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Started By
Message
Trying to figure out the downside between a new health plan offered via employer
Posted on 6/24/15 at 4:34 pm
Posted on 6/24/15 at 4:34 pm
I'm on a standard PPO with the general benefits that I've seen with most plans:
- $30 Doc CoPay
- $55 Specalist
- $100 Urgent Care
$1500 in-network deductible
$6000 out of pocket max
Any surgeries, hospital stays, etc. are deductible first then 20% co-insurance up to the out of pocket max.
We're being offered a plan that lowers the monthly premium by $45/month but removes the deductible.
Doctors visits are $15 more a visit. But any procedures are capped at $1000 co-pay for outpatient and $3000 co-pay for inpatient.
I'm leaning towards the new plan but would appreciate any suggestions otherwise.
- $30 Doc CoPay
- $55 Specalist
- $100 Urgent Care
$1500 in-network deductible
$6000 out of pocket max
Any surgeries, hospital stays, etc. are deductible first then 20% co-insurance up to the out of pocket max.
We're being offered a plan that lowers the monthly premium by $45/month but removes the deductible.
Doctors visits are $15 more a visit. But any procedures are capped at $1000 co-pay for outpatient and $3000 co-pay for inpatient.
I'm leaning towards the new plan but would appreciate any suggestions otherwise.
This post was edited on 6/24/15 at 5:13 pm
4
Posted on 6/24/15 at 5:07 pm to Golfer
quote:
$1000 co-pay for outpatient and $3000 co-pay
you mean co-insurance?
Is it with the same insurance company or different one?
If you're comparing plans from the same insurance company then I'd definitely go with the new plan.
Posted on 6/24/15 at 5:08 pm to Golfer
quote:
Doctors visits are $15 more a month.
Did you mean per visit? I.e. co-pay is now $45/$70?
quote:
But any procedures are capped at $1000 co-pay for outpatient and $3000 co-pay for inpatient.
So basically you have this large co-pay but then everything else is covered?
Posted on 6/24/15 at 5:09 pm to Golfer
No ded would be a good thing wouldn't it? MD visits $15 more per month but how often do you guys go? Maybe a little maybe a lot. If you go 3 times you've spent the $45 in premium savings but if you don't go at all well, you've saved $45 in premuims.
Is there an oop max with the new plan? Like if you have to have numerous procedures in a year
I'd guess part of it just has to do with how often is "typical" for you guys to need medical care. Save $45 x12 = $540 per year savings for something that you MAY or may not need.
We're both self employed and have an individual policy so I may not be looking at this right.
Is there an oop max with the new plan? Like if you have to have numerous procedures in a year
I'd guess part of it just has to do with how often is "typical" for you guys to need medical care. Save $45 x12 = $540 per year savings for something that you MAY or may not need.
We're both self employed and have an individual policy so I may not be looking at this right.
Posted on 6/24/15 at 5:13 pm to DowntheBayouTiger
quote:
you mean co-insurance?
No. Co-Pay
quote:
If you're comparing plans from the same insurance company then I'd definitely go with the new plan.
Same companies.
Posted on 6/24/15 at 5:15 pm to LSUFanHouston
quote:
Did you mean per visit? I.e. co-pay is now $45/$70?
yea
quote:
So basically you have this large co-pay but then everything else is covered?
Correct. As long as its in-network.
Posted on 6/24/15 at 5:15 pm to tiger91
quote:
Is there an oop max with the new plan? Like if you have to have numerous procedures in a year
Same OOP max on both plans.
Posted on 6/24/15 at 5:24 pm to Golfer
Is this the Humana plan? We looked at it because of the premium , but opted away from it once we looked closely at the in network list and the specifics of the plan. I forget all the details but it was not the best choice for us
Posted on 6/24/15 at 5:40 pm to Tigerpaw123
quote:
Is this the Humana plan? We looked at it because of the premium , but opted away from it once we looked closely at the in network list and the specifics of the plan. I forget all the details but it was not the best choice for us
Yea. Humana plan. Is the network of doctors different from their standard PPO?
Posted on 6/24/15 at 6:59 pm to Golfer
I forget all the details, just remember the more I looked into it the less I liked it, I think t he copy for PT was $65/visit and everything required pre approval , just look at it close, it ended up not being right for us
Posted on 6/24/15 at 7:09 pm to Golfer
They won't pay for your trans surgery
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