Giving Up A Great Health Insurance For A Job?

[terestrife]

I am currently a state of florida employee. I pay $100 a month for insurance, and then copay for office visits.

I recently had an endoscopy (allergy issues) and the doctors visit, plus the procedure i was only charge $40 for everything.

I might be offered a job with miami dade college, and the insurance doesnt seem as good to me.

Is there anyone that is good at reading insurance policies that can tell me if it would be a mistake to leave my job?

Current pay: $13.03
pay for potential new job: $15.47

i attached the info of the insurance options as pdf files for the new job.

my current benefits: 2019 Plans and Benefits - AvMed.

I have the one that says:
Standard HMO Plan

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personal note: i think i'm mostly nervous due to seeing a loved one pass from cancer, that now its obsessively going through my mind that the same could happen to me.

 

[foxxycat]

Is your current plan the HMO or the other one fron that first link you gave? HMO sounds like it covers quite a bit BUT you will have to do some digging and find out how many doctors are in that network.

Aetna is ok. I know someone close to me who has it. The in network doctors are not as large as other providers. But so far I've not heard of issues from them. Alot of doctors don't accept Aetna from what I have heard but you can always file as out of network if it's a specialist or something like that.

It looks like the deductible is around what I pay. Is your plan family or single? I think the Aetna works out to be about 15 or 20 a week for single...but thats just off the top of my head. Yes having insurance is better than none. The one you have now if HMO looks like it covers quite a bit but Aetna may have more doctors to choose from.

Find out which hospitals are in network for both plans you are looking at. Also hospitals pull sneaky thing by subcontracting out doctors that are not in your networ . I called them up and told them I'm not responsible for paying the bill since it was the ER and they didn't give me a choice of who provider is. They ended up sending a check to cover those fees but ya know it was a rude awakening how sneaky these providers are with sub fees etc. To make things more complicated.

 

[foxxycat]

Opps so those attachments, is that 4 seperate insurance offers? Sorry if not paying attention. Lol. Let me reread those attachments....the insurance industry is sneaky...each plan could be good depending on your medical needs.

If you want to have children or have children is another thing to make sure they cover or what up front fees are for doctors visits...looks like you have an option of 4 different insurance carriers if I am reading this correctly? Forgive my slow brain-Just winding down from a busy day.


I'm glad you are asking these questions. It's good to get imput from others.

@denice can you help? I know you probably know alot more about insurance than I do. Thanks!

 

[terestrife]

I have avmed hmo currently. Im not sure how many options I have with the new job. Those four attachments are what I found in the Miami Dade college website.

Im just worried that if I ever need to have tests like an an endoscopy for example, that it would be expensive.


Thank you so much for helping! And for the heads up on things to look out for.

 

[foxxycat]

Well it could be expensive but you have to price out the total amount paid for the year in premiums you pay from paycheck vs fees for tests...even if it looks like price for test would or could be more money, if your fees for other areas are less than current plan, you may end up saving money. It all comes down to your medical needs, prices hospital charge, prices doctors charge and then compare the plans.

I would make a list of your medical needs and try to match up with a plan that gives you what you need.

Unfortunately it may take some phone calls to different hospitals and asking how much fees are for that scope then ask hospital/doctors which insurance they accept...kind of a complicated situation but don't get discouraged..it may seem some of the plans have higher deductibles but they may pay more of the end bill.

Personally not sure how I feel about that plan that says you pay 30% of fees from procedures....that could end up being alot of money.

Flat rate may be th3 better way to go so you don't have surprises that are higher than you expected.
I learned by accident that if the insurance company isn't paying enough to cover your appointment/procedures, call them up and request them to redo the process of claim..let them know that you cant afford to pay that and see if they negotiate with the doctor to pay more or reimbursement for your money spent on said procedures.

If all possible always avoid emergency rooms. Try using a walk in urgent care instead and have them refer you to hospital..you may be able to get insurance company to cover more fees since you tried to take the cheaper way out first. It does get confusing...between weekly deductions from your paycheck, then deductible then the percentage you will need to cover can make one go batty.

