I spent quite a bit of time yesterday with MisterMoonbeam on switching over benefits and trying to do math. It was sobering. When we first compared DarkKnight’s and his insurance offerings a while back, I remember being appalled and terrified and sick to my stomach at the numbers. MisterMoonbeam’s was the best by far, but it’s still financially devastating to our family.
To give some actual figures - right now MisterMoonbeam pays a separate amount for vision insurance and dental insurance, both very, very cheap though, and very generous on what is covered. (I’ll edit this later as I don’t remember the cost.) He shells out about $19 pp into a limited flexible spending account (Flex) which can only be used for vision and dental expenses that aren’t covered by his insurance. He won’t be making any changes to this, because with my mental health issues I won’t be going to the dentist this year, and the new glasses and eye exam I need right now will be affordable with what he has budgeted and what the insurance covers already. It’s extremely generous and covers the cost of almost everything!
DarkKnight has no vision insurance available (you may remember me “crowdsourcing” my $600 bill a year or so ago when I went to the eye doctor, where each partner sent me $$$ through PayPal so I could continue to see) and his dental is limited to a free xray and 2 cleanings a year. The dental actually isn’t bad.
Anyway, having vision coverage is going to be awesome for me, and I will be scheduling an appointment at the eye doctor just as soon as I have a card in hand to cover it! My prescription has definitely changed since I went last time.
Right now MisterMoonbeam also has a health savings account (HSA) to cover copays and expenses not addressed through his health insurance. He currently pays about $38 pp into that. This will be changing because of me!
A difference between the HSA and the Flex mentioned earlier is that any money not used in the Flex at the end of the year is lost forever, but the HSA carries over. So guessing/estimating what expenses might be for the entire year, must be done with as much accuracy as possible. So why would anyone risk putting cash into a Flex? The most important thing, is that the HSA balance increases each pay period, like as MisterMoonbeam deposits that $38. So if he has a $300 medical bill due, he can’t pay it until he’s accrued $300: $38 + $38 + 38 etc. Which can be fine - lots of doctor offices will send a bill that can be paid in chunks. However, all medication must be paid for immediately, and surgical procedures will usually require a significant amount of money up front to be scheduled.
With the Flex account, the entire total he sets up and budgets for the year is deposited immediately, and can be accessed immediately. So if he knows he needs new eyeglasses in January and $200 of the costs aren’t covered by insurance, he can still go get them with no hesitation, as he doesn’t need to wait for the biweekly deposits to add up to the total needed.
DarkKnight only has an HSA, so we can’t schedule any sort of surgery until we have the amount saved that the surgical center wants immediately. Which would be $3,000 in this instance.
This is somewhat complicated, but hopefully everything I wrote is understandable.
DarkKnight’s employer knows that HSAs suck for this reason, so they actually gift all employees $2500 to start their HSAs each January. Which has been lovely for us - this allowed me to go get the ultrasound I needed, and DarkKnight got an eye exam and glasses/contacts that he needed already.
However, the differences are in the details. Actual insurance plans are varied. Some refuse to outright cover some procedures at all, or have decided not to pay for specific medications without a lot of documentation from doctors. DarkKnight’s plan excludes all diabetes medications that my doctors have prescribed EXCEPT for the one (Metformin) that causes me to have horrific side effects. My doctor has appealed this twice, with all of the testing and proof that the insurance requires, but they continue to disallow me to try anything else.
In this case, I would need to pay out of pocket for the medication my doctor wants me on, which is around $1000 a month. With DarkKnight’s HSA, yeah, we’d have to budget $500 pp just to cover that medication. And that amount would not go against his deductible.
Deductibles are the other issue here. DarkKnight works for a smaller company, so they don’t have many options. The plan he has on offer is a “high deductible” plan. So what he pays from his check just to get insurance each pay period only covers the cost of things once he reaches an annual deductible. So, a doctor visit is allowable and covered, but he pays 100% of the cost if he hasn’t yet reached the deductible. So every time I’ve gone to the doctor this year, I get billed $175. The insurance company marks it down as allowable and covered, but we must pay for it each time until we reach $6,000.
Most people don’t reach that deductible amount. They just cover everything with the HSA and curse their insurance company for being a black hole that steals the premiums and actually covers nothing.
I have to be honest that I am currently guessing that DarkKnight’s deductible is $6,000. I think it might be $8,000. It’s ass o’clock and I haven’t looked at his numbers for several months - since we decided his insurance was going to kill me and that I needed to get coverage from MisterMoonbeam.
Ugh I am already tiring of writing about this. My sunburn is itching like a motherfucker and my armpits smell.
I’m going to shower as soon as I wrap up this post!
Anyway, I wrote all that about DarkKnight’s health plan and what I really wanted to get down was MisterMoonbeam’s info. It’s still not the greatest, but again, the details matter.
The medication not covered at all by DarkKnight’s insurance is 100% covered by MisterMoonbeam’s, with nothing needed to be paid by us. So that is instantly better and saves us directly $1000 a month. To be clear, I’ve been completely unmedicated for my diabetes since November because we can’t afford this medication and because of the complications the other prescribed medication causes me. I will be starting this after I get my surgery.
MisterMoonbeam’s insurance deductible is $1750, with an out of pocket max of $3000. Which means we only need to cover that and EVERYTHING else for the year is 100% covered. For both of us.
Still, this late in the year, with only 19 pay periods left to go, putting that cost into a Flex will cost $158 a pp. Still, you can see that is much better value than shelling out $500 pp for a single medication that doesn’t go toward the deductible at all!
I should clarify that the insurance plan that MisterMoonbeam is switching to right now will do away with his HSA. Everything will now be going into a separate new Flex that will pay bills instantly. Which will be great, as my surgical copay looks like it will be $4,000 alone.
So that’s just talking about the Flex and HSA expenses. The actual cost of the insurance - the premiums - are really high. However, when compared to DarkKnight’s plan, it just makes sense. MisterMoonbeam actually had a couple of plans to choose from, which was nice but made the math more of a pain in the ass because we had to calculate costs for each one. Also, because he makes more than $100,000 a year, his company has slightly higher premium prices for those employees.
I’m really going nuts now with the itchiness of my sunburn and this is way too long now anyway, so I’m going to end with the final figures.
The insurance premiums on the new plan will be $348 pp, plus the $158 pp for the Flex account, and $19 pp for the limited Flex. Which brings us to a total of $525 a pay period this year for my insurance costs.
Figuring out how to absorb this into our budgets would require a post just about as long. Just know it sucks ass for us.