Health Insurance Poll (but not official poll!)

[Indianamom2]

I'm just curious how plans compare, so here goes:

1. What is your family deductible, before anything is paid?

2. What is your family out of pocket yearly max?

3. What type of plan (HSA, FSA, ACA, other)?

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Unfortunately because of my back surgeries and ongoing issues, we have hit our deductible and out of pocket family max quite easily already this year and last year. I am intimately familiar with the details of my own health insurance plan as a result. I have even garnered a "Complex Care" nurse to assist me in decisions as a part of my Anthem plan. (Yay me....NOT!)

So here are my answers:

1. Family deductible is $2500 before anything at all is paid. DD and I both have a single prescription (Lyrica for me...tried the cheaper options to no avail and Focalin XR for DD, that are almost $300 each/month.)

2. Family OOP max is $5600/year. Last year it was $5000. This year Dh's heart cath hospital bill alone (for less than 6 hours in the hospital) was $14,000. Add my x-rays, MRI, CT scan and ultrasound and we are already WAY over the limit. (Yay us...not!)

3. We have a high-deductible HSA plan through Anthem via DH's employer.

[khalloc]

1. What is your family deductible, before anything is paid?
Our family deductible is $3000. But DH's company kicks in $1500 of that, so after $1500 we have to pay the next $1500.

2. What is your family out of pocket yearly max?
$4500 for a single person, $9000 for the entire family

3. What type of plan (HSA, FSA, ACA, other)?
HRA (Health Reimbursement Account)

I take Enbrel which is very expensive, but Enbrel gives assistance so its not really very much per month.

[Binkandabee]

1. What is your family deductible, before anything is paid?

$275 individual/$550 family

2. What is your family out of pocket yearly max?

$5,000.00

3. What type of plan (HSA, FSA, ACA, other)?

This is a PPO plan through my employer (federal employee)

[vonfirmath]

Individual deductible is $1000 We pay 20% after that.

I don't know what the family deductible is. We haven't hit it yet and paid >$6K when DD was born (Incl $1K deductible for me and $1K deductible for her. Right off the bat. With DS he was covered under my deductible for the first 30 days)

Type of plan is whatever the Union negotiated for.

[citymama]

Without looking at the details, off the top of my head i can only answer questions 1 and 3.

1) Our family deductible is also $2500, but my employer pays half of that into my HSA
2) I honestly don't know so need to consult my paperwork
3) High deductible PPO plan through my employer, I have an HSA

Sorry about all the health troubles you have been having. Hope the rest of the year is going to be easier for you.

[AnnieW625]

I'm just curious how plans compare, so here goes:

1. What is your family deductible, before anything is paid?
this is our health plan: http://www.calpers.ca.gov/eip-docs/about/video-web-center/videos/health-benefits/2015-transcript-anthem-ppo.pdf . I posted the link because it will explain better than I can. However I will say that for routine care they are paying 80% and we pay the remaining 20%. We pay a $20 co pay for most office visits, including urgent care. I think the ER is $50 or $100 and as long as it ia in network we just have to pay the 20%. Honestly the most I ever paid to a PPO was when I had Dd1 and my bill was right about $12k and we only had to pay about $1100, so it was within the 20% they didn't pay. We have never met the family maximum or even I think the individual minimum of $1500.

2. What is your family out of pocket yearly max?
See above, but I think it is about $3500

3. What type of plan (HSA, FSA, ACA, other)?
We have an FSA that is separate from our health care plan, but we contribute $1800 a year to it and even if we don't use all of the money in it having the PPO and paying the additional $150 a month it is still cheaper than most, if not all of the HMO plans available. If I wanted more kids though I would switch back to an HMO Ina heartbeat because everything is covered, my surgery with baby 2 was $17k and every cent less maybe $150 in co pays and non covered drugs was covered. I don't even want to know how much we would have had to pay oop had we had a PPO, maybe my max of $1500, but I still think it would have been more.

[Indianamom2]

I'm just curious how plans compare, so here goes:

1. What is your family deductible, before anything is paid?
this is our health plan: http://www.calpers.ca.gov/eip-docs/about/video-web-center/videos/health-benefits/2015-transcript-anthem-ppo.pdf . I posted the link because it will explain better than I can. However I will say that for routine care they are paying 80% and we pay the remaining 20%. We pay a $20 co pay for most office visits, including urgent care. I think the ER is $50 or $100 and as long as it ia in network we just have to pay the 20%. Honestly the most I ever paid to a PPO was when I had Dd1 and my bill was right about $12k and we only had to pay about $1100, so it was within the 20% they didn't pay. We have never met the family maximum or even I think the individual minimum of $1500.