 

[terestrife]

Well it could be expensive but you have to price out the total amount paid for the year in premiums you pay from paycheck vs fees for tests...even if it looks like price for test would or could be more money, if your fees for other areas are less than current plan, you may end up saving money. It all comes down to your medical needs, prices hospital charge, prices doctors charge and then compare the plans.

I would make a list of your medical needs and try to match up with a plan that gives you what you need.

Unfortunately it may take some phone calls to different hospitals and asking how much fees are for that scope then ask hospital/doctors which insurance they accept...kind of a complicated situation but don't get discouraged..it may seem some of the plans have higher deductibles but they may pay more of the end bill.

Personally not sure how I feel about that plan that says you pay 30% of fees from procedures....that could end up being alot of money.

Flat rate may be th3 better way to go so you don't have surprises that are higher than you expected.
I learned by accident that if the insurance company isn't paying enough to cover your appointment/procedures, call them up and request them to redo the process of claim..let them know that you cant afford to pay that and see if they negotiate with the doctor to pay more or reimbursement for your money spent on said procedures.

If all possible always avoid emergency rooms. Try using a walk in urgent care instead and have them refer you to hospital..you may be able to get insurance company to cover more fees since you tried to take the cheaper way out first. It does get confusing...between weekly deductions from your paycheck, then deductible then the percentage you will need to cover can make one go batty.

Thank you for all the time you spent helping me. It makes a lot more sense now. I'll look more into this.


It's just hard because of the worry of unknown illness coming up.

 

[foxxycat]

I was able to reread your HMO stuff now that I am on the puter and you know, even though you won't make more money at this current job-depending on health issues you could make out better on that insurance. I see the HMO has no deductible..that's almost unheard of. In my insurance, I have to pay 1500 or is it 1000 before they cover 80/20 of fees. Also the out of pocket max is crazy for my insurance..8000 I think it is..which means the insurance won't pick up 100% until you spend 8000. Isn't that crazy? I think that's how it was explained to me about what out of pocket max means. Also a trick they do now=they include prescription drugs in that price=lets face it-most of us maybe only use 500 to 1000 dollars of meds a year if it's maintence and generic...so instead of out of pocket max for drugs at 500 for example-now it's 7000 or whatever your plan lists...very very sneaky of insurance companies to do...that's how they make money..by combining these out of pocket max then there's less chance they will fully cover meds 100%-obviously if one is on specialty meds or other expensive setup=then that will work out in your favor but I am guessing 75% of us don't spend that much on meds a year...

2 years ago our insurance had a seperate out of pocket max for drugs set at 200 or 300? now it's like 8000 combined with medical out of pocket. Crazy world we live in.


Are you going to stay in your current job or do you want to move on? Is there a reason you feel you may have medical stuff goin on in the future? Family connections? Cancer runs in my family on both sides but no heart disease other than my sister so it's a guess what's in my future...

 

[Kieka]

Don't forget to factor in any retirement contributions or bonuses with either. I worked at a place that contributed 3% a year to a retirement plan for me that that equated to a nice little bonus over several years. My current employer does profit sharing for retirement (my division profit gets split based on contribution to the department basically. Half goes in a retirement account, half to a cash bonus.) You aren't vested for 5 years so I'd be walking away from a decent amount if I left before the vesting period is over. So anywhere I went would also need to be paying enough to compensate for loss retirement funds from leaving early and future loss of not getting additional. Once I am fully vested, I'd still have to get enough either income to add to my retirement or company provided retirement to substitute for what I wouldn't be getting anymore.

 

[foxxycat]

yes that's another good point..company match for 401K is a nice bonus. Even if it is only 35 a week, that's 2000 a year to tuck away. And the vesting is another thing..mine is 5 years as well..so it's sometimes not worth it to leave in year 3-4..but it depends on your situation and how much you can put up with until you move on.

 

[terestrife]

My current job and the new job offer retirement using FRS (Florida retirement system) .

Im trying to switch jobs due to money issues. But I worry since I do have some minor health issues.