I have become very familiar with health insurance over the past few years. First, we had our little Roo in February of 2010. Second, while cleaning windows at someone’s home I fell about 12 feet from a ladder and broke an assortment of bones in both feet. Lastly and most recently we had our little Moo.
These experiences gave me a crash course in how my health plan works. You would think that since I had insurance during all of these events I would have gotten off easy and not had to pay a bundle; unfortunately insurance is not what it used to be.
When we would go to the doctor the insurance paid out of the HRA whatever we owed the doctor. All the money spent out of the HRA was applied to each individual’s deductible which was $1000 per person.
The HRA would cover at least one full deductible and then half of another person’s. Once our deductible was met for Janna during the pregnancy, then it starts what the insurance companies call “Co-insurance”.
Our co-insurance is 80-20 up to $2500. This means that for every bill we got after the deductible was met we had to pay 20% of all the doctors’ bills until the total paid equaled $2500.
After all was said and done my employer paid for the $1000 deductible then also paid $500 of our coinsurance which left us with a bill for the rest ($2000).
We ran into a pretty big problem as this all played out; since Roo was born in Feb 2010 all the appointments leading up to the birth were on the 2009 plan year then add the birth to the 2010 plan year and we maxed out 2 plan years with one condition.
Some advice for those wanting to be parents; try your best to make the 9 month pregnancy all happen before December 31st, this seems simple enough but I didn’t think about it beforehand.
This will also help you come tax time you will be able to claim him/her on your taxes for that year.
Next, I broke my feet, I don’t have much to say about it other than nobody is invincible on a ladder. I fell from about 12 feet on concrete, I’m super lucky I did not fall on my back or even worse my head. Click here to see the gross picture if you dare.
*Just FYI, if you are a nurse or doctor and you happen to be giving a patient the same drug that killed Michael Jackson… don’t tell them that. I was able to recover from the whole experience and am able to walk fine today.
Add the broken feet numbers to the mix and our 2010 health expenses were staggering. The next time open enrollment came around I decided to really buckle down and understand what was happening. I received all the information from my employer about the different plans and looked it over.
Keep in mind Janna and I decided at this point we were going to have another child in 2011. Knowing that we would max out the policy all I had to do was find out the worst possible scenario for each plan and go with the cheapest.
As it turned out that the cheapest health insurance plan was an HSA (Health Savings Account). The deductible was quite a bit more than the HRA but there was no coinsurance after the deductible was met. I think the deductible was about $2300.
For 2012 we switched back to the HRA because we don’t plan on any major hospital stays (fingers crossed) and it worked out to be a little cheaper because of that.
A few tips I’ve learned along the way…
- Never pay a hospital bill the first time it shows up in the mail. It’s likely the insurance company just received it as well; wait until you know insurance has paid its share.
- Don’t pay big lump sums. It’s like an interest free loan, just pay something towards it every month and most of the time they won’t hassle you.
- Know the worst case scenario with your insurance plan; find out what the total cost would be if you had something catastrophic happen.
- Make sure you are visiting an in network doctor. Believe it or not before I checked myself into the hospital for my broken feet, I checked on my iPhone if the closest hospital was in my network… I know I’m crazy but a lot of times using an out of network provider can double the cost of care.
- Because I broke both of my feet I was obviously unable to walk. This created problems that I cannot count, I was not able to get back into our apartment and as a result my inlaws took us in for my recovery period. Unfortunatly I was not able to navigate my wheelchair into their bathroom… have you ever seen those stand alone adult size potty chairs? Yep I had to use one. Let me tell you how not cool it is to have to do your business in the living room on one of those things and then letting people know when it’s safe to enter the room again. Bless Janna’s heart she was so good to me.
What are some tips you have about health insurance? Please leave a comment below and share.