Category Archives: Healthcare

To go to the doctor, or not go to the doctor – that is the question

High deductible health plans are great when you hit your deductible – except when they’re not. Specifically, they’re not great when over the course of the year you have to start over paying your deductible due to company health plan changes and/or changing companies. Thus, this leads me to move away from my former infatuation with the HSA-enabled HDHP.

In November, my $2600 deductible restarted. I figured I could survive until the end of the year without seeing a doctor. Then, I got pregnant. And then, I got sick. Sick with a cold / sore throat / lost voice that’s likely a virus that has no cure anyway… not worth a doctor’s visit and certainly not worth spending $300 on. I already made that mistake a few times this year when I didn’t realize my deductible had not only reset, but doubled (thanks to my former company who didn’t notify me that as of Aug 1 they switched plans and the $1500 deductible was now $2600 and reset *cough*bullshit*cough.*) Yes, that cost me $1000 in medical fees that I expected to be covered due to a series of “fuck I lost my job and I’m incredibly depressed” psychologist appointments (nothing like a surprise $1000 bill you fix your mental health!)

But now, I’m going back and forth on whether to go to the doctor. Being pregnant changes things. I’m five weeks, two days pregnant… and, 3 weeks, 6 days away from a brand new year of health insurance and deductibles. Since I’m switching to Kaiser, my medical costs are going to go way down next year (it’s a $1500 out of pocket max, no deductible,  no more surprise charges PPO BS. I hope I do not regret this decision.) Can’t I just stop talking for a few weeks (who needs a voice anyway) and hold out?

I do get to see my reproductive endocrinologist tomorrow – or at least the nurse – and perhaps they’ll be able to advise if I should do anything about this stupid cold. Luckily, my follow up appointments for my pregnancy at my RE are “free” (well, covered by my monthly $800 cycle fee) until I’m handed off to an ObGyn… so I’m hoping they can help at least provide some medical advice of what to do if I’m super sick and cannot talk.

The good news is I haven’t had a fever yet. I know fevers can be dangerous to baby and the second I get a high fever I’m paying that $300 and going to the doctor. For now, I think I just need to figure out how to get some rest and eat a lot of chicken soup.

Open Enrollment & Pregnant: Anthem or Kaiser? PPO, HDHP or HMO?

It’s quite the luxury to fall pregnant the month of open enrollment. This means hubby and I can (theoretically) make smart financial decisions when it comes to selecting health insurance for next year which covers both the birth of our first child and their first six months of medical care.

Even with this great fortune, it’s unclear which of our options is the right one. Luckily, my company provides relatively good insurance. Given how much health insurance costs in this country, the $200-$300 we’ll be paying a month as a couple (and $200 to $400 as a family) is nothing compared to what insurance on our own would cost. Still, I want to make a smart choice here.

It’s hard to make smart choices when the data is all hidden. Plus, not every decision in life should be based on financial impact alone. Delivering a baby is serious business, and having the option to choose my doctors (especially in case anything goes wrong) feels, to me, like a must have. My husband disagrees.

As a “Kaiser baby,” he speaks highly of the whole Kaiser health system (which also happens to be our lowest-cost option by far.) While some people report Kaiser is horrible, it seems to be that they have their shit together in California. Still, it makes me incredibly nervous to switch to a new health system now with its own style of care.

According to the calculator provided by the open enrollment system — with maternity care and other costs this year (for family of 2) our Kaiser total out of pocket costs would be $3000 or less for the year, whereas Anthem PPO (low deductible) would be around $5000-$6000 and Anthem HDHP would be $8000 (but also includes a $6900 contribution to HSA pre-tax, so that’s about a $3000 discount long term if we buy and hold.)

Financially-saavy me thinks — go for Kaiser — it’s clearly a lot cheaper and it’s not bad – just different. People who dislike Kaiser seem to have rare medical conditions that the organization doesn’t find fast enough since they have no incentive to spend more money on your health, and you have to advocate for yourself. Their maternity situation actually seems to be well regarded. It might not be a horrible idea to go to Kaiser and save $2000=$5000 next year. Lawrd knows we’ll need it for daycare* (more on that in another post.)

Before I was pregnant, I found an ObGyn who looks great (lots of 5 star reviews online) and she didn’t have an opening until January so I booked it a while ago. I planned to talk to her about infertility but now that I’m pregnant, it works out that it’s week 10 of my pregnancy and likely ok to be my first prenatal appointment (I’m assuming — especially since my Reproductive Endocrinologist provides ultrasounds and bloodwork until I’m turned over to the Ob.) I’m just not sure if that trade off is supposed to happen at 8 weeks or if 10 is ok… but I’ll find out.

So… I’m leaning towards Anthem… even though it’s a waste of money. If we start with Kaiser now, we’re stuck (I’ll have a pediatrician selected for my child through them, and unless that doctor is horrible, we’ll likely want to stay with that pediatrician for our child’s entire… childhood.)

Regarding the Anthem options – I’m torn between the HDHP and the PPO. The PPO is cheaper, according to the calculator, and for my husband it’s nice that it has a $250 deductible. The monthly cost is definitely higher and doesn’t include any company contribution, so that’s why it starts to even out. Then the HDHP has that HSA which I love so much, being able to invest nearly $7000 in pre-tax dollars in an account we can invest in and use for healthcare later in life. That $7000 invested over 10 years at 5% would be worth $9.4k – $2.4k back, plus the $3000 or so savings in taxes up front, which is $5.4k, which covers the cost of the difference between this plan and Kaiser.  And that’s with 5% growth and only over 10 years. So is Kaiser really cheaper? — That said, we’d have to pay $7000 up-front now out of our take-home income (though it would only feel like $3500 lost, comparable to the Kaiser costs, I think?)

Either way, I’m fortunate to have a job that pays well enough to be able to be able to decide on this. Keeping my job has never been this vital, and every day I step in the office I know I have to get my game face on and make this work. Somehow. I haven’t told my boss yet that I’m pregnant (one doesn’t do that until week 12 or so, apparently), but I’m nervous about sharing this news with him since I’m not covered by FLMA until 3 months after giving birth to my child. More on that, later…