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It is annual Enrollment time at my work. I am trying to pick choose medical insurance and would like some assistance.
I have been using Highmark for eight years and two companies and have had zero issues. I am looking closer at the UPMC option and wondering if I should choose them. Here are details:
Highmark (Family coverage) PPO
Deductible: $300 individual/$600 family
Out of Pocket Max: $1,200/2,400
Coinsurance: 80% plan pays/20% me
Monthly premium: $298
UPMC (family) EPO
Deductible: $0
Out of Pocket Max: $6,300/$12,700
Coinsurance: 100% plan pays
Monthly premium: $400
None of us go to the doctors except for covered physicals/routine checkups for the kids. The only difference for next year is my wife will be having a baby. I know with our past child with the same Highmark plan as above, we had to pay the hospital about $1,720 when all was said and done after the baby was born. With the UPMC plan above (UPMC is accepted at our hospital) we would pay $0 based on the documents and coverage comparison tool from my work.
So UPMC is $102 more a month out of my paycheck. Come June when it will be time to start paying hospital bills, I would pay approx $443 a month if I was on Highmark ($298 premium+$144 budget amount for hospital bills) vs. $400 premium only for UPMC. Is it worth it to switch to pay $102 more a month for the first half of 2014 in order to save $43 a month for the second half of 2014? Or does it cancel out? If we weren't having a baby next year, I would most likely just go with Highmark again.
PS: All other insurance options (Dental, Vision, Prescription, etc) are the same no matter if UPMC or Highmark is chosen.
There is something missing in this translation. If the company pays 100% of the co-insurance there wouldn't be an out of pocket max. Did you mean to say they pay 100% after you meet your out of pocket max? The premium difference alone makes the plan you are on less expensive unless your new baby has some unexpected medical costs, has to be in the ICU for example. If you have to pay more than $1000 out of pocket on the new plan, you've spent more with that plan then the Highmark plan. Then you have to be concerned about network. You typically have NO coverage out of network with an EPO. Are ALL of your doctors and providers in that network, including anyone your wife might have for the birth..maybe an anesthesiologist if she has a c-section, etc.
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