Caveat emptor: The advice you are getting is worth what you are paying for it :) .
The information I'm providing is a combination of what I have done for my own situation and what I have learned by researching this topic for my own personal benefit. I'm sharing what I've learned to help others but I don't know whether my solution to paying for this care meets your needs.
I get insurance through my employer.
I pay for about 30% of my insurance while my employer pays the rest. So my out of pocket premium costs are about $315 / month.
1. Worst case costs
My employer offers a minimum of 6 different plans. I select plans by assuming a "worst case" for the next year. For me, a "worst case" is multiple hospitalizations, major surgery (or 3 or more minor surgeries), multiple major diagnostics (CT scans and/or MRIs at $2000 / image), and multiple ER visits - total costs >$100,000. I have experienced these worst cases a couple of times in my working career.
2. Coverage
Because I have a chronic incurable disease, I have a whole medical team I depend upon for care. I examine each plan to ensure that it includes my entire medical team and any facilities that they use as "in-plan" coverage.
3. Customer satisfaction
I select the 3 plans with the lowest "worst case" costs (premium + copay + any other costs borne by me) and examine their customer satisfaction. If any of the top 3 plans have noticeably poorer customer satisfaction, I eliminate them from further consideration.
4. Mid case costs
For the last couple of years, only two plans survived to this point. I then examine the costs of the insurance for a "mid case" scenario (total costs around $10,000 for the year). For the last two years, both plans.
5. Convenience
The last two years two plans satisfied all of the above. So the deciding factor for me was, I stayed with the plan I had the previous year. It makes it more convenient to work with various medical providers to keep with the same insurance plan.
The HSA allows me to put money into an account *Tax Free* and use that money to pay for medical expenses. The tax free benefit is worth whatever your marginal tax rate is. If your marginal tax rate is 25%, then your HSA money "costs" you only 75% of the amount in your HSA fund. If you have an HSA account, I recommend putting as much money as you can into this fund.
HSA money may be carried over from year to year. Due to the expenses of my treatment, this has never happened for me. However, if you ever don't spend all the HSA money, then you'll have even more money saved for years in which you incur exceptional medical expenses. Even better, you may transfer money from your HSA into a retirement account if you believe you have more than enough money to cover your medical expenses.
My plan includes a provision called "maximum out of pocket." This means that if I pay this amount for my medical care in a year, the insurance company will pick up 100% of any additional medical care for my treatments. I rely upon this to limit my total insurance costs in a "worst case" year.
My total medical costs last year with *no* Remicade infusions was $11,000 of copays and other out of pocket expenses and about $12,500 insurance premiums (family insurance). My company pays more than 2/3 of the premium costs and the $11,000 is mostly tax deductible (consider it a 25% discount based upon an assumed marginal tax rate of 25%).
So my out of pocket expenses were about 75% of $11,000 + 33% of $12,500 = $12,375 - that's the most I should ever pay. Last year my total medical costs exceeded $250,000 and I still paid only the above amount.
I expect Remi infusions this year and my costs shouldn't exceed the above amount either.
On the one hand, it is extremely expensive. On the other hand, I consumed a LOT of medical services last year!
The information I'm providing is a combination of what I have done for my own situation and what I have learned by researching this topic for my own personal benefit. I'm sharing what I've learned to help others but I don't know whether my solution to paying for this care meets your needs.
I get insurance through my employer.
Premium costs
Since I'm the sole income earner for my family of six, I get coverage for my spouse + family too. This coverage costs ~$12,600 / year or ~$1,050 / month.I pay for about 30% of my insurance while my employer pays the rest. So my out of pocket premium costs are about $315 / month.
Choosing
I choose my insurance each year by a multistep process.
My employer offers a minimum of 6 different plans. I select plans by assuming a "worst case" for the next year. For me, a "worst case" is multiple hospitalizations, major surgery (or 3 or more minor surgeries), multiple major diagnostics (CT scans and/or MRIs at $2000 / image), and multiple ER visits - total costs >$100,000. I have experienced these worst cases a couple of times in my working career.
2. Coverage
Because I have a chronic incurable disease, I have a whole medical team I depend upon for care. I examine each plan to ensure that it includes my entire medical team and any facilities that they use as "in-plan" coverage.
3. Customer satisfaction
I select the 3 plans with the lowest "worst case" costs (premium + copay + any other costs borne by me) and examine their customer satisfaction. If any of the top 3 plans have noticeably poorer customer satisfaction, I eliminate them from further consideration.
4. Mid case costs
For the last couple of years, only two plans survived to this point. I then examine the costs of the insurance for a "mid case" scenario (total costs around $10,000 for the year). For the last two years, both plans.
5. Convenience
The last two years two plans satisfied all of the above. So the deciding factor for me was, I stayed with the plan I had the previous year. It makes it more convenient to work with various medical providers to keep with the same insurance plan.
Type
For me the plan that I chose was a "High Deductible Medical Plan" (HDMP) with an "Health Savings Account" (HSA). I include the costs of funding the HSA as part of the cost of the plan.The HSA allows me to put money into an account *Tax Free* and use that money to pay for medical expenses. The tax free benefit is worth whatever your marginal tax rate is. If your marginal tax rate is 25%, then your HSA money "costs" you only 75% of the amount in your HSA fund. If you have an HSA account, I recommend putting as much money as you can into this fund.
HSA money may be carried over from year to year. Due to the expenses of my treatment, this has never happened for me. However, if you ever don't spend all the HSA money, then you'll have even more money saved for years in which you incur exceptional medical expenses. Even better, you may transfer money from your HSA into a retirement account if you believe you have more than enough money to cover your medical expenses.
My plan includes a provision called "maximum out of pocket." This means that if I pay this amount for my medical care in a year, the insurance company will pick up 100% of any additional medical care for my treatments. I rely upon this to limit my total insurance costs in a "worst case" year.
Example
My total medical costs last year with *no* Remicade infusions was $11,000 of copays and other out of pocket expenses and about $12,500 insurance premiums (family insurance). My company pays more than 2/3 of the premium costs and the $11,000 is mostly tax deductible (consider it a 25% discount based upon an assumed marginal tax rate of 25%).
So my out of pocket expenses were about 75% of $11,000 + 33% of $12,500 = $12,375 - that's the most I should ever pay. Last year my total medical costs exceeded $250,000 and I still paid only the above amount.
I expect Remi infusions this year and my costs shouldn't exceed the above amount either.
On the one hand, it is extremely expensive. On the other hand, I consumed a LOT of medical services last year!
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