For those of you who don’t recall, I’m applying to stay on Medicare as a working disabled person. I’ll have to pay Part A, which means my premiums will be just over $500. That’s only $30 more per month than I pay now, and Medicare has no deductible.
But since you can’t hurry bureaucracy, I’m in the process of choosing a new marketplace plan for 2018.
It was pretty easy to winnow down the options. I have a few regular doctor appointments and four prescription drugs — all of which I want covered before I pay a thousands-of-dollars premium.
This means it’s down to (of course) the top two plans. Both have standard co-pays for prescriptions and doctor visits, including specialists and mental health professionals. The difference? Oh, just $150 a month in premiums.
The first plan, Ambetter Balanced Care 4, has the same premium as my current one. The plan is similar except that — surprise, surprise — coverage decreased.
In 2017, doctor visits and medications weren’t the only things with straight co-pays. Emergency room visits, while a painful $400, were at least set amounts. Same with blood work and a few other things.
In 2018, anything other than doctor appointments and medications isn’t covered until the deductible is met. Did I mention it’s a $7,050 deductible?
The second option is Ambetter Secure Care 4, which has a similar setup in that only doctor visits and medications are covered before the deductible. But that deductible is only $1,400.
After that, I’d pay 10% coinsurance up to another $4,350. Once I hit that, I’d be at my maximum out-of-pocket expense for the year. From then on, I wouldn’t pay a cent for my care (other than my heinous premiums, of course).
Unfortunately, the Secure Care premium is $148.23 more per month than Balanced Care. Lower co-pays defray the cost a bit, but I’d still be paying about $100 more a month.
Better coverage is cheaper, right?
Normally, it seems like a no-brainer that better coverage would definitely even out costs. But that’s not necessarily the case here.
Remember, all of my regular expenses are ones with standard co-pays. That means they’re not affected by whether I’ve hit my deductible yet. Under Secure Care, I’ll pay $10 to see my therapist whether I’ve spent $200 or $2,000 so far that year. So a lower deductible doesn’t matter in that regard.
No, the lower deductible is there to guard against unexpected procedures or tests that need to be run: x-rays, blood work, an ER trip, an in-patient hospital stay, etc.
And even then, there’s something of a problem — mainly because co-pays would be so low. They’re going to barely make a dent in the deductible for most of the year, which is important for the timing of any extra expenses.
Specifically, in order for me to see any savings with the costlier plan, an extra bill would have to be a lot higher earlier in the year than it would if it came later.
For example, if I have an ER trip or some other non-standard bill in late December, it could be as “low” as $1,250 and the Secure Plan will officially have saved us money:
- Balanced Care: $1,250 plus the rest of the year’s costs ($7,619, including premiums) = $8,869
- Secure Care: Remaining deductible ($140) plus 10% co-insurance ($111) plus the rest of the year’s costs ($8607, including premiums) = $8.858
But if that extra expense comes in January, it would need to be around $2,750 for me to see any savings:
- Balanced Care: $2,750 plus the rest of the year’s costs ($7,619, with premiums) = $10,369
- Secure Care: $1,400 deductible plus co-insurance ($135) plus the rest of the year’s costs ($8607 with premiums) = $10,142
And if I’m lucky enough to avoid any extra bills, then I’ll have paid about $1,000 more than I needed to.
Context is everything
In short, my decision involves a lot of guesswork. Maybe in other years that wouldn’t be as big an issue, but this year has been remarkably quiet on the medical-bill front. (No whammy no whammy no whammy no whammy!)
In fact, I’ve barely seen doctors this year other than my therapist and medication management doctor. I saw a nurse practitioner when FinCon crud made me start wheezing. Beyond that and some vision exams (which aren’t covered by any plans), I’ve had no unexpected medical bills this year.
Intellectually, I know that this year might just be a fluke. Then again, medical life has been a lot quieter since we stopped trying to have kids.
So it’s difficult to feel like thousands of dollars of bills could easily hit. Or if not “easily” then at least that the probability is high enough to merit an extra $1,000 in premiums.
But it could
I have to remember that, regardless of how it feels, anyone has a pretty high chance at thousands in medical bills. A single emergency room visit runs more than $1,000. One of Tim’s was $2,000. Maybe even $2,300.
And given my klutiziness — seriously, a couple months back I went to kneel, hit a spray paint can with my patella and it hurt to walk for a day or two — it’s scarily easy to end up in the emergency room.
Heck, potential injuries aside, it’s terrifyingly easy for a normal malady to spiral out of control without warning. Add in a spouse whose health problems I help manage and a depression that can make phone calls (and therefore appointment-making) difficult, and you’re looking squarely at “yeah I’ll probably end up in the ER at some point.” Especially when your plan’s urgent care centers close at 5 p.m. (I mean… What’s even the point?!)
What I need vs what I want
I need to contact an insurance broker to see if there are any better deals out there. But I’m guessing my issues will mean that the marketplace options are as good as it gets for me.
If so, I have to weigh peace of mind against a potential $1,000 in unnecessary spending. And try to figure out where an out-of-nowhere or let-it-escalate illness falls on the likelihood spectrum.
In the end, we all know what I’m going to do. I’m (almost definitely) going to choose the more expensive plan. I’m once again (just about certainly) going to pay extra money for peace of mind and have to vacillate between hoping a bill makes it worthwhile and hoping that nothing comes up bill-wise (or health-wise) that makes it worthwhile.
But for now I want to pretend I have a real choice. I want to make believe that I could reliably believe that 2018 wouldn’t bring with it some heretofore unknown, unsuspected ailment/diagnosis/bill.
In short, I want to ever so briefly be the kind of normal person who feels safe predicting a quiet year medically, rather than someone flabbergasted by (please don’t let me be tempting fate) a year without any major medical surprises/expenses of her own.