Health Insurance Suggestions - US Open Season

So open season for health insurance is just around the corner and I'm newly diagnosed with UC (pancolitis) and my first flare was really bad; had to spend 5 days in the hospital plus a couple weeks of misery at home.

I haven't really had any significant health issues before this so I always just picked the cheap high deductible PPO plan and paid for my one or two Dr visits a year with my HSA.

We'll, that has all changed now. I'm thinking I may need to rethink what type of plan I want this year. I'm still on 40 MG prednisone since this all just happened less than two weeks ago. I'm also doing a mesalamine enima every night and taking Pentasa (2 pills, 4x/day). The meds are really expensive (~$1,700/m) and I know if these don't work some of the other meds I'll be trying are insanely expensive. I haven't seen the hospital bill yet but I'm guessing with all the scans, imaging, probing, specialists, meds and room charges it's going to be pretty expensive.

It seems that I need to consider my current meds and a number of visits to my GI and general Dr as static costs each year to start. I probably need to consider that my medications may change and that I might find myself in the hospital to recover from a flare again or worse need surgery.

With all that said, I work for a big company that has multiple insurance companies to choose from, each with multiple plans to choose from. So my question for the community is what type of plan have you found to be most cost effective and what company do you find is easiest/best to work with?

For a basis, I currently have a high deductible PPO with Aetna. The deductible is $1,500. After that I pay 10%, they pay 90%. My max out of pocket is $4,000. I have an HSA with this for which my employer contributes $750 per year (half the deductible). Aetna has been easy to work with so far and easy to get ahold of a representative who has always been very helpful. It seems like a really sweet plan but I'm not sure if switching over to a straight PPO or something else would be more cost effective. I imagine an HMO would be the least preferred. Also wondering if switching to another insurer would be beneficial?

I understand this question is more involved than what I'm making it out to be because each company and plan has different premiums and covers meds differently but without getting to into the weeds can you offer some advice, recommendations, suggestions, experiences, etc. That might help us green horns out?

What mom2boys says is right. Here's my add-on:

1. If you like your GI you need to make sure he (and family doc) is in whatever network you choose, otherwise being "out of network" will cost you more, and the colonoscopy facility will be more, etc.

2. RX meds. You need to see a full list of what RX meds are covered based on what you might take in the next year. Your GI can help with this but of course there can be unexpected changes in your condition. Rowasa (including generic) is expensive so you need to make sure it's on the RX list.

3. Is the hospital your GI and family doc affiliated with in the plan you choose? You've already been in once and although your goal is to stay out you need to be prepared for those expenses.

It's not an easy job choosing a plan. I continue to carry a high deductible plan (before and after UC) because my UC is under control and my RX cost is less than paying for a more expensive plan. Mom2boys has a family and kids have unexpected expenses so I can see why she has the gold/platinum plan. I don't qualify for any subsidies and pay for everything (retired but not Medicare age).

IMO you are super lucky to be employed with a company that subsidizes your healthcare expenses.
I have an HSA too and in a bad year can itemize my healthcare expenses on taxes (almost never happens).

So you've heard from 2 extremes between mom2boys and me. Hers is all-expense plan and mine is pay-your-way plan. You'll have to pick one and try it for the 1st year and by then maybe there will be a bipartisan healthcare plan than makes RX mfrs (read that as you will) get real about their ridiculous prices. And be sure to VOTE!

edit to add: OMG I'd LOVE to have $1500 deductible but I'm old and punished by insurance. My ded. is $7500 and only 50% afterwards, rarely get to 50% however.

Post Edited (imagardener2) : 10/7/2017 5:07:25 PM (GMT-6)