Employer-sponsored health insurance 101 please

amother

Copper

Mon, Nov 14 2016, 7:00 pm

I don't have all the details yet but DH is about to be promoted from part time to full time at work which means he can get employer health insurance. We have never had regular health insurance before so I have no idea how it works and feel like a dunce.

Currently our children are on Child Health Plus and DH and I recently graduated from medicaid to "essential plan" under obamacare. My kids get everything they need 100% covered, no copays, but with some limitations like using network providers and a few things aren't covered (one is supposed to get ABA and they don't provide that, but right now I don't even know if they really need it). So far we've had pretty decent luck finding good in-network providers and it's nice to not have to pay for anything. For myself, I have low copays and a harder time with staying in network and with the fact that it's nearly impossible to get anything covered out of network. On the other hand you can't beat the price.

Even with DH's full time job we're not going to have any money to spare. We were living a deficit budget until now so being able to balance it would already be a big improvement. We were previously eligible for food stamps and WIC and won't be anymore (don't get me wrong, I'm happy with the advancement, but it needs to go into the calculation). So the idea of paying more for health insurance plus deductibles plus copays plus whatever I don't know about because I never had to do this... it's not exciting.

Does it pay to stay with obamacare (we'd have to pay more into it but still qualify for some level of subsidy) and Child Health Plus (again we'd have to pay into it but probably not very much, kids who are born into medicaid are able to stay with CHP for life) or does it pay to go into the employer plan? What kinds of questions should I be asking to help make this determination?

Amarante

Mon, Nov 14 2016, 8:35 pm

You can't get Obamacare if you can get insurance through your employer. It should be cheaper and better than your current plan since most employers subsidize as part of the benefit

Your children may still be eligible r current program depending on your income. Yiu would have to determine that depending on your state eligibility. Of course, it may be cancelled if the republicans go through ugh with their stated intentions.

amother

Chocolate

Mon, Nov 14 2016, 8:49 pm

There's no way to answer without details. Some employers don't cover any of the cost, some cover a part (50/50 or NY other combination) and some cover 100%. Every different plan has different details likebpremiums, deductibles, how big the network is etc. Some plans have better coverage then others.

Once you find out details then crunch the numbers and you'll see if it is worth it to stay as you are (it very well maybe) or to get from his employer.

For example my dh's employer offers insurance. They cover 50% of dh's cost, none of the rest if the family. They offer a few tiers with larger premiums and smaller deductibles or smaller premiums And larger deductibles. The cheapest plan was $400/adult and over $200 per child. So dh went on that insurance for $200 off his paycheck. My kids are eligible for mediciad/CHIP (don't live in NY so diff plans) where I pay a small monthly premium for all of them and most visits are free and have a family annual deductible of $500 which is basically only for hospital visits. And I in was not eligible for the credits on the marketplace so I got a private plan that was $200/adult. It has a high deductible and not the best network but I wasn't planning on a pregnancy and it was a few months into the year so I knew I'd be safe.

For 2017 I'm gonna be getting a new plan cause I may become pregnant and my old plan went up a ton and will have a smaller network. I may still get on the marketplace or private. Depends what my broker finds for me. And if all the plans he has to offer are $400+ then I may go on dhs insurance. Well see hopefully soon.

You gotta do what makes the most sense.

Amarante

Tue, Nov 15 2016, 11:44 am

It's very difficult to advise someone without knowing all the circumstances.

Theoretically you calculate the yearly cost for each type of insurance option based on how you anticipate using medical care - I.e. what the cost would be with deductible, premiums and co-payments.

Amother chocolate did explain that not all corporate health plans are created equal. If it is a small business, the plans tend to be less subsidized and therefore more expensive for the employee. Again, you would have to compare your annual cost based on the plans.

The glitch is that since your family is eligible for an employer plan, it can NOT receive any subsidies and therefore the cost of private health insurance is probably going to be higher than even a not so good plan from the employer for your husband. However, many small employers do not subsidize the cost for spouses and children and therefore, even without a subsidy, you might get a less expensive plan on the private market - but you will have to pay the full cost.

Depending on your state rules, your children may or may not be eligible for CHIP or other public health assistance. Assuming of course, it survives a Trump presidency.

With respect to a network, it's hard to know. Obviously an HMO only has doctors in that HMO but networks differ. Good employer plans tend to have wide networks even if they re PPO. I would suggest checking which hospitals are in the plan as a measure of what they are like and run a few doctors you use and like to see if they are in the plan. If you are not tied to a particular doctor or have a strange critical illness this might be less important as there are always going to be competent doctors in any plan.

You can always consult a broker for help if you go the private route.

Tue, Nov 15 2016, 12:28 pm

I think for starters, I'd ask to speak to the employer's broker. Ask him details about the policy. Find out from the employer if/how much comes off his pay check.

A premium is the amount you pay each month.
A deductible is how much you have to pay in medical costs before the insurance company pays anything for you. (Unless you have copays, in which case they do pay part from the beginning)

It's not a bad thing not to know this stuff and you don't have to feel stupid about it. Find out what the employer plan will cost, what the plan entails, and take it from there.

And if you are consisting private insurance, use a broker.

saw50st8

Tue, Nov 15 2016, 12:43 pm

amother wrote:

Can someone explain to me the whole premium vs deductible thing? I get it in theory but not sure how that plays out in reality. What factors help you decide which is better for you? And how do you know who has a better network?

Premium: cost you pay from your paycheck for the privilege of having insurance

Deductible: amount you pay before the insurance company starts paying

It's really hard to know what's best without analyzing the data. My company offers a lot of plans and the best way for me to analyze which plan was right was to graph the data. When you get the details, I can help you with it if you want to send me the information.

gibberish

Tue, Nov 15 2016, 1:31 pm

Just one thing to add:

If you are getting a subsidy through Obamacare now, you most likely will no longer be eligible if your family can enroll on your husband's plan with his employer. If that would be the case, it would most likely be better for you to enroll on your husband's employer plan, since the plans on Obamacare on mostly lousy.