your HR rep & have your husband do the same to see if that is how easy they say the portability is.

Now as far as our experience with our HD plan?? We have had Lifewise's Preferred Provider Plan since March 1st. Just so you know, my husband works for a company with only 3 employees, so the fact that we even have insurance is a complete miracle. Also, his employer insists on paying the full insurance premium for his employees as a part of their benefits package since he is paying them a wage below market rate (company is a new startup), and he didn't feel it was fair for the employees to have to take the premiums out of our already lowered salary. We also have the added benefit of having an HSA account that was started up for us by his employer. In that account we receive $470/month....

because...

We have a $6000 annual deductible for our entire family, or $3500/member. After our deductible is met then we have a 30% copay for most everything until we hit our deductible (coinsurance) maximum of $4000 per family or 1,500 per member. Some things are already only a 30% copay, including well-baby checkups & annual exams. And, apparently (as I am actually closely reading over our materials right now) we have a 100% payment of Preventive Immunizations, Flu Shots, Paps & Mammograms, PSA tests, & Generic Cardiovascular Drugs.

Oh, and we do not have any dental insurance at this time which completely sucks, but I digress.

At any rate, how do we like the plan? Quite frankly it sucks. But, my husband's employer has made it as easy as possible for us to spend as little $$ as possible for our insurance. My husband is diabetic, and needs at least $225 in drugs & needles/testing strips most months. I have asthma & bad seasonal allergies (my dr has instructed me to not take my meds during the seasons I don't need them to lessen our financial responsibility. He actually would prefer I stay on them year round, but understands our situation). My two drugs are $180/month, not including $45 for my BC & $40 for my fast acting inhaler. My son has asthma as well, so his inhaler is the same as mine.

On a good month (just a one of dh's insulins, & my BC being filled) we have spent $125 out of our HSA acct in drugs alone. In a bad month, we all need everything to total $530 in just our regular drugs alone. This does not include dh's diabetes appts which run $150 - $175 every 3 months. and other routine checkups. God forbid we actually get sick!

So far, since we have started with this plan we have only had to spend $100 out of pocket that wasn't covered by HSA funds (medical only, not including dental). We are very fortunate to have doctors that understand our situation and will accept payments over time, and so far have not charged us any late charges. Dh's diabetic doctor even offers us a discount if we can pay her fee in full at the time of his visit.. Since I discovered this, I have suggested to dh that he makes those appts for the first week of the month as our HSA deposit happens by the end of the previous month. I have worked it out with our family doctor that I will make a payment to our account of a minimum of $20/visit that occured during the month, and an additional $20 if we have a balance running.. no matter if it comes out of our HSA account or not. If it was a good month drug wise, and I have extra HSA $$ I of course pay more towards the balance. Luckily we had a low visit summer, so at the moment we are 100% caught up, but that could change at any time.

To sum up: Do I like this plan? Flat out NO. It is so much of a hassle. Do I love my dh's employer? You bet! Because of his kindness we are actually paying less out of pocket for medical bills at the moment than we were at dh's previous job, even with the higher deductables.

I would suggest that you sit down and estimate the number of visits you actually make a year.. See if you can get the billing department for your doctors to give you an estimated costs of your visits. Call the pharmacy to find out what the retail costs are of any drugs you know you will be using. Then use those numbers to figure out how much you will be spending towards the deductible. Don't forget to add your insurance premium co payment as well. Do the same information for dh's insurance, but this time use your copays instead. You might be surprised which ends up being cheaper in the long run.

Thank goodness you have found about this early enough to do your research!! Good Luck with what ever you decide!

In my opinion, high deductible plans tend to be best suited to families/people who are in generally good health and who don't have chronic medical conditions. My husband's employer started offering one last year so we looked into it as an option, but he has ulcerative colitis which requires daily medication, specialist visits and lab work every three months (plus we have small children) so we decided it wasn't our best option. We stuck with our PPO but switched to one that had a higher deductible and a lower premium and also opened a healthcare spending account.

Ultimately, high deductible plans have a trade-off (like everything). The premiums that you pay up front are lower than those you'd pay with a traditional insurance plan (like a PPO) but you don't sacrifice flexibility (like you would in an HMO) so it can be a very effective choice if you don't see the doctor beyond the few regular preventative visits that those types of plans typically cover. BUT if a major illness/hospitalization were to occur - can you cover your deductible?

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Stephanie
Mom to: Caleb (8/03), Ian (9/05), & Baby Boy #3 (EDD 11-9-2008)

i would say you really have to way the options here. a higher deductible would have been fine for us had we not had children. having children that get sick in the winter and i have one thats just turnin one and still need imuniztions for us it would put us in a really hard spot...you need to look at do you have the cash to cover the expenses as they arise in case you are not even close to your deductible also do you have a health care saving acct thru your employer this does help reduces your taxable income and help you pay for the stuff out of pocket. i also would look at dh's plan and then about the transferablilty. i know i did transfer when dh got layed off and i had no problem switching as long as we were previously insured and we did it mid year. i would really look at this option for yourselves.

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'The will of God will never take you where the
Grace of God will not protect you.'

HAVE A BOOTIFUL HALLOWEEN

Thanks for your responses. Our plan will be similar to BabeintheMoon. We sould have to pay for everything out of pocket, prescription also, until we hit our deductible (which they haven't given us the numbers yet but our assuming $6000/year). We do not have children yet and probably never come close to $6000 a year, but prescriptions and doctors visits may add up to 3000-4000, which would mean we are essentially making 3000-4000 less a year. We can set up an HSA account but we have to put the money into it ourselves. My major concern is if I do become pregnant the money I would have to spend on ultrasounds, etc. It seems this plan is a big rip-off. Besides they said the premium and not much less than the ppo (maybe 20%.)

We also have this type of insurance. When we purchased it, the salesman did make sure we weren't having more kids, because it would cost a lot out of pocket. I do not like having this kind of insurance because I dread when I have to take one of the kids to the doctor. We spent around $900 last winter because my daughter had trouble getting rid of strep throat. Now, if I had the money to fully fund my health insurance acct, that would make things much better.

We have this insurance because my husband is self-employed.