If you’re going to be starting a new job or your current job is changing health insurance plans and you’re having a difficult time deciding whether to choose a plan where you have to pay all for all your healthcare out of pocket until you meet a deductible and then 100 % of everything is covered or a traditional 80/20 with little to no deductible to meet, there are some things that you need to take into consideration when making this decision. Of course one of your first determining factors should be how often you currently or will be going to the doctor. If you have one or more chronic conditions that must be followed up on a regular basis, most insurance agents would suggest choosing the traditional 80/20 plan as a way to pay as little as possible out of pocket. According to Beth Miller, Human Resources and Health Insurance expert for Carolinas Health Systems in North Carolina, this suggestion may not necessarily be the cheapest route for those with chronic illnesses. There are additional factors that much be taken into consideration when choosing a health insurance plan, including exactly how much the deductible would be on the 100% plan as well as the specifics of the other plans.
I have personally found Ms. Miller’s advice to be very true. I have more than one chronic illness, and it seems like I’m always at the doctor’s office, whether it’s the neurologist, rheumatologist, dermatologist or even my regular PCP, and my husband has United Health Care insurance in which he has coverage for me as well. The traditional 80/20 option would have required a $150 weekly deduction from his paycheck. With me currently unemployed and our bills mounting, there was no way we could afford to have that much money missing from his paycheck each week. This forced us to choose the plan that would only cost $80 per week, but we had to pay all our doctor’s visits, testing, etc. up fron until we had reached our deductible which was $2,500 per year per person. In the beginning we thought this was totally impossible because we figured there was no way we could afford to pay for $2,500 worth of healthcare while waiting for the insurance company to take over. What we didn’t realize, though, is that healthcare is expensive and adds up very quickly. My doctor ordered some very expensive blood tests that totaled over $1,000, two MRIs as well as a spinal tap, and I had quickly gone over the $2,500 deductible, causing the insurance to kick in and cover 100% of everything else. And another great thing that really helped up financially is that the hospital allowed us to make very reasonable payment arrangements for the $2,500, so we weren’t forced to try to cough up money we didn’t have all at once. I’ve also had to have a couple of pretty expensive surgeries, and they were paid for 100 % by United Healthcare. Had we gone with the 80/20 plan, we would have had to pay 20% of a $12,000 surgery as well as a $40,000 one! That would have been over $10,000 that we would have had to pay out of pocket.
So if you have to decide which health insurance plan option is best for you and your family, don’t take one person’s advice without doing a little research on your own. You could end up paying a lot more money out of pocket by choosing an 80/20 plan automatically. Before making a final decision, you should consider all of your family’s health and whether or not anyone might need surgery or any other type of expensive treatments that could really add up. Of course if your family is basically healthy and no one has any chronic illnesses, you will actually save more money by choosing the 80/20 option, although this option isn’t for everyone.