(Michigan) Unsure if we should drop our private health insurance plan now that both my spouse and I have VA healthcare and our kids are eligible for ChampVA.
Hello!
As the title states, I am having difficulties in determining the best health insurance for my family now that my dependents are newly eligible for ChampVA (enrollment is processing now) and I am newly eligible for VA care. Unfortunately, I have cognitive impairments resulting from my disabilities so not only do I get overwhelmed by this stuff easily, I don’t trust myself to make the correct decision. Sorry if the answer if obvious.
I have reached out to resources provided by both the VA and non-profits in my community and although they have been helpful with explaining what falls in their wheelhouse, I have been unsuccessful finding someone who can help compare private insurance vs. ChampVA and the pros and cons of carrying both.
As I understood it, ChampVA was more supplemental insurance than primary and would essentially pick up what our private insurance doesn’t. I’ve read from others that ChampVA shouldn’t be the sole “insurance” and should strictly be used to supplement. However, after speaking to the VA, they felt confident that we could drop our private health insurance once enrolled with ChampVA.
After looking into it, I am leaning towards dropping private insurance and having the kids on ChampVA while my husband and I use the VA. However, I am posting here first because I am terrified that I’m overlooking something and making a costly mistake.
I’ve tried to include as much information as possible but if I’m missing something important, I am happy to provide the details.
Thanks in advance to anyone who can help provide guidance!
Family/Health Info
2 adults, 2 children (preschooler and toddler.)
Both kids are healthy and have only been to urgent care a handful of times. Both have their dental covered through our private (separate) dental insurance. Neither need glasses.
Both adults have complex health issues but all medical and prescription costs are 100% covered through the VA. We are happy with our provider and our care at the outpatient clinic. We can have ER visits at local hospital covered if we call within a certain amount of time. Urgent care is a bit more difficult and requires authorization. Neither one of us need glasses.
1 adult has full dental coverage through the VA, and the other adult does not. The VA offers private dental plans for purchase and are comparable to the private plan we have now.
Since my husband is eligible for VA care, he is not eligible for ChampVA.
We live in a rural area with 1 urgent care, 1 ER, and 1 VA outpatient clinic. We get approved for Community Care (seeing a private provider) for everything outside of primary care which are the same providers we have seen with our private insurance.
Current Health Coverage
We have been covered by Blue Cross Blue Shield’s Federal Employee Program (Basic Option for self + family – plan brochure here for nearly 5 years. While we can afford the premium if needed, we could certainly use that money to help us reach other financial goals.
Current Dental Coverage:
Delta Dental Standard
Class A: Routine cleanings, x-rays, oral exams, sealants: 100%
Plans/Programs Available to Us
1. ChampVA Coverage (PDF plan brochure here | Full program guide here)
Cost Share? Yes. 25% of ChampVA allowable amount.
Deductible: Annual deductible for covered outpatient medical services and supplies is $50 per beneficiary or $100 per family. Annual deductible must be paid prior to ChampVA paying 75% of allowable amount.
Catastrophic Cap: $3,000/year
2. BCBS FEP Blue Focus
Bi-weekly premium: $125.67
Annual Deductible: $1,000
HSA?: No
Annual OOP Max (for self + family): $17,000
Primary/Specialty Care Co-Pay: $10 or 30% for both
ER Care: 30%
Urgent Care: $0 or $25
Outpatient Surgery (doctor charges): 30%
Inpatient Surgery (doctor charges): 30%
Hospital Inpatient Costs: 30%
Preventative Dental for Adults/Children? No/No
Minor Restorative Dental for Adults/Children? No/No
Routine Eye Exams for Adults/Children? No/No
Glasses for Adults/Children? No/No
3. GEHA HDHP
Bi-weekly premium: $167.67
Annual Deductible: $3,000
HSA?: Yes (HSA/HRA. Medical Account Contribution: $1,800) Edit: just found out we cannot have an HSA if we receive certain care from the VA.
Annual OOP Max (for self + family): $10,000
Primary/Specialty Care Co-Pay: 5% for both
ER Care: 5%
Urgent Care: 5%
Outpatient Surgery (doctor charges): 5%
Inpatient Surgery (doctor charges): 5%
Hospital Inpatient Costs: 5%
Preventative Dental for Adults/Children? Yes/Yes
Minor Restorative Dental for Adults/Children? Yes/Yes
Routine Eye Exams for Adults/Children? Yes/Yes
Glasses for Adults/Children? Yes/Yes
