Just when I thought I had the health insurance game all figured out, I’m beginning to rethink my current healthcare choices.
Back in August, I wrote about preparing for open enrollment for health benefits through my husband’s employer. It was the first time he was eligible to enroll in an open access plan (OAP) rather than a high-deductible health plan (HDHP).
When I had health insurance benefits through my employer and used my husband’s plan as secondary insurance, healthcare seemed so much more manageable for some reason. Maybe it just seemed easier because I only had to calculate my healthcare needs instead of both of ours. Also, I had always enrolled in an OAP because I assumed it would be financially smarter, so I never explored other options.
After being covered solely by an HDHP for a full benefit year in 2019 and going back on an OAP, I’m beginning to wonder if an HDHP would have been the better choice. As the fourth month of being enrolled in an OAP draws to a close, I’ve been reviewing our medical expenses compared with the same time last year. I feel like we’re paying more money out of pocket, and none of the costs are applying toward our deductible.
Granted, my husband’s recent blood pressure issues have added to our medical bills. However, as I compare my expenses year to year, I’m contemplating whether we should go back on the HDHP plan next year.
I knew we would pay a higher monthly premium for an OAP in exchange for having a lower deductible. However, during these first four months on our new “platinum” plan, I’m noticing various charges adding up fast, especially for office visits and my Remicade (infliximab) infusions.
Doctors’ office visits
Under our HDHP, we paid different amounts for doctor visits. Depending on the doctor, this would range from $75 to $225. Before we met our deductible, we had to pay the full amount. After we met our deductible, we only had to pay a percentage of the rate.
With our OAP, we owe a set copay: $25 for a visit with a general practitioner and $50 for a visit with a specialist. Aside from my primary care physician, all my doctors are specialists, and $50 a visit starts to add up. With eight more months in our benefit year to go, we have at least six more doctors’ appointments scheduled.
Last year, we met our deductible after one or two doctor visits. Even though we may have paid a few hundred dollars upfront, the rest of the year we only had to pay $10 to $15 a visit. Moreover, what surprised me about our OAP is that our copays don’t apply toward our deductible like the office visits did with our HDHP.
Remicade infusions
My biggest medical expense, of course, is my bimonthly Remicade infusions. Because my employer’s plan paid for 100 percent of my infusions, I had quite the sticker shock when I received the bill for my first infusion under the HDHP — it was almost $3,000!
More than 91 percent of that cost was the medication. Fortunately, I had a Janssen CarePath card that paid for the Remicade. Because we had not yet met our deductible at the time, my share out of pocket was around $230. Even though CarePath paid for the medication, the total amount for the infusion counted toward and met our annual $3,500 deductible during the first four months of our plan. For the rest of the year, I paid about $20 for each infusion.
Under our OAP, I have a $50 copay for my infusion. As I mentioned, our copays don’t apply toward our deductible. Our plan also covers the total cost of Remicade, so nothing is applied toward our deductible.
The unknowns
We haven’t made a dent in our deductible so I’m concerned about upcoming healthcare costs, including colonoscopies for my husband and me, my bone density scan, and the breast ultrasound I get in addition to my annual mammogram because I have dense breast tissue. Last year, we paid less than $100. I have no clue what our out-of-pocket costs will be this year since we still need to meet our $750 deductible.
Although I already keep a spreadsheet of our yearly medical costs, I’ll need to create one with a side-by-side comparison with what we paid under our HDHP. That way, I can compare apples to apples to determine what type of health insurance plan we should enroll in for 2021.
I always joke that I’ve earned an honorary medical degree because of all my health issues. By the time I figure out the cost for the best health insurance plan, I’ll have an honorary minor in mathematics.
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