Insurance questions for the gurus of the board please

I'm so excited.

I was offered a permanent position at my job.

And I'm getting married in September.

After the crappy year I had last year, this year is looking FABBO.

Now, I couldn't afford to keep up the Obama insurance I qualified for at $400 bucks a month (before I got this job - long story). I had to drop it, and when I got gainfully employed at a contract-to-hire no benefits position, it was too late, I couldn't re-apply to the insurance for another 6 months. Right now I'm without insurance.

But hey, I about to enter health insurance nirvana!

Because, at my new job I have two insurance plans I can chose from. And when I get married, we can choose his, too.

Now, my fiance works for a small company of only about 60 employees. They have a bare bones United Health PPO with a high deductible (not sure of the number), co-pays and 80% pay after that. I don't have the exact details. BUT his employer pays 100% of the premiums, which is nice.

I will have my choice of Aetna plans:

HMO - about $800 month for full family coverage - BUT no deductible, just copays and then it pays 100% of the bill.

PPO - about $300 a month for full family coverage and it has a $1,000 deductible that has to be met, co-pays, and then pays 80%.

Now, we KNOW I will always have medical issues. The least of which are labs, I'm scared I may need gallbladder out at some time, I want to get aggressive with seeing a hematologist, and getting treatment for hemorrhoids, female issues, hip pain, neck and shoulder pain and a whole bunch of other stuff I put up with because I don't have insurance!

In addition, my new husband brings along a lovely disabled child. He was born with several deformities and needs medications and possible future surgery (he has already had 7 surgeries in his tender 13 years on this planet!). Because of his bare bones plan, this has always been a financial struggle for him. Thank heavens for Shriner's Hospital! So, again, we KNOW there will always be medical issues with his son as well as with me.

Getting to the point - do you think it would be worth paying that extra $500 a month for the HMO - or - do you think we can use both PPO plans to better benefit? If we bill to both, wouldn't that effectively cover everything at 100% anyway? I'm not sure how that will work.

with an HMO you are usually limited to THEIR doctors- if you can investigate who they use in your area it might be some of the same ones you use now, or NOT. I personally would go with a PPO which means you can go more places & have a selection of doctors. I think it's worth a little more out of pocket to have the freedom & choice, especially with the DS you might not encounter any that know about it in an HMO. I dont know about you but I have changed doctors a couple times in the past few years when I didnt like their attitude or personality- I would have hated to be stuck with one of them!

I can't help you with insurance, but just wanted to say congrats on getting the permanent position! I know you have been hoping for it for a while! Congrats on the wedding too!! I can't wait to see the pics

Ann-Marie

Personally, having Aetna as my HMO provider I would go with with the HMO even with the additional cost. I mean, if you end up in the hospital because of your gallbladder you have to pay $1000 to make the deductible, then another 20% on top of that?  So if it costs, $20K you would have to pay another $4K! Even with the additional cost of the plan it seems to me that the HMO is a better deal.

Right, that was my first thought. But then I did some research and thought I can have both mine and my new husband's plans, and the first one would cover 80% and the secondary plan would cover the remaining 20% and when I meet the deductible, it will count towards both (so, if I pay $500 it will deduct from both plans simultaneously....and reduce both deductibles). So, I thought doubling up on the PPO would give me more choice for less money (both up front and in the long run).

I just wanted to make sure I was right on this. Because we can have both plans, and his is free!

Well whichever one you choose it isn't permanent. You can always change when the enrollment period comes around again.  Sounds like the PPO might be better given that one plan will be a secondary.

In order to make this decision,   you need a copy of the list of providers on their HMO plan,  you need to know if there is an out of network option on the HMO plan,  and you need to read the plans' coverage descriptions and exclusions - which you can get from your employer.

Every plan differs from employer to employer - Aetna in one state can be completely different in another state,  and even with another employer.  It all depends on what your employer has chosen to pay for and provide its employees.

Larissa,
Nothing new to add on the insurance. Over the years I've had both. I did want to send congratulations for your permanent job and upcoming marriage.

 Personally, I would choose a PPO over an HMO any day because then I can choose my doctors and don't need referrals to specialists.  

Congrats on both items of great news!

Since hubby-to-be's insurance premiums are covered, then yes, his is your secondary. So your primary coverage is what you must think about. Since it will be your primary, and given your history, I would choose the PPO personally. The big trade off for no deductible and 100% coverage is potentially not the first choice in caregivers. 
Also...moneywise: Assuming that the copays are equal, in 2 months you will have spent $1000 less in premiums, so that is your deductible right there. Then in the other 10 months you are saving $5000 in premium costs. Any thing above that you owe 20% of, and $5000 is 20% of %25,000. So I guess if your total costs are way more than that, then the HMO might be a go, but for me, I know we don't ever come close to that amount with my health issues and with 3 kids - hubby is never sick. (This year it will prob surpass that cuz I am having my DS this year.) 
The trade off of not having much choice in physicians doesn't cut it for me. But you need to look at those caregivers that are covered. And the hospital's that are covered as well. HMO's used to make you call them even before you went to the ER to see if they thought you should just wait for an office visit - so make sure what that coverage is too.
Lisa