Question for people who actually use their health insurance:

[thanate]

We're looking at a new set of plan options, and the new company has a boatload of supposedly good ones, and I'm the kind of mostly healthy ex-Navy ex-dependent who hasn't really needed doctors much since I was too young to be paying attention to the details, so it's possible that my eyes glaze over more than usual when faced with coverage summaries, given my relative lack of context.

For those of you who use your healthcare, what's important to you? Particularly with reference to possible kids & the having thereof... What features do you love about your plan (current or past), what do you hate, what's turned up suddenly to cause you headaches, etc.

Any input much appreciated!

Comments

[zagzagael.livejournal.com]

We have Blue Cross - we like their local providers and there is only one hospital here so our choices are limited. We have a VERY high deductible - $5,000 a person....but we keep the cash handy to cover that. For example, my discetomy cost us $6,000 by the end of it, but it was a $37,000 job if paid cash, so we came out ahead.

It is going to be a bit pricier for you because of the maternity coverage.

We don't carry optical or dental but ask for cash discounts and pay on the spot for those services.

[cheshiretiffy.livejournal.com]

When I worked at Wegman's I had Blue Cross/Blue Sheild full coverage which was a no co-pay plan and it was great. My troubled pregnancy with I don't know how many ultrasounds, usually somewhere around $200 each at the time, and Dommy's birth didn't cost us anything other than me having to pay the ambulance ride out of pocket. My stay at the hospital, the surgery and the medication were all at no cost to us. His care wasn't covered once he left my body so we had to pay for that, too.

Its a really expensive plan, though. I know I was paying about $20 a month, and the company was paying closer to $900.

I'm sure you could find a reasonable family coverage plan with them, though I've heard both good and bad things from people who have BC/BS privately.

[belfebe.livejournal.com]

Honestly, the more comprehensive your plan, the better. Even if you never get sick, you never know what's going to happen. I was the poster child for someone who would never get diagnosed with breast cancer, and lo and behold, I did. And I didn't even have any lumps. (Note to self, mammograms are a life saver. Really.) The fact that my plan covered everything, was absolutely great.

What I am trying to say is, it's better to prevent than to get yourself diagnosed with something and then you "Holy crap! What now?"

Flexibility on your choice of doctors is great. PPO plans as opposed to HMO are better in that regard. A good coverage in pharmacy too. Often, it's the medication prices that do you in. See if they have a mail in option. By this, I mean that you can order 3 month supply of your prescription for one flat rate, as opposed to refilling at the pharmacy which is more expensive. And, do they cover contraception? Mail orders for that are great, if you are using it.

Whatever you do, don't skimp on coverage. And I don't know if you guys are planning on having kids eventually. If you do, that's even more critical.

Hope this helps.

[dancinglights.livejournal.com]

I'm on a good employer-mostly-funded BC/BS plan. We go for the PPO because fighting through my medically-related anxiety to find a doctor/specialist I can trust is scary and panic-inducing enough without the limitations and extra layers of paperwork of an HMO. Check the pharmacy plan if you have multiple options, and think about what you're most likely to need. Our scrip plan is AWESOME for the small children we don't have - most antibiotics and inhalers and assorted stuff I needed as a kid is absolutely free - and terrible for us, as Pod requires specific-brand maintenance drugs that are still $50/month and my recommended birth control, when I'm on it, costs the same as out of pocket.

Also, if you need maintenence meds or will have kids with the attendant frequent co-pays, HSA prepaid benefits are awesome, and if either of you need glasses/contacts, you can dump the extra money at the end of the year into that.

[heuchera.livejournal.com]

We have a plan managed by Aetna, which has been okay. Used to be HMO, now is PPO; I was happy with both. The most confusing thing is working out how our deductible stuff gets applied, and what the various negotiated rates are and who pays what. The 85/15 breakdown is not as straightforward as one might think. That part of things was less confusing on the HMO. However both my doctor and the insurance folks have been reasonable in working through discrepancies.

We have an FSA and I really like that for prescriptions and copays we can anticipate; your needs may differ in that regard.

I don't have any experience on the childbearing/pediatric visit end of things, but usually the plans lay out pretty clearly what is covered for that.