Shawn, a subscriber and frequent commenter here at Clever Dude, as well as a personal friend of the Clever Dude and Dudette will be posting occasional guest articles. You can read his introduction here.
In my introduction post “Choosing the Right Health Care Plan“, I presented the health plan options my employer is offering this year, some of my own life issues and assumptions, and some definitions of terms I’ll be using in this series.
The plan for this series is to allow you, the reader, the chance to see into the calculations and decision process I’ve taken to decide the best health plan from my employer based on my own parameters. You can use this series as a basis for your own calculations and decision, but keep in mind our lives and life issues are uniquely different. This article will focus on the second plan: No Deductible.
Option Three: No Deductible Plan
Unlike the previous two options, I would have a monthly premium of $52 for myself, plus $157 to cover my wife and $77 to cover our child. This works out to a premium cost of $2,970 for the year.
There are no deductibles with this plan, while the out-of-pocket maximums are $3,092 per individual and $4,638 per family.
Co-pays on this plan are 20% of the negotiated rate for most services (in-patient hospital stays, ER visits, etc) and 25% for maternity care.
Working with the assumptions from the Introduction article, the negotiated cost of the OB services is around $2,500. Since there is no deductible, we would only be responsible for 25%, or $625.
For a normal delivery, the negotiated costs for mom would be around $2,973. We’d be responsible for 20% of that, or $594.50. For the baby, the total negotiated cost is around $1,080. Once again, because there is no deductible, we’d be responsible for 20% of that, or $216.00.
For a C-Section delivery, the co-pays go up a bit. For the OB, the co-pay would be around $700. For mom’s hospital stay, the co-pay would be around $1,081, and for the baby, $324.
For my assumed ER visit, the negotiated cost is around $4,000. Of this, I would be responsible for 20% of this, or $800.
Our Total Costs on the No Deductible Plan
With my assumptions, here’s the break down of the total cost for this plan for the year
- $2,970 for the premium
- $2,236 – $2,906 for co-pays
- $0 for deductibles
Making the total cost of this plan $5,206 – $5,876 out of the maximum of $7,608 possible for this plan. That maximum total accounts for the premiums plus the out-of-pocket maximum for the family.
As we test out our estimated costs with each plan, the total cost keeps coming down. This No Deductible Plan is a few hundred less than the Low Deductible Plan, and thousands less than the High Deductible Plan. Let’s keep this in mind when we check out the last plan: the In-Network-Only with No Deductible Plan.