Hello all! I’ll summarize our situation as best I can:
My girlfriend (24) and I (26) just moved to Seattle (98102) for her new job. We recently found out that I qualify to be on her plan due to our having a lease together (I currently have no health insurance; livin’ the writer life), so we’ve been trying to choose between the two available plans we can afford, but are hitting a wall due to our limited knowledge. Neither plan is that great and they seem to contradict what I thought I knew about the differences between types of plans.
Our health information as background: I have a number of nagging health conditions (run-of-the-mill mental health issues, asthma, allergies, nearsightedness, and scoliosis), but nothing that significantly impedes my daily life. I take one maintenance medication for my mental health (Prozac) and occasionally need a refill of my rescue inhaler, but that’s about it as far as prescriptions go. The rest I handle through healthy living choices. I do see my primary care physician more than the average person (about 6-7 times a year), however, because my body likes to rebel against me in small ways and it can be difficult to discern exactly which condition is the root cause. I don’t currently see a therapist but I’d like to once I find steady employment in Seattle.
My girlfriend is a bit more complicated. She has major depressive disorder and takes three maintenance meds daily for it. She’s also gone through two (pricey) rounds of TMS (transcranial magnetic stimulation) for her depression in the past few years and is likely to want another round if things worsen again. She sees a therapist weekly and that’s an absolute must for her. As far as I know, neither of us will be requiring any major surgeries or procedures beyond her TMS in the foreseeable future, though I have a history of ending up at the ER or Urgent Care with an asthma attack like once every two years. We both take a lot of care to choose in-network specialists whenever possible.
With that out of the way, the plans: out of the three plans that United Healthcare is offering through my girlfriend’s employer, we can afford the “Wellness PPO Plan” and the “HSA Value Plan”. We’re living on her $41,000 salary until I find work in Seattle and neither of us have a ton of savings. The differences between the plans have been a source of confusion for me, as I’ve typically associated HSAs with HDHPs, but that doesn’t seem to be the case here (at least comparatively).
Here’s the main details of the plans:
Wellness PPO:
In-network deductibles: $4,000 individual / $8,000 family. Out-of-network deductibles: $8,000 individual / $16,000 family. Premium: $33 biweekly. In-network out of pocket max: $7,000 individual / $14,000 family. Out-of-network out of pocket max: no limit. Referral not required for specialists. (everything from here on out is after deductible has been met and assuming in-network) Primary care visit: $35 copay. Specialist visit: $50 copay. Preventative/screening/immunization: $0. Diagnostic tests and imaging: 20% coinsurance. Generic meds (all our prescriptions are generic minus my occasional albuterol inhaler): preventative copay $5, non-preventative copay $25. Outpatient surgery/emergency room care/hospital stays: 20% coinsurance. Urgent care: $75 copay. Outpatient mental health: $50 copay.
HSA Value Plan:
Includes health savings account (having trouble wrapping my head around that one in general, to be honest). In-network deductibles: $2,800 individual / $5,400 family. Out-of-network deductibles: $5,400 individual / $10,800 family. Premium: $75 biweekly. In-network out of pocket max: $6,250 individual / $12,500 family. Out-of-network out of pocket max: $12,500 individual / $25,000 family. Referral not required for specialists. (everything from here on out is after deductible has been met and assuming in-network) Primary care visit: 20% coinsurance. Specialist visit: 20% coinsurance. Preventative/screening/immunization: $0. Diagnostic tests and imaging: 20% coinsurance. Generic meds (all our prescriptions are generic minus my occasional albuterol inhaler): preventative copay $5, non-preventative copay $10. Outpatient surgery/emergency room care/hospital stays: 20% coinsurance. Urgent care: 20% coinsurance. Outpatient mental health: 20% coinsurance.
