I am in Florida and a 31 year old female. My husband is 27 years old. No kids. Combined we make about $115K. Both are in good health and exercise. No health issues other than my anemia which is controlled. I work at a hospital for the federal government so we are able to select from a mind boggling amount of plans. My husband is under my plan. I previously worked at a different hospital where the only plan was humana which seemed to cover most things with a small co-pay. Im currently with GEHA HDHP (works under the umbrella of United healthcare).
So I heard that after mortgage and student loans that medical bills are the next biggest debt due to hospitalizations. I went with GEHA because their in-patient hospitalization rate was 5% compared to other plans that were 20-30%. I was attempting to avoid any huge hospital bills if, God- forbid, my husband or myself end up in the hospital. Ive had the plan for three years now, never been hospitalized and im tired of paying such high out of pocket expenses for the deductible. It results in my husband and I sort of avoiding preventative care because we end up getting a bill from the doctor, the lab, high pay out for any prescriptions and everyone in between. My husband caught Covid in August and we had to pay a percentage for the Urgent care visit then at the pharmacy they wanted us to pay a whopping $1,200 for the Paxlovid covid medicine. The pharmacist took pity on us and did some sort of sign up that made the medicine free. Recently i went to the ER for dehydration, was there for about 3 hours and now got hit with a $1,300 bill. Im tired of this HDHP even though I like the HSA. I’m lost as to what percentages are best for young people in our situation but also offers protection if we end up staying in the hospital. Im looking for low prescription costs and low co pays. I also like the ability to visit a specialist without a referral. Am I looking for a goldilocks insurance?
It seems you get insurance through your employer, so your choices depend on what they offer, and you can only switch during their Open Enrollment period.
There’s no magic answer since predicting your total yearly medical costs perfectly is nearly impossible.
The best approach is to create a spreadsheet. Estimate your total yearly costs, including premiums, deductibles, co-payments, and out-of-pocket maximums, based on your expected medical use.
If you need more care than expected, your out-of-pocket maximum is the most you’ll have to pay.
Typically, plans with lower deductibles and co-pays have higher premiums.
For a couple with no kids and your income level, a high-deductible plan with lower premiums might work well, especially if you can cover the deductible and have an HSA.
When choosing a health insurance plan, don’t worry too much about the percentage for inpatient hospitalization. Even if you have a big accident and need to stay in the hospital for a long time, you’ll probably reach your out-of-pocket maximum anyway. Instead, focus on comparing the costs of predictable care and finding a plan with a low out-of-pocket maximum.
You said you work at a government hospital. Does your hospital offer Blue Cross Blue Shield insurance? I work for the Veterans Administration and chose the federal Blue Cross Blue Shield plan. It covers almost everything. When I had a C-section, I only paid about $300.
The Federal Employees Health Benefits (FEHB) program offers many different options, so you’ll need to spend some time figuring out which one is best for you. If you’re young and healthy, it might be cheaper to choose a plan with a high deductible and a Health Savings Account (HSA). However, many people don’t like paying out-of-pocket costs, even if it’s the most affordable option. FEHB also offers plans with co-pays and a Preferred Provider Organization (PPO) network, but these plans will have higher premiums.
Health insurance is expensive, and everyone knows it. Here’s what I recommend:
First, find out how much the most expensive plan costs. Let’s say it’s $1,000 per month. This will give you an idea of what a full-coverage plan should cost.
Choose a high-deductible health plan (HDHP), which is usually about 60% of the cost of the most expensive plan. HDHPs have lower monthly costs and let you save money in a Health Savings Account (HSA). Use the other 40% to fund your HSA. When you need medical care, pay for it with your HSA money. This will make it less expensive.
If you’re already using an HSA, you can lower your costs even more. When you get a medical bill, first transfer money from your regular account to your HSA. Then, pay the bill with the HSA money. This way, you can get a tax deduction for the money you put into your HSA. If you’ve already paid a bill from your regular account, you can reimburse yourself from your HSA and still get the tax deduction. Just keep your records in case you’re audited.