TTC & Health insurance question

posted 2 years ago in TTC
Post # 2
Member
1287 posts
Bumble bee
  • Wedding: May 2014

mco06:  Honestly, insurance companies are a dime a dozen…it is the plan your work offers/the plan you pick within those companies that will determine your benefits:  good vs. bad.  Of course, the better the plan, the more you tend to pay our of pocket in your payroll deduction, whereas you will end up paying ‘less’ out of pocket per calendar year (as far as medical expenses go).

My BEST advice is to get a summary plan description from both employers, and ask them to include any, and all riders with it (a lot will have a seperate maternity rider, etc).  Then, review costs to you, plan specific details, etc.   Stuff to look at/review more thoroughly:  Deductible per year, per family.  Co-payments, co-insurance, and of course maternity benefits (hospitalization allowance, etc).  Newborn health and wellness is now ‘mandated’ to be covered at 100% for vaccines, etc with the Afforadble Healthcare Act.

Hope this helps 🙂

Post # 3
Member
2252 posts
Buzzing bee
  • Wedding: September 2014

mco06:  those are both huge companies with large networks. I’ve almost always had Aetna, and although I’ve never been pregnant, I did have a major surgery that required hospitalization. Overall I’ve been happy with Aetna. The main points to consider would be copays, deductibles, out of pocket max, lab benefits, hospitalization costs, and whether or not your chosen ob/gyn and hospital are in network. Even under the same insurer, all plans are not created equal. 

Post # 4
Member
258 posts
Helper bee
  • Wedding: March 2014

Every plan is different, so just because someone says “go with Aetna because they covered everything” or something similar doesn’t mean that is the plan that is most beneficial for you.  

 

Do your homework and look at deductibles (money you pay before services are covered), premiums (money you pay monthly for enrollment in the plan), coinsurance (your percentage of total cost that you pay, usually after deductible), and out of pocket expense (how much money, generally after deductible and coinsurance, that you will have to pay before all services are covered at 100%.  Also pay attention to benefit maximums.  If your out of pocket is $3000 and your yearly maximum is $6000, you will pay $3000 and they will pay $3000 and then the benefits are maxed out, so they won’t pay for the rest of the term.

 

You also want to look at FSA or HSA possibilities, because those generally let you take tax-free money out of your paycheck to pay for health expenses.

Post # 5
Member
3360 posts
Sugar bee
  • Wedding: December 2011

It’s best to look at the specific plan brochure to see what will be covered, as even the same insurance company can offer plans that cover different things (or cover them to a different extent).  I’m on my husband’s plan, which is part of the UnitedHealth network (it’s a government employees plan, GEHA).  All maternity care and labor and delivery are covered 100%.  It’s amazing.

Otherwise, though, you’ll want to look at what your deductible would be (the amount you need to pay out of pocket before coverage kicks in), your out-of-pocket max (the most you’d have to pay in a year, including deductible, co-pay, and co-insurance), whether or not there’s a network of providers you have to use to get coverage (and how big the network is), and consider what your likely use of the plan will be (my husband and I are young and healthy – barring health emergencies, we will likely just be using it for regular checkups).

Researching health insurance is a pain in the butt – I wish you luck!  But I found it makes it a lot easier on you the more organized you are about the process (I made a spreadsheet to compare coverage for the different plans we were considering).

Post # 6
Member
1566 posts
Bumble bee
  • Wedding: May 2014

mco06:  It is better to look at the actual benefits from each option.

See what your premiums are, what your deductible is, what is in network and out of network and how the insurance treats them differently.

Some companies fund their own insurance and just use an insurance company to facilitate it, other’s buy in to the insurance company’s plans. That’s something to look into from your and your husband’s companies.

Post # 7
Member
13021 posts
Honey Beekeeper
  • Wedding: June 2011

You need to work out the benefit details of both of the plans, there is no one better company than the other.

Post # 8
Member
6510 posts
Bee Keeper
  • Wedding: June 2013

You need to look at the specifics of the plan your company offers. My work and my husband’s work both offer United, however, the plans are drastically different between our two companies. We won’t be able to tell you which is better just based on the insurance company names.

Post # 10
Member
11668 posts
Sugar Beekeeper
  • Wedding: November 1999

Biggest thing I would consider is deductible. My pregnancy fell over two plan years so I had just met my deductible ($2k) before I delivered then had to turn around and pay it again (only it was $4k BC i had added DH and babY). Next time in going to try to have my pregnancy fall in one plan year!!

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