I recognize that this is a ton of information, but hopefully I’ve come to the right place. Which plan better fits our situations? Should we seek healthcare on the marketplace instead? If anyone has any suggestions, you’re my hero forever. Thank you!!
submitted by /u/-Rajko-
[link] [comments]
Hello all! I’ll summarize our situation as best I can: My girlfriend (24) and I (26) just moved to Seattle (98102) for her new job. We recently found out that I qualify to be on her plan due to our having a lease together (I currently have no health insurance; livin’ the writer life), so we’ve been trying to choose between the two available plans we can afford, but are hitting a wall due to our limited knowledge. Neither plan is that great and they seem to contradict what I thought I knew about the differences between types of plans. Our health information as background: I have a number of nagging health conditions (run-of-the-mill mental health issues, asthma, allergies, nearsightedness, and scoliosis), but nothing that significantly impedes my daily life. I take one maintenance medication for my mental health (Prozac) and occasionally need a refill of my rescue inhaler, but that’s about it as far as prescriptions go. The rest I handle through healthy living choices. I do see my primary care physician more than the average person (about 6-7 times a year), however, because my body likes to rebel against me in small ways and it can be difficult to discern exactly which condition is the root cause. I don’t currently see a therapist but I’d like to once I find steady employment in Seattle. My girlfriend is a bit more complicated. She has major depressive disorder and takes three maintenance meds daily for it. She’s also gone through two (pricey) rounds of TMS (transcranial magnetic stimulation) for her depression in the past few years and is likely to want another round if things worsen again. She sees a therapist weekly and that’s an absolute must for her. As far as I know, neither of us will be requiring any major surgeries or procedures beyond her TMS in the foreseeable future, though I have a history of ending up at the ER or Urgent Care with an asthma attack like once every two years. We both take a lot of care to choose in-network specialists whenever possible. With that out of the way, the plans: out of the three plans that United Healthcare is offering through my girlfriend’s employer, we can afford the “Wellness PPO Plan” and the “HSA Value Plan”. We’re living on her $41,000 salary until I find work in Seattle and neither of us have a ton of savings. The differences between the plans have been a source of confusion for me, as I’ve typically associated HSAs with HDHPs, but that doesn’t seem to be the case here (at least comparatively). Here’s the main details of the plans: Wellness PPO:
In-network deductibles: $4,000 individual / $8,000 family. Out-of-network deductibles: $8,000 individual / $16,000 family. Premium: $33 biweekly. In-network out of pocket max: $7,000 individual / $14,000 family. Out-of-network out of pocket max: no limit. Referral not required for specialists. (everything from here on out is after deductible has been met and assuming in-network) Primary care visit: $35 copay. Specialist visit: $50 copay. Preventative/screening/immunization: $0. Diagnostic tests and imaging: 20% coinsurance. Generic meds (all our prescriptions are generic minus my occasional albuterol inhaler): preventative copay $5, non-preventative copay $25. Outpatient surgery/emergency room care/hospital stays: 20% coinsurance. Urgent care: $75 copay. Outpatient mental health: $50 copay.
HSA Value Plan:
Includes health savings account (having trouble wrapping my head around that one in general, to be honest). In-network deductibles: $2,800 individual / $5,400 family. Out-of-network deductibles: $5,400 individual / $10,800 family. Premium: $75 biweekly. In-network out of pocket max: $6,250 individual / $12,500 family. Out-of-network out of pocket max: $12,500 individual / $25,000 family. Referral not required for specialists. (everything from here on out is after deductible has been met and assuming in-network) Primary care visit: 20% coinsurance. Specialist visit: 20% coinsurance. Preventative/screening/immunization: $0. Diagnostic tests and imaging: 20% coinsurance. Generic meds (all our prescriptions are generic minus my occasional albuterol inhaler): preventative copay $5, non-preventative copay $10. Outpatient surgery/emergency room care/hospital stays: 20% coinsurance. Urgent care: 20% coinsurance. Outpatient mental health: 20% coinsurance.
I recognize that this is a ton of information, but hopefully I’ve come to the right place. Which plan better fits our situations? Should we seek healthcare on the marketplace instead? If anyone has any suggestions, you’re my hero forever. Thank you!!
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