Originally Posted by
NERD
Cohiba,
I live in DFW, so lots of in network(all my doc's). I'm just covering myself and a child. They look like the same coverage(preventive 100%, co-insurance in-network 80/20, out of 60/140 and prescrips the same) The only difference I see is the deductibles of 1150/2300 vs 2150/4300. Unless I'm missing something(highly likely) in a worst case max deductible situation I'm out an extra $550 family and $350 individual with the silver. If my usage is like last year which was standard(annual checkup for my son and I, and usually one or two visits each for a cold or other minor issue((knock on wood it continues this way)) So for me it looks like if I have another status quo year I save $700 dollars per year with the silver. I do agree if you go out of network it is a no-brainer. What am I missing?
Look at max coinsurance as well. I ran the numbers a week ago when my wife's company was in open enrollment. I don't remember the exact numbers but the max coinsurance was significantly higher for the silver than gold (if I remember correctly.)
Like scambo said, run the numbers for worst case to determine your max out of pocket should the worst occur. Worst case should be the sum of: annual premium (fixed), family deductible and max coinsurance. That will give you the maximum you could be stuck with out of pocket should something really bad happen next year.
Best case would be if you paid premiums only and no one gets sick or has any medical expenses throughout the year - you could make the case that as long as those expenses don't exceed your delta dollars then it's still $0 out of pocket for expenses. Some guys like to factor in the value of their rollover balance.
Once you have those numbers for each plan it's a risk/reward based on your expected expenses, potential for an unknown (expensive) event, and the best case/worst case numbers. It's all a trade off and what you're comfortable with.
Good luck. I absolutely hate sifting through all this stuff. Glad to have it behind me for another year.
Fwiw, we have a babysitter that watches the kids 3 days a week and we have been able to pay her with dependent FSA dollars for the past several years. Since she's not a business, she just has to sign the claim form and put her tax ID on there. The downside of this is the IRS sees us as an employer so we have to withhold FICA, unemployment, etc for her. To keep it all above the table and pay the CPA to figure it all out decreases the value of the tax benefit, BUT it's still worth it to us, and she gets some benefit in the form of SS contributions (not that it will be around for her to collect) and unemployment should she ever need it when we part ways.