Check out some similar questions!

charlie004 · Sep 24, 2009, 01:19 AM

Hi, I'm a healthy 45-49 yr old, never sick and never see doctors.
I'm trying to decide between two plans. Both have a $1500 deductible, 80/20, and $20.00 copays. The big difference is that one has a $2500 out of pocket maximum ($312/month); the other has a $4000 out of pocket maximum ($250/month premium). I really want to save money, and the one would save me $744.00. Is $4000 a lot for an out of pocket max, and is it worth it, or is it risky? Thanks for any help.

ebaines · Sep 24, 2009, 06:04 AM

First - you say you "never see doctors" - if you mean that literally, then the biggest risk reduction you can take is to take advantage of your plan's features and have an annual check up. It's silly and incredibly risky to not do this, and as you get into your late 40's and older it's especially important.

As for the two choices you've laid out - it's impossible to say which is better for you, as I don't know your finances or risk tolerance. If you have a fair amount of savings so that you can take a bit of risk, you should consider the lower priced plan, realizing that you may have to pay up to $1500 more out of pocket if you do get sick or have an accident. So if you are in a position where having to pay this amount won't be too much of a hardship to you, I'd say go for the less expensive plan. In fact, if you were to save the $62/month difference into a medical savings account, you would build up the $1500 difference in max out of pocket payments in 2 years. Stated another way - if you think there's less than a 50% chance of spending more than $2500 next year, then go for the cheaper policy.

On the other hand, if a $4000 expense would destroy you, then don't take the chance. Pay the higher premium and sleep better at night.

Cedarln2265 · Sep 24, 2009, 06:16 AM

With Health Insurance, you need to also consider any exclusions.
1) 80/20 of what- CAT scans but 50/50 on x-rays and what is excluded -PET scans.
2)is the prescription coverage only for generics. The brand name you would be out of pocket.
and/or when you get the prescription from local pharmacy or mailed to you
3)Are you limited to only In network Providers and what percentage of coverage do you have if you see out of network provider
Some out of pocket costs are also not considered as part of the policies out of pocket expense.
There are policies with $10,000 deductibles and $10,000 out of pocket
Choosing health insurance coverage can be daunting but getting the most for your dollar is the priority.
good luck

nikosmom · Sep 24, 2009, 01:34 PM

If you rarely go to doctors, why choose a plan with co-pays? If you only visit the doctor once or twice per year for a check-up, you may fare better by foregoing a plan with co-pays. Honestly, plans with co-pays are more beneficial to people that visit the doctor several times a year. Even if you pay out-of-pocket for your dr. visits, you still may save money by going this route.

I think ebaines made a good suggestion- look into a Health Savings account to save towards the cost of medical expenses.

@ Cedar- I don't think your response really addresses the OP's actual question. Based on what he said, it's fitting to conclude the plans are identical with the exception of the Max Out Of Pocket expense which is what he is asking about.

Cedarln2265 · Sep 24, 2009, 01:36 PM

When you shop for an insurance policy, you want to get the most for your dollar. If youshop around and make sure then you won't have any surprises at the end of the day. The devil is in the details.

nikosmom · Sep 24, 2009, 01:38 PM

The issue isn't shopping around; the question was deciding between identical plans with different Max OOP expenses.

Cedarln2265 · Sep 24, 2009, 01:41 PM

Soo shopping around and getting a plan with a $500 adeductible and $1500 copay and better benefits isn't more for his dollar? To purchase anything when there are other available options of "saving money" which is his goal and the big picture here, which is how the situation can be explained.

nikosmom · Sep 24, 2009, 01:54 PM

His question is not about benefits, it is about saving money on identical plans.

Please read questions carefully because I'm not saying your advice is bad, it's just not what the OP is asking.

Cedarln2265 · Sep 24, 2009, 02:02 PM

"I really want to save money,"

charlie004 · Sep 24, 2009, 05:32 PM

Thank you all for your responses.

I guess I should have made it more clear in my original post, but yes, the plans are virtually identical. The only difference I can see is that the lower premium/higher out of pocket max has just two (more expensive) levels for prescription drugs, generic and brand name, while the other has four levels.

The only plans with $0.00 copay have much lower deductibles, which I just can't do anymore. I now have a $500 deductible that will cost me $500/month if I don't raise the deductible. These two plans seem to be my best options at this point.

Fortunately, I've never had to use my insurance and have never even met a deductible. And of course, it just keeps going up and up. So yes, I really could use the money I would save in premiums. Who wouldn't? I've been pouring over all these plans and more for a month now, so I fear I may have lost all perspective about this. But maybe just the fact that I'm concerned about having a higher out of pocket maximum is leading me to my answer. Or not.

We can all agree on one thing, I guess-- health insurance is BEYOND confusing!

Cedarln2265 · Sep 24, 2009, 08:51 PM

You'r welcome hope at the end of the day all is well for you...