The holiday season is upon us, and now it’s time to review my health insurance needs for next year. I am lucky enough to work for an employer that pays for my health insurance, so I only have to pay for my husband’s portion of the spousal premium. I currently pay $316.55 a month for my husband’s portion of the Bronze plan, with a (high) deductible of $12,000.00 between us. Next year’s premiums are rising, so I created a spreadsheet to calculate whether it’s worth it to stay on the Bronze plan or not.
My out of pocket cost of the plan is rising from $316.55 to $347.40 per month. The deductible of that plan is also rising, from $12,000.00 to $12,900.00. My out of pocket cost for the Silver plan, which is the next plan up, that covers both my husband and myself is $725.84 per month, with a deductible of $4,400.00. My cost for the Gold plan is $868.12 per month, with a deductible of $2,600.00. And the Platinum plan, which is the top plan, would cost me $1,168.47 per month, with no deductible.
I also looked at the differences in the types of services that are covered in each plan. I focused on the services that my hubby and I are most likely to use. Specifically, all the plans cover routine checkups, and routine OBGYN visits for me, as well as any prenatal visits (although I am not pregnant at the moment) in full. The differences in the plans are related to maternity, office visits, and emergency room visits. On the Bronze plan, all three services are subject to the deductible. On the Silver and Gold plan, all three services are subject to the deductible as well, which is much lower than the Bronze plan, but once the deductible is met, is then subject to coinsurance. That means that once the deductible is met (either $4,400.00 on the Silver plan or $2,600.00 on the Gold plan), I have to pay a relatively small percentage (the coinsurance rate of 15%) of the remaining balance, up to a maximum. On the Platinum plan, where there is no deductible, I would pay just a copay for the three services, anywhere from $15 to $250, depending on the type of doctor.
Then I calculated how much each insurance plan would cost for the year, both including and excluding the deductible. My out of pocket cost for just the health insurance plan itself, without seeing any doctor, is $4,168.80 ($347.40 X 12) for the Bronze, $8,710.08 ($725.84 X 12) for the Silver, $10,417.44 ($868.12 X 12) for the Gold, and $14,021.64 ($1,168.47 X 12) for the Platinum. Including the full deductible into the annual cost brings the total cost per year to $17,068.80 ($4,168.80 + $12,900.00) for the Bronze, $13,110.08 ($8,710.08 + $4,400.00) for the Silver, and $13,017.44 ($10,417.44 + $2,600.00) for the Gold plan. The cost of the Platinum plan remains the same at $14,021.64 since there is no deductible.
Next I considered how likely it is that we will use the full deductible of the Bronze plan. Barring an unlikely emergency situation where either of us end up in the ER, the most likely reason we would use anywhere near the Bronze deductible is if I we’re to give birth to a child (maternity) during 2017, which is subject to the deductible. Since there is no guarantee that we will have a baby in 2017, I am not willing to spend the money on a higher plan just to get a lower deductible.
Picking a higher plan means that I would definitely spend at least $8,710.08, the cost of the Silver plan, next year. If we do get pregnant, as long as it’s not during the winter, the baby would be born in 2018, at a time when I could change the plan to a lower deductible. And even if I do get pregnant during the winter time, I already get a 50% discount through the financial assistance program that I previously enrolled in at my local hospital. That discount applies to the remaining balance after any adjustments, including insurance adjustments. So if my maternity bill from the hospital is $12,900, and the Bronze plan doesn’t cover any part of it, the hospital will grant me a 50% discount on the bill, reducing it to $6,450.