Reader Question - What Insurance Plan Did You Sign Up For And Why?
Last week, I got a question from one of the readers of My Two Dollars:
“Can you write more about your health insurance plan and the company that you got it from and how you went about choosing it and the alternatives you considered?”
I sure can Pam! When I left my job about 13 months ago, I gave up our company paid health insurance plan and had to go about finding a new affordable plan for my wife and I. Even though she is a full-time teacher, her school does not offer health insurance so we had to go get it on our own. After researching different plans for a while, I decided on a Blue Cross PPO plan with a high deductible and we have been happy with it so far.
The reason I stuck with Blue Cross is that I have had them for every plan since I moved to California 12 years ago and have never had any major issues. Of course, every insurance company has it’s share of complaints, but some of the other ones available here in Southern California get really bad reviews, so I figured I should stay with what I know. And the reason I chose the PPO is because I have had the same doctor since I moved here and I did not want to start over with another doctor - mine does not take HMO patients so I had to sign up for the PPO. My wife now goes to my doctor as well and we both really like him, so I wanted to be sure I could stay with him.
Another thing I had to look out for was to make sure that whatever plan I picked out covered maternity costs. A lot of them don’t, and sometimes you really have to dig deep in order to find that info. Since my wife and I are on the verge of having children, we wanted to make sure we had some coverage for the costs. Births can cost a ton of money, and if there are complications it can get even more expensive!
The plan we have is the Blue Cross of California PPO Share 5000 plan. This gives us a deductible of $5,000 per year for anything above and beyond regular doctor visits and lab tests ordered by our doctor. Our annual out of pocket maximum is $7,500, our co-payment is $40, and generic drugs are $10. We also get free annual exams. Our monthly cost for both of us is around $275. Since we are both healthy (I think!), we decided to get the higher deductible plan so our monthly outlay would be a lot less. And just in case anything bad does happen, we are still covered for anything above and beyond $7500…which is one reason we have an emergency fund. If we needed to pay that giant bill, we could pay it off right away.
I hope that helps answer your question, and please feel free to let me know if it doesn’t!
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the baglady | Nov 13, 2007 | Reply
hmm. That’s really weird that she doesn’t have health insurance but works full time. I think it’s California law to give people who work at least 35 hours a week health insurance.
the baglady | Nov 13, 2007 | Reply
yup, the law is SB2, health insurance act of 2003: http://www.csufresno.edu/ccchhs/documents/publications/Health_Heartland_employment_insurance_2004.pdf
david | Nov 14, 2007 | Reply
I will look into it when I get back from vacation, but I think it only applies to companies of a certain size. Hers is very small and private, thus….but thanks, will check it out. Either way, we don’t pay any more than we probably would with her company even if they did offer it.
Pam | Nov 18, 2007 | Reply
Thanks David for answering my question in detail. You said:
“The plan we have is the Blue Cross of California PPO Share 5000 plan. This gives us a deductible of $5,000 per year for anything above and beyond regular doctor visits and lab tests ordered by our doctor. Our annual out of pocket maximum is $7,500, our co-payment is $40, and generic drugs are $10.”
What I’d like to understand is this — if you go to a regular doctor visit, is the max you pay $40 for copayment? What if your doctor refers you to a specialist? Is that $40 too or would you have to pay out of pocket until you reach the annual deductible of $5000?
Where is the yearly max of $7500 coming from?
-Pam
david | Nov 19, 2007 | Reply
The max is $40 for a doctor’s visit. If he orders blood tests, etc, we pay more, of course. For a specialist, it’s a $40 copay as well, but that is just for the visit. Tests, procedures, etc, always cost more. Since it is not an HMO, I don’t need a referral to a specialist, thus they are just like any doctor with a $40 copay.
Yearly max is just that - the yearly max I have to pay out in it’s entirety.