Family plan health insurance through new job.. any other options? (HSA, medical)

[Icemodeled]

Posted in work and unemployment section and told to try posting here also.

We have been on marketplace insurance for years now(self employed or jobs without benefits). Before that we bought our own private plan through BCBS as it was cheaper then work plan(this was before ACA). We live in Florida.

My husband took a new job and after 90 days is eligible for health insurance. Marketplace will not be an option since you cannot get a subsidy if employer offers "affordable" insurance. We're struggling to decide on a plan or if there may be any other options out there.

We are age early 30s with one toddler and currently pregnant with baby#2. My husband has a genetic gene that makes cancer very likely(80% for colon) so he has yearly colonoscopy, biyearly endoscopy screenings plus visits urologist, dermatologist and genetic counselor yearly. So he sees many specialists and has screenings done.

I was found to have a genetic blood clotting disorder and am considered high risk this pregnancy. I am on blood thinners and will stay on them through postpartum. I will be having frequent office visits, high risk doctor visits, ultrasounds and blood tests. Due in July 2022.

My son is 2 and is pretty healthy but has recurring ear infections. His first started out with a seizure(ambulance ride and ER visit). His pediatrician left the practice in November and he is on a wait list to be established but that isn't until May. We've been using urgent care in the meantime when he needs meds.

So.. we do use insurance often. We are unfortunately not the people who say they never see a doctor. The last 3-4 years we maxed out our high deductibles. Left us in big medical debt we are just finally paying off and want to avoid again.

Income: (after tax)
Husband's new job 2400
2nd job 1500
Total income after tax $3900

So here are the health plan options at his job...
Plan 1 is best coverage but costs $1600/mo for family plan.
$0 deductible which is great with $25 copay PCP, $60 copay specialist. Out of pocket max $2250/6750 family. ER $300 copay. Inpatient $400 a day copay. Outpatient $300 copay. It's an HMO so I believe will require referrals (we have only had PPO plans) prescription drugs are same as plan 3.

Plan 2 is next best coverage but costs $1200/mo
750 deductible/2250 family.
3250 max/9750 family. Urgent care $50 copay.
Everything else is same as plan 3.

Plan 3 is probably our best option and is $650 a month.
1250 deductible/3750 family
4250 out of pocket max/12700 family
Annual checkups $0
Physician visits $30 copay
Urgent care $60 copay
Specialist 80% AFTER deductible
ER visit 80% after $150 copay
Hospital inpatient 100% after 500-1000 copay(depends on tier)
Hospital outpatient 100% after 150-250 copay
Prescription drug brand deductible $100
Retail, generic drug $10
Preferred brand up to $75 max

Plan 4 is a high deductible health plan that doesn't even cover a PCP visit until deductible is met. We're not even going to consider this one but it's $450 a month premium.

Thoughts on Plan 3? First two are far to expensive a month. Last is not enough coverage. I'm most worried about specialist not being covered with plan 3. Specialists is all my husband sees(GI, urologist, dermatologist, genetic counselor) and for my pregnancy I'll often be seeing my OB and high risk doctor. When I seen a hematologist she billed $500 for the visit. This would really add up fast! Even after meeting deductible our cost of 20% a visit could be substantial.

Other concern is my blood thinners (lovenox) but I take generic version. If I'm understanding this right my medication would be $10? Since it's generic. Without insurance it would cost thousands a month so trying to make sure coverage is decent.

We have a very good plan through the marketplace at half the cost and I'm feeling so stressed over this. Any advice, thoughts, suggestions or info would be great. We cannot get subsidies because insurance is offered through an employer and "affordable" based on their employee only cheapest plan option. We make to much for medicaid(even temp Medicaid while pregnant were $500/mo over limit). I'm so worried to fall down into deep medical debt again. Is there any other options? Should be just choose plan 3 and hope our costs won't be as high as expected(we are planning to max out of pocket with me for pregnancy). Thoughts on Plan 3 coverages? We can afford the $650 a month premium but not sure about the plan coverage.

[beezle1]

If I were in your situation I would probably take Plan 3. I do like high deductible plans though, as they usually offer an HSA where you can put away funds in a savings account BEFORE taxes, and use them for medical expenses, tax free. But perhaps the deductible is too high for you to consider that plan.

[Angie682]

This is a tough situation OP. Healthcare and out of pocket expenses are really a burden on the middle class. I broke my ankle a few years ago. I was responsible for my 10k out of pocket (I work for the insurance company...

[Hemlock140]

It's too bad the employer is offering insurance but making the employees pay the full amount. Mine for a family would be about $300/month, for just me it's $140, and my employer pays the difference. With both my wife and I being treated for cancer in 2019-20 we were able to manage with only paying the maximum out-of-pocket, mine $2000 (met in January both years) and my wife's through her employer $2,800. Each session of chemo for me would have been over $40,000.

It's ridiculous for an employer to provide insurance that costs 70% of their salary! Unfortunately the ACA law prevents you from rejecting it and staying with Marketplace, it's a catch-22.

My only suggestion short of a job with better benefits is to look at "cancer insurance." It's supplemental to health insurance, but I have no idea of the cost or screening requirements to get it.