General Question

srmorgan's avatar

Evaluating Health Care Options?

Asked by srmorgan (6768points) April 5th, 2010

My wife’s employer is changing her medical plan by setting up two plans with different co-pays, coinsurance and premium levels.

For the life of me, I can’t figure this out. One plan is has lower co-pays and coinsurance and annual limits but the monthly premium is 18% higher than the other option.

Can anyone suggest a publicly available spreadsheet to work this out or is there a rule of thumb about how to evaluate the options?


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3 Answers

njnyjobs's avatar

It all depends on your state of health. If you have been sickly and periodically requires medical attention, then you would appreciate the plan with lower co-pays/co-insurance at a higher insurance premium that remains constant week in and week out. However, if the health coverage is more of a safety net, at this point, than anything else, the savings by paying the lower premium for the policy that has higher co-pays/co-insurance will be more to your advantage.

wundayatta's avatar

How healthy are you? If you are generally in good health, then you take the plan with higher deductibles and copays since you won’t be using health services very much. If you are sick and plan to use a lot of health services, you want low copays.

The wild card is an unexpected serious illness. But it can’t be helped. You can’t make an informed decision without taking the odds into account. That’s what insurers do. That’s how they set rates. You should, too.

One thing you can do is to figure out how many visits you made last year. Calculate the total copays and deductibles you paid, and compare that to how much you would save by buying the less expensive plan. If you do not save money using your current utilization, get the more comprehensive plan.

whiteroseman's avatar

Oh dear – people living in under-developed countries where you have to worry/think about accessing health care and worry about how to afford it. Bring on the National Health Service! Seriously looking in from the outside I cannot see how paying a higher proportion of your GDP but leaving a significant % of the citizens with no/poor access is acceptable to such a fantastic,1st World country as the US.

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