One Dollar Allowance

Last year, Mr. ODA took the deferred resignation program offer. As part of this offer, we kept our insurance through the end of September as normal because his pay check continued as normal. After the separation, we kept our policy for 30 days and then could opt to keep the insurance policy for 18 months. Opting in meant that we had to pay 100% of the cost of the policy, which is $1,906 per month.

Around the time that this decision needed to be made, an opportunity came up in my office to join their insurance policy. With the coverage offered by my employer, it was still going to cost us over $1700 per month. There were several red flags from the insurance agent, and there was gap coverage, which would have required me to submit claim information to a 3rd party to get further coverage. As someone who has to fight nearly every EOB that comes through my mail, I really didn’t want to take on having to also submit it and manage that request. In the end, we decided it wasn’t worth the risk of losing the “enemy we know,” nor that I would eventually quit this job and we would lose that insurance.

Around the beginning of the year, Mr. ODA discovered that insurance premiums are only considered “pre tax” if they’re through an employer. So since we are paying our own insurance, it doesn’t count. That started a quest for Mr. ODA to find a part-time job that he could get insurance.

He interviewed several times with Lowe’s. There were several bumps in the road over the last couple of months, but he’s ended up with a cashier position near our house. He needs to work at least 13 hours a pay period to qualify for their insurance. Their insurance is not great. This is a gamble.

Here are the questions I asked myself during the process.

1. Are our current doctors in network? The website has a way for me to search by doctor names and practice names. We have moved a lot in our life. I had a few doctors I saw in Fairfax, VA. Then we moved to Richmond, VA, and I had a few other doctors I liked. Actually, when we decided to move to central KY, one of the biggest “against” items were the doctors. I loved my ob-gyn. I loved the kids’ pediatrician. I loved that there was a kid urgent care near our house, which we used when our oldest split his forehead open. We moved just outside Lexington for a few years, and I settled into a routine there. Less than 2 years later, we moved into Lexington, and I needed to start over with the doctors. It took me some time to get into a routine, but I now have myself and all the kids on routine check up schedules with a primary care, dentist, and eye doctor. So while I COULD get new doctors, it just isn’t something I’m all that interested in figuring out. At this time, it appears all our current doctors, except our eye doctor, is in network.
2. How much is it going to cost? Currently, we have a high deductible plan. Even with that statement, you’ll be surprised to find out the deductible is only $3,800. We haven’t hit that yet this year though. When the kids go to the doctor, it’s about $81 until we meet the deductible and it drops to about $5. Going forward, this policy has a $20 copay for all regular visits and no deductible. However, urgent care is a $100 copayment, and there is $0 covered for an ER visit. That’s scary. I use the kid’s urgent care pretty frequently. I also have used the urgent care by my house (although it’s terrible) more often than I use my doctor’s office. Having to gauge whether something can wait until tomorrow’s office hours or if it’s worth $100 copay is going to be a stressor I wish wasn’t there. I’m also expecting that everything will shake itself out.
3. What is the coverage like? There are a few key things I’m looking at in the summary of benefits. There are the simple ones like, “is it a copayment or coinsurance” and “is there a deductible?” Then there are more complicated ones like, “are routine dental visits covered,” and “are diagnostic lab work and imaging included?” Both of those are no. That’s concerning. However, there is supplementary insurance options that will get us vision, dental, and accident coverage (e.g., ER payment). This is less than ideal, as it was one of the reasons that I didn’t want my employer’s insurance, but I will figure out the process to submit claims for extra payment. If I’m not working, I’ll have better time to manage that.

The cost is a glaring win on this less-than-stellar policy. For $186 per pay check (every other week), we get this insurance. That’s about $372 per month, give or take those extra pay checks that shake out. Essentially, that’s $4,800 per year. Currently, our premium is $22,872 per year, plus a $3,800 deductible that has to be met. The difference is glaring. So I’m hopeful that our sick visits being a $20 copay and the occasional need for urgent care at $100 per visit will still not exceed the cost of the policy we currently have. Plus, the policy we currently have is painful to manage, so how bad can another option really be?