Which Insurance Plan would you choose?

We have health insurance through DH's job. They're switching from Oxford to Empire and we have a choice between 2 plans and I have no idea which one to pick lol. We will be a family of 4 within the next few weeks!

Option 1:
$30/$60 copay for Primary/Specialist
No referral for specialist
$1000 individual deductible/$2500 family deductible per calendar year
$200 ER copay
Inpatient Hospital, Outpatient Surgery, Imaging copays are subject to deductible
Prescription copays are $15- Tier 1, $35- Tier 2, $75 Tier 3.

This plan will cost $30 a week for a family.

Option 2:
$20/$30 copay for Primary/Specialist
No referral for specialist
No deductible
$150 ER copay
Inpatient Hospital - $500 per admission
Outpatient Surgery - $200 copay
Imaging - $50 copay
Prescription copays are $10 for Tier 1, $40 for Tier 2, $60 for Tier 3.

This plan will cost $102 a week for a family.

So basically I'm wondering if it's worth it for the 2nd (higher) plan.

Our current plan is $30/week for a plan with a higher deductible.

Which Insurance Plan would you choose?

Do you know if your children's well visits will be have a copay?

Which Insurance Plan would you choose?

over all it sounds like option 1 with the ded will cost less, without adding in meds and DR visits.

how many daily meds are taken on avg?
how many PCP visits does your family take a yr?

Message edited 8/10/2015 7:40:17 PM.

Which Insurance Plan would you choose?

Personally, I'd pay the extra premium for the extra coverage. I'd go for option 2.

Re: Which Insurance Plan would you choose?

Check on copays

My old insurance had $30-$60 copays but everything the dr did during that visit (blood work, urine, biopsy) was include in that.

My new one, copays are $15-$35 and monthly charges are $300 less as well. But , I have a copay for everything!

I go to PCP pay $15 copay. He takes blood, I get a bill for $35 copay for it from lab. My PCP sent me to a specialist who cost $35 for copay, who did more blood work and urine. Blood work from that lab $35 copay and then separate copay for urine of $35. So the PCP cost me $50 and then the specialist cost me $105. All in the same week.

Check that before deciding

Which Insurance Plan would you choose?

I would choose the plan without the deductible. We have a deductible ($10K) and it is so annoying. I feel like every time I walk into a dr's office I owe a few hundred bucks. Granted my deductible is huge. Also are prescriptions counted toward the deductible and is the copay after the deductible is met?

I believe, but could be wrong, that well visits for children and 1 annual physical per year for adults, is mandated to be covered with no copay. It also does not apply toward the deductible.

Re: Which Insurance Plan would you choose?

Which Insurance Plan would you choose?

I hate making this choices, my new insurance is $40/70 for a Dr visit plus $70 co-pay for all blood draws even if I use in network lab, plus $2000 deduc. I need to see the Dr since its been 6 mo without, plus I need a sono or scan... I almost dont want to go to the Dr.

Re: Which Insurance Plan would you choose?

Re: Which Insurance Plan would you choose?

I would go with the cheaper co pay but that's probably because I feel we are always at dr. DH will go for almost every little thing and I go through times when the kis are going often esp. Specialist. DD earlier this year had to see an ear specialist and had to go every 2weeks for a couple months. My copayment was $50 each time and we pay $115 a week for insurance

Re: Which Insurance Plan would you choose?

Re: Which Insurance Plan would you choose?

I would go with the second option. I would rather pay for more insurance. You never know when you may need it. I had emergency back surgrey and when my bills came I wish we would have chosen the more expensive insurance.

Which Insurance Plan would you choose?

I would go with option two- health insurance payments come out of the pay check pre-tax.

Which Insurance Plan would you choose?

I would go with option 2.

Re: Which Insurance Plan would you choose?

Re: Which Insurance Plan would you choose?

I may consider to stick with option 1.

If I am understanding this correctly, and you do the math, you are paying an additional $72 per week for option 2; which equals $3,744 a year

The family deductible is only $2,500; so you are paying an additional $1,244. Yes, the copays are higher, but you should check to see what is covered. On my plan, all well visits/physicals (for me and my kids) are covered 100% so the copays only come into play for sick visits.

I would also see if your current doctors accept the new insurance because you may need to switch

ETA - can someone explain why they say option 2 is more coverage? DH and i need to decide if we are sticking to our current plan or changing come October, so I am trying to learn about this

Message edited 8/11/2015 11:10:13 AM.

Which Insurance Plan would you choose?

I double checked and all of our drs take the new insurance. Well visits for kids and annuals for adults + women's care do not have a copay with either plan.

I'm concerned that if we go with the lower plan, something will happen or the baby will God forbid need specialists. It's so hard to decide with all the what ifs!

Re: Which Insurance Plan would you choose?

Which Insurance Plan would you choose?

I hate this kind of shit, my coverage sucks

Which Insurance Plan would you choose?

Are these items, Inpatient Hospital, Outpatient Surgery, Imaging copays are subject to deductible, subject to separate deductibles in addition to the $2500 per family? have you husband double check that these items
Do not have separate deductibles- my empire plan recent remove my deductible for mental Health but I have one for physical medicine even though I have no deductible for medical care.