What is high deductible health insurance

amother

Wed, Mar 06 2024, 7:15 am

Switching jobs and need to be on cobra for a few months. To continue the plan I have is about $700 more per month than the high deductible plan they offer. What is a high deductible plan? Does that mean I’ll pay when I or my kids go to the doctor instead of just a copay?
If pregnant would I be entirely responsible for the ultrasounds blood work and doctors visits etc until deductible is met?

amother

Dimgray

Wed, Mar 06 2024, 7:25 am

Yes, your premium will be lower because your out of pocket expenses are much much higher. A high deductible plan is a good idea for people who do not expect to have many medical expenses because then you can spend way less overall.

$700 is a lot a month is a lot but if the high deductible is ~$8k more and you're anticipating a lot of medical expenses, itll be cheaper in the long run

Eta medical expenses doesn't just mean Drs appointments. Also any medications or therapies will be out of pocket

teachkids

Wed, Mar 06 2024, 7:26 am

A high deductible plan only covers standard preventative care- the actual ob visits and well check ups and vaccines for the kids until the high deductible is met (generally though a hospital stay) and everything else you’ll pay in full (including blood tests and sick visits)

teachkids

Wed, Mar 06 2024, 7:27 am

amother Dimgray wrote:

The other way to look at it is : even with a high deductible plan, will you have to pay $700 out of pocket each month to make it worth the better plan

amother

Wed, Mar 06 2024, 7:33 am

teachkids wrote:

Trying to decide if it’s worth it for three months

listenhere

Wed, Mar 06 2024, 7:35 am

I was on a high deductible plan.

If there is a major expense, even a simple emergency room visit with a kid, it eats up the deductible. You have to pay in cash. Think a fall, X-Ray, stitches. These add up quickly.

Most years we ended up spending the entire deductible. I had 3 kids then, and am not the type that runs to the doctor for every little thing.

amother

Clematis

Wed, Mar 06 2024, 7:59 am

I have a high deductible plan
They paid for 1 well visit a year for adults. There was sign in the doctor's office that if you brought up a problem during a well visit, it is documented and you might be charged for it like a sick visit. There is also tier 1 and tier 2 specialists in network. Regular specialists are all tier 2 and you pay deductible and copay, runs up to hundreds of dollars for a local specialist. I discovered that specialists who's offices are in a particular hospital over an hour away, are tier 1 and I only pay copay. If someone needed a procedure or surgery, it costed out of pocket at least $5,000.
They pay for medication with a copay even without meeting deductible. They cover blood work too without much of a copay.
It was very hard to meet deductible even with visits and testing because of all their "calculations".
It's a great plan if you don't need medical care

teachkids

Wed, Mar 06 2024, 8:08 am

amother OP wrote:

Trying to decide if it’s worth it for three months

Do you think you’ll spend $700 in doctors cost per month? If it helps, I spend $150 per sick visit, and about $50 per blood work

amother

Wed, Mar 06 2024, 8:10 am

teachkids wrote:

Do you think you’ll spend $700 in doctors cost per month? If it helps, I spend $150 per sick visit, and about $50 per blood work

I would think not but who knows

I am ttc and don’t want to push off because of this
Thanks for the info that’s helpful. I wish I could ask my ob for pricing but I doubt they’d tell me

teachkids

Wed, Mar 06 2024, 8:11 am

listenhere wrote:

Just btw I’ve never paid in cash- I always ask to set up a payment plan with the hospital and they always let me. I take a high deductible plan because for me the deductible is still less than the difference in premiums, so even if I hit my whole deductible, I still pay less.

amother

Stonewash

Wed, Mar 06 2024, 8:11 am

teachkids wrote:

Do you think you’ll spend $700 in doctors cost per month? If it helps, I spend $150 per sick visit, and about $50 per blood work

She’s pregnant, ultrasounds alone will cost her a couple thousand..

teachkids

Wed, Mar 06 2024, 8:14 am

amother OP wrote:

I would think not but who knows

I am ttc and don’t want to push off because of this
Thanks for the info that’s helpful. I wish I could ask my ob for pricing but I doubt they’d tell me

If you’re not yet pregnant, and in 3 months you’ll have other insurance, you don’t need to go to the ob before then- most don’t want to see you before 8-12 weeks anyway.

amother

Wed, Mar 06 2024, 8:16 am

teachkids wrote:

If you’re not yet pregnant, and in 3 months you’ll have other insurance, you don’t need to go to the ob before then- most don’t want to see you before 8-12 weeks anyway.

It’s not 3 months from now. It’s three months from the job change which itself is in a few months

listenhere

Wed, Mar 06 2024, 8:19 am

amother OP wrote:

I would think not but who knows

I am ttc and don’t want to push off because of this
Thanks for the info that’s helpful. I wish I could ask my ob for pricing but I doubt they’d tell me

The visits aren’t as expensive as the baby being born. The hospital bill ate up the entire deductible plus insurance paid the rest.

teachkids

Wed, Mar 06 2024, 8:23 am

amother OP wrote:

It’s not 3 months from now. It’s three months from the job change which itself is in a few months

Ahh, that changes things. The two most expensive parts (other than unpredictable emergencies) are the 20 week ultrasound which is around 1-2k if I remember correctly, and delivery which will eat up the entire deductible and then some. How far before you switch jobs do you need to make the decision?

amother

Bone

Wed, Mar 06 2024, 8:33 am

We're on a high deductible plan. You do pay in full but it's the insurance negotiated rate, not the "real" bloated cost. The years I was pregnant, we met the deductible. Generally regular care like well visits are free and sick visits are 80-100, while specialist doctors are more like 250. Plus labs and scans and stuff like that are extra. It adds up, but it depends how much your family goes to the doctor.

amother

Wed, Mar 06 2024, 9:07 am

teachkids wrote:

Not far but I’m doing research now.

It would be a 20 week ultrasound. It would be the first ultrasound.
But I have a history of hematomas so they actually did ultrasounds at almost every visit in previous pregnancies.

teachkids

Wed, Mar 06 2024, 10:02 am

amother OP wrote:

If you’re high risk that changes things…
What I was going to say is that if your pregnant by the time you switch take the better plan, if you’re not, take the high deductible.

amother

Whitesmoke

Wed, Mar 06 2024, 10:11 am

amother OP wrote:

Legally, you have to choose COBRA coverage within 60 days of getting notice of your eligibility.
So you don't have to make the decision now.
You can make the decision then to see if you already conceived.

amother

Stonewash

Wed, Mar 06 2024, 10:52 am

OP are you switching jobs or losing your job? Will your new job offer insurance?

If your pregnant at the time you leave, and are income eligible- you may be able to go on Medicaid