Health Insurance for me and the kids

[MDPhDWife]

Hey Everyone! I've been MIA for some time while we were wrapping up training and moving to TX for The Job. I'll post soon to catch up with everyone, but meanwhile I need to pick your brains. We've been spoiled with really good affordable insurance through all the universities that DH has worked and trained. Now that he's in PP, I'm getting a reality check. The job pays 100% of DH's premiums, but the cost for the girls and me seems expensive at $1100 per month. This is a POS plan with a $1500 deductible (co pays don't apply) and $2K out of pocket max. Seeing as I'm a SAHM, I'll need to shop on my own to compare which I've never had to do before. The insurance lady at DH's work advised me to stay away from healthcare.gov and marketplace. After doing a little googling, that's all I'm finding. Do any of you get insurance for yourself and your kids that's not employer sponsored? Where do you shop? Does what I described seem high to you as well or am I just not being realistic?

[SoonerTexan]

My mom and siblings are in your situation. Yes, the deals were better outside the marketplace, but frankly I doubt you are going to find a better deal than what you described. Load up that HSA and be prepared to pay all your expenses out of pocket for anything not major. If it makes you feel better, our residency plan has a higher deductible and a 30% copay for any care we would actually use. The premium is lower at $400/month...on a residents paycheck.

It's the new reality

ETA: Whoops--it will be $500! As much as our food budget.

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[SoonerTexan]

I asked her. They have a mid tier BCBS of TX plan. $850 a month for her and my 3 siblings. $6k individual deductible and $10k family deductible...and my mom shopped around hard. Basically they pay for all medical care out of pocket barring a major illness or accident


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[ides]

This just really freaking annoys me. You pay this ridiculous premium and basically get nothing for it but have it incase of something catastrophic. What a scam.

[SoonerTexan]

I'm not bitter at all


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[fluffhead]

Sorry to say - I'd go with the employer sponsored plan. Less headaches, and more responsiveness, I think. Our new plan is BC/BS and it's terrible, but I'd still go with it rather than shop around.

[PrincessFiona]

Health Insurance for me and the kids

Our insurance through DH's employer is BC/BS. It's expensive. We have a "Cadillac" plan so I guess we can look forward to being taxed out the ass too. We have an $8900 family deductible with a $3500 deductible per person.

Let me translate that for you: we avoid doctors and hospitals. We had a situation this weekend that we felt required emergency room care. We handled it at home. With 2 kids in college we simply can't afford it. Our "insurance" isn't worth shit to me. I can't get help for Andrew right now because I don't have the money.

This is not an uncommon problem. Part of my work day is spent dealing with bastard insurance companies. They deny almost all prior authorization requests and refuse to pay on the ones they have authorized. For the last 2 months, they paid $89 on $1000 charges (4 diff companies). They kicked back all $500 charges. My boss had to actually ask us to not cash our paychecks for awhile.

There are no good insurance companies. And don't even get me started on Medicaid.


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[mommax3]

We pay $350/month for our insurance. We have a $2500 per person deductible, and a $12,000 family deductible. We keep about 12K in our HSA and hope for the best. DH had a choice of plans, and chose the lowest premium since we are generally healthy.


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[PrincessFiona]

It's crazy that there is such a wide range of costs and plans. We have the hospital's plan that all of the physicians use. Once you hit the deductibles it pays 100%. There is only one plan though as far as I know. I wonder if ours costs more because of my lymphoma?


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[v-girl]

Health Insurance for me and the kids

Our premium is $500/month for five. I don't know deductibles but I can say my asthma mess cost $187.50 in for the first RX of the insurance year — starts over every September — for a 3 month supply and $87.50 after that. Between daily inhalers and rescue inhalers we spend a lot. Co-pays for appointments are $35. I just canceled speech and OT for the boy until mid-January. That will give him a needed break and save $400-500/month.

Per DH, only the truly wealthy and those on Medicaid/Medicare can afford asthma or autism. It sucks. And the mail order pharmacy we have to use is so slow. Ordered daily inhalers Tuesday. Still don't have a daily inhaler so DH won't let me exercise outside or do any running.

Edit to add we can afford it, but I don't want to choose between new tires on the minivan or inhalers.

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[Sheherezade]

Jeez! You guys are making me so happy that DH's hospital self insures. I have to stay in system, which is a pain in the ass, but it's affordable. And the system has generally awesome doctors.


Angie

[spotty_dog]

Ours is about $520 a month for the four of us. It is such poor coverage that it doesn't meet ACA standards, we are grandfathered in. I think the deductible is $10k, and it only pays about 80% after that. We chose a simple, almost-catastrophic plan because we have a dawkter in the family. This means A) we avoid a lot of little visits and costs (eg. my broken finger a month ago cost us $0) and B) we can afford the deductible when/if it comes into play (we hit the max when DH broke his ankle a few years ago.) Because it's a high-deductible health plan (HDHP) we are eligible for an HSA but we don't necessarily use it like that. For the first few years we didn't carry a balance, we just transferred into the HSA when we needed to pay for a health-related expense. Now we do contribute to it annually for tax reasons, but I don't think we max it out.

FWIW, DH does have a colleague who has decided simply to pay the penalty under the ACA and remain uninsured (paying out of pocket). It's quite a gamble, but...it's an option. We prefer to have the peace of mind of knowing our costs won't exceed the out-of-pocket max, as well as the little perk of paying the insurance-negotiated rate for care and prescriptions.

I shopped for our insurance on ehealthinsurance.com.

[rufflesanddots]

We're lucky right now in that DH is covered as a student and I only pay $95/mth for a pretty decent plan through my employer (who covers my dental and vision in full). The maternity benefits are also pretty great, though I hope to be back in school by the time we start trying for our first kid. Looking at that, we'll be paying at least $5,000 for baby unless I can get a research assistant or TA position and have access to a better plan. C'est la vie.

[gcuthbe1]

We're lucky right now in that DH is covered as a student and I only pay $95/mth for a pretty decent plan through my employer (who covers my dental and vision in full). The maternity benefits are also pretty great, though I hope to be back in school by the time we start trying for our first kid. Looking at that, we'll be paying at least $5,000 for baby unless I can get a research assistant or TA position and have access to a better plan. C'est la vie.

This discussion is making me feel like I should have kids while my hubby is still in residency/fellowship! I knew my work insurance was tough with just me on it, and I was thrilled to get on his when we got married recently. Definitely something for me to keep in mind... Yikes!

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[MDPhDWife]

This discussion is making me feel like I should have kids while my hubby is still in residency/fellowship! I knew my work insurance was tough with just me on it, and I was thrilled to get on his when we got married recently. Definitely something for me to keep in mind... Yikes!

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Yep, that's what I was thinking yesterday when I saw our coverage. I was so relieved that we had our kids back in the day when all we paid was a $100 prenatal copay and a $250 hospital copay. That was for high risk c-sections. I was also thinking how glad I was that I got my Mirena and DH's vasectomy done in the last year too, otherwise those would've been $$$ on the new plan.

Ugh ITA with Ides' comment on feeling like I'm paying through the nose and not getting alot for it. I asked the insurance rep yesterday to send me some quotes to purchase individual insurance for me and the girls. She followed up today with 8 different options all with BC/BS. One is a HMO with a zero deductible which looks pretty appealing. All seven range in cost from $550-$700 a month so they are all several hundred dollars less than the employer sponsored one. Is this too good to be true? What pitfalls should I be looking for?