I’m not really sure where this belongs, so mods please feel free to move it.
my D22 has had the college insurance for the past four years and will need to find her own insurance by August. Going on a parent’s insurance is not possible for reasons not worth going into but trust me it’s not a possibility. She is currently living at home to make money with the goal of moving to NYC by the end of the calendar year. She recently got a waitressing job at a local resort which turns out to be owned by an (inter)national company and miracle of miracles has amazing benefits (pure luck on this one). There are five health insurance plans to choose from. One that looks intriguing is called a Copay plan which is something I’ve never heard of. No deductible, no coinsurance, but high co-pays (could be up to $180 or as low as $70 for a specialist depending on the “tier”). $750 copay for ER and $85 for urgent care. The rub is if she ended up in the hospital for any reason - inpatient is $3250-5250 depending on tier. But that is the out of pocket max for the other plans after deductible and coinsurance and it seems to me she’s more likely to end up paying for deductible/coinsurance under the other plans than for inpatient care under this plan. Just wondering if anyone else has heard of this kind of plan and if I’m missing anything. For the record she sees an out of state specialist four times a year or more so will end up paying something there plus dermatologist. A couple of inexpensive prescriptions. The premiums are $150/month which seems great to me. The more traditional PPO plan with deductible, coinsurance and also hefty but lower copays is $85/month but I think that will end up costing her more in deductible/coinsurance than the increase in premiums. There is also a high deductible plan at $230/month (mildly higher deductible, lower coinsurance, but same OOP max as the lower PPO plan) and an enhanced PPO at $240/month neither of which really make sense to me over the copay plan. I’ve also ruled out the HMO which is really cheap but doesn’t make sense given she doesn’t really have a PCP, it is an out of state plan and she doesn’t want to jump through hoops for her speciality care. So anyone familiar with this kind of copay plan??? Am I missing anything or is this the best choice for her given her circumstances? Thanks!
I’m not familiar with that per se, but for my kids (and actually for me and DH) I always end up picking the low premium, high deductible plan. Why pay upfront, I figure?
If I end up needing to be hospitalized or something, okay, then I pay. But I don’t want to pay a huge premium in the event that I stay healthy!
I’d just make sure the doctors and hospitals you prefer are covered.
I would agree except we know she’s going to need the specialist procedure four times a year - so she’ll end up spending the deductible ($1300) most likely and possibly coinsurance as well after that’s spent. But for most 22-year olds, yeah, I’d go with that $85/month plan and hope they used no care! But at $65 more a month to have no deductible (albeit with higher copays) when you know you’ll use care it seems to make sense?
If she is likely to go to NYC before she has a job there, she should be looking at how effective this plan will be there as she is likely to be on this plan through COBRA. Another reason to avoid HMOs or anything geographically limited.
I’d ask a different question- how easy will it be for her to get a PCP? If she’s already seeing a specialist, I get it that a young person feels like that’s not necessary. But to have ONE provider in the mix who will monitor everything (Gyn, dermatologist, whatever specialist she’s already seeing) is actually valuable from my perspective. It only takes one thing to go wrong or get funky before the lack of a PCP becomes obvious.
If I (hopefully) understand the question, yes there are 2 basic types of (Non HMO) insurance plans. Separate from the deductible issue (which both will have), one has a co-insurance patient portion (meaning a percent of the amount paid to the provider by the insurance) and the other is a simple “copay” plan, where you pay a fixed amount per visit, regardless of what insurance pays. So if, for example, you have a 20% co-insurance plan, you would pay $40 for a visit that insurance approved $200 for (they pay 160, you pay 40). With a “copay” plan, you pay a set copay (not a coinsurance) regardless of what insurance is paying. So if insurance allowed $200, you are going to pay your copay (in your case you said IIRC , for eg, $85) and insurance would pay $115. Make sense?
eta: But if a copay is $85 and the visit/procedure is, say, $500, you could be doing better than with a (eg) 20% coinsurance plan, where you would pay $100 of that charge.
She currently has a PCP but I’ve been told she is leaving. We live in a rural area where if she can even find someone taking new patients it will be 9 months before she’ll be able to get a new patient visit and therefore she’ll be in limbo until then. It’s possible someone else at the clinic will see her/write referrals, etc., but they don’t know her. Unfortunately I’m in the same situation. We do have someone close to us who is a primary care doctor who will curbside us if necessary but that’s not a permanent solution. But I’m not sure it makes sense for her to get another pcp here.
Agreed, that makes sense. It’s possible she can get a job with this same company in NY if she’s still just looking for a job rather than a career once she moves.
Right? That’s what I thought but just checking I’m not missing anything. It’s only if she ends up inpatient which of course is unlikely as a healthy 22-year old though not impossible that she ends up with up to $5250 exposure. But that’s true with the deductible/coinsurance plans as well (that’s the max OOP for those plans).
D22 checked and says specialist is in the network. I’m being vague here but note the reason she sees the specialist is an isolated issue that doesn’t affect her overall health. She is a mostly healthy 22 year old otherwise.
I just read through your longer response which is actually super helpful in thinking this through. I hadn’t thought of it that way. So the fact that her specialist visit is likely expensive means the copay plan really is the way to go - coinsurance I think was quite a hefty percentage.
Thanks.
There are a lot of different BCBS plans, and having it in another state is not an issue (they just process them there). At one point we had a BCBS plan out of Illinois, and when I was in practice a lot of patients from one particular company had BCBS of ALA. We are neither in ILL or ALA