After taking a brief foray into the normally employed, I went back to being an independent contractor as of January 1st this year. That meant that in December I was frantically refreshing the Washington Health Plan Finder site trying to purchase a plan so that my pregnant self and my baby son wouldn’t have any lapse in coverage. I had no problem getting a quote, but I did find that the website was a little buggy as I tried to buy. I’m sure this is because website traffic was incredibly high the day I purchased – the last day to get coverage by January 1st. It wasn’t that bad, I just had to resubmit a few pages a few times before everything actually went through.
The Nitty Gritty:
- Coverage for me (almost 30, pregnant, non-smoker) and son (1.5 years old, includes dental)
- $516.95 per month for a Premera Gold PPO Plan
- Deductible is $1000 ($2000 total for both of us)
- Out of Pocket Max is $4500 ($9000 total for both of us)
- In-Network coinsurance is 20% (which includes maternity coverage after deductible)
- $10 copay on Primary Care office visits/$30 copay for specialists
- $200 copay for emergency room visits
- No subsidy, we don’t qualify for any
Our other option was to go onto my husband’s plan. For comparison:
- Add spouse and children $610/month (dental for both)
- Premera PPO Plan
- Deductible is $1500
- Out of Pocket Max is $5000
- 20% coinsurance
- $35 copay for office visits
- $250 copay for emergency room visits
So, as you can see we have nearly the same coverage, except a little better, and for almost $1200 less per year.
(The only thing that isn’t apples to apples in these plans is that I would have had dental coverage under my husband’s plan, but under the plan we went with I chose to only get my son dental because I never go to the dentist. It still would have been less expensive overall through the ACA, even if I had added dental for me.)
I’m definitely happy with the plan we went with. When I was previously an independent contractor – back when Bush was president and I was a barely twenty year old something – I purchased a catastrophic plan through Regence Blue Shield for a little over $100 per month. The cost went up a bit every year, and I was paying about $150 per month by the time I was 27 with no dental. I believe the deductible was $10,000, so for a $1000 deductible and coverage for two (three if you count my pregnancy!) I think that $516.95 seems reasonable.
I typically would never go with a Gold level plan. I have a still practicing Dr. Mom who is always on call for me, and I’m a generally very healthy young(ish) person with very low health costs. This year I decided to splurge on Gold because of my pregnancy, but I will likely switch to a bronze level plan in the future, and put our children on my husband’s insurance, since once we have multiple kids this will likely make the most financial sense. In the case of the “condition” I’m currently in, I actually could plan for it and get the best possible insurance to cover my pregnancy. But in the face of some other kind of medical catastrophe that I can’t plan for, I’m prepared to pay higher out of pocket expenses. I’m not prepared to drown in hundreds of thousands of unexpected medical bills, but we are financially in a place that we could handle say $10,000 without being financially ruined, so it’s a risk I’m willing to take.
So far this year I’ve been billed $5,320.51 (about half of which was actually “allowed”) for pregnancy appointments and 3 prescription refills, and I’ve paid $381.11 total out of pocket. That’s three $10 prescription copays with the rest being my 20% coinsurance. Everything that I’ve paid so far has counted against my out of pocket expenses, but none has counted towards my deductible. I’m kind of at a loss as to what counts towards deductibles! And everything I read online seems to say that I should be paying for 100% of my charges until I meet my deductible, at which point the 20% coinsurance and OOP Max kick in, but clearly that’s not the way my insurance is actually working in practice. Feel free to educate me if you understand this stuff better than I do!
And feel free to leave a comment with your experience with health insurance this year. I’m very interested to see how the ACA is affecting different people.