2. What is your family out of pocket yearly max?
See above, but I think it is about $3500

3. What type of plan (HSA, FSA, ACA, other)?
We have an FSA that is separate from our health care plan, but we contribute $1800 a year to it and even if we don't use all of the money in it having the PPO and paying the additional $150 a month it is still cheaper than most, if not all of the HMO plans available. If I wanted more kids though I would switch back to an HMO Ina heartbeat because everything is covered, my surgery with baby 2 was $17k and every cent less maybe $150 in co pays and non covered drugs was covered. I don't even want to know how much we would have had to pay oop had we had a PPO, maybe my max of $1500, but I still think it would have been more.

Annie, minus the additional FSA, this is what we had for the first 12 years of our marriage and it was a nice plan. Then Dh switched employers and now we have the high deductible HSA. It's been...an adjustment. If we could not have major surgeries or issues, it would be nice, but that hasn't been our case!!

[AnnieW625]

Annie, minus the additional FSA, this is what we had for the first 12 years of our marriage and it was a nice plan. Then Dh switched employers and now we have the high deductible HSA. It's been...an adjustment. If we could not have major surgeries or issues, it would be nice, but that hasn't been our case!!

I am clueless about how high deductible plans work as they have never been an option for me. I guess that is a perk of working for the govt., I get paid 25% or so less, but I have better more affordable health insurance. Hugs, and I hope your recovery from your surgery is going well.

[Indianamom2]

I am clueless about how high deductible plans work as they have never been an option for me. I guess that is a perk of working for the govt., I get paid 25% or so less, but I have better more affordable health insurance. Hugs, and I hope your recovery from your surgery is going well.

Thanks. I'm still hanging in here. I am still having some nerve pain/weakness in my left leg/foot (mostly foot/ankle). I think I may be gaining some strength back in my upper leg, so that's encouraging, but it's a LONG process. It's been 6 months since my fusion and almost 3 since half the screws were removed, but any change for the positive is very good.

[o_mom]

1. What is your family deductible, before anything is paid?

$3000 family, pays 80% after that.


2. What is your family out of pocket yearly max?

$11,000 in-network, $16,000 out of network, $4000 prescriptions (that includes the deductible - so $3k + $8k additional)


3. What type of plan (HSA, FSA, ACA, other)?

HSA

We get $1,200 put in by the company and I think a few hundred more for various bonuses. That basically covers our premiums.

We usually meet the deductible, but have never hit the OOP limits. We would need to have about $45k in allowable expenses to reach that and we have not so far had quite that much. We have close to that amount in the HSA and basically at this point we replenish what we used the year before.

[KrisM]

Family deductible is $3000, but DH's employer gives us $1000/year and it rolls, so we have $2800 in it right now.

I think OOP max is $5000, but would have to look it up.

I'm not sure what type of plan it is. We have a $0 monthly contribution. We do not qualify for HSA. I know the $1000 they give is an HRA. We have 100% of well visits covered. We rarely pay anything out of pocket, it seems.

[schrocat]

$3800 family deductible.

We pay $0 every month for health insurance though so it works out to cheaper than when we lived in another state and we had a PPO with a $20 ish deductible. We had hundreds deducted from DH's pay every month for health insurance. At least now you just pay for what you use.

[AnnieW625]

Thanks. I'm still hanging in here. I am still having some nerve pain/weakness in my left leg/foot (mostly foot/ankle). I think I may be gaining some strength back in my upper leg, so that's encouraging, but it's a LONG process. It's been 6 months since my fusion and almost 3 since half the screws were removed, but any change for the positive is very good.
My only other advice is say no to a spinal cord stimulator and a pain pump, you want neither IMHO. I have seen so many issues with people in my line of work who have had either.

[lalasmama]

Our deductible is $0. No idea what our OOP max is, as we haven't come close. We have Kaiser Perm through my husband's employer. $150/mo for he and I (employer pays the other $800 or so) and $20 copays for PCP'S, $5 for prescriptions, and $30 for specialists. Heck, DH's whole knee surgery was like $50, and that was including the specialist's fees!

Yes, we are incredibly blessed!

[calebsmama03]

I am so jealous of everyone's insurance here! DH works for a small company. We have an HSA plan. There is no individual ded if you're on a family plan, even if just one person seeks care they have to meet the family ded. This year that is $7500, iirc. After that it is 80/20. Company puts nothing into the HSA account towards deductible so we are on our own. The OOP max is somewhere around $12 or 15k. I have become fanatical about asking upfront for costs and we totally ration healthcare for ourselves and often don't go when we really should. :( the plan covers one preventive care visit every 366 days and some minimal lab work. Everything else we pay OOP.