When I was working we selected a health plan that suited our needs based on things like out of network coverage, etc... I am going to have to move off of my current plan soon (COBRA period is ending) and elect one of their Retiree plans. What is different is that they are basically the same in what things are covered but with varying premium prices, deductibles and copay %. What seems to be similar however is that they all have about the same Out of Pocket Maximum.

There are 3 plans, High, Medium and Low deductible plans. As would be expected the premiums for the High Deductible are lowest, with the Low Deductible having the largest premium. I have sized the plans with different Medical Expense levels and the High Deductible always seems to be the cheapest. Since all have roughly the same Maximum out of pocket in the end, I don't understand why anyone would not take the High Deductible plan.

Am I missing something?

 

I don't know but I decided to look and see if anyone had answered your question in an article. Did not find a direct answer but did find this:

https://www.consumerreports.org/heal...lth-insurance/

 

And this:

https://www.cbsnews.com/news/high-he...cial-hardship/

 

Not sure if I can answer your question or not but are you aware that the out of pocket maximum is not the same as the deductible?

What are the deductibles for the different plans?

 

Many, if not most people do not hit their maximum out-of-pocket unless they have a pretty severe health issue during the year, such as surgery or inpatient hospitalization.

If you don't reach your maximum out-of-pocket then your total healthcare cost will simply be a combination of premiums and copays/deductables. People who don't expect to have many claims in the coming year, for example they have no expensive prescriptions or significant health issues, will probably go for the low premium high deductible plan as this will result in the lowest total cost.

This shouldn't be taken as advise, just an answer to your question.

 

I reached my maximum in March. It was pretty shocking to see how much my surgery and follow-up cost in total. Even though the surgery was in Nov, most of the bills came in the first three months of this year after going through my insurance. I was very fortunate not to have to pay most of it. Was by far the biggest health issue for me ever. And I certainly hope the last issue. IMO there is no substitute for good health insurance even at higher premium costs. I hope you get a good plan, Jim and it does not cost you an arm and a leg.

 

But if it does cost an arm or leg, at least the removal will be covered.

 

I'm self employed and have been since '95. I have been high deductible since it became available. So are all of my partners.

 

yes, i know the deductible and out of poket max are different. To evaluate i took the annual premium and then assume different medical expenses, applied the deductible and then the remaining for copay.

 

yes and in the end the high deductible plan is cheapest every time