02-18-2010, 12:53 PM | #1 | |||
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Help me understand health insurance?
It almost sounds too good to be true with no annual deductible and only $20 co-pays for a primary physician. The plan got a 4.5 out of 5 rating, though. Quote:
Thanks
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02-18-2010, 01:07 PM | #2 |
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can you get a PPO plan?
you should make sure your primary physician is in the network- sounds like if it's not in the network you're SOL.
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02-18-2010, 01:20 PM | #3 |
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That plan is probably fairly expensive. PPO will be even more so. If you're not perfectly healthy expect to pay extra and not have those pre-existing conditions covered. Prescription plan isn't too hot either that's a good sized deductible if you ever need expensive pills.
Keystone isn't too bad though I hear. Whatever you do don't lie about past medical history, if you ever have a serious bill even completely unrelated to it they will screw you guaranteed. Read the fine print when you get the policy, if you miss something they will not.
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02-18-2010, 01:42 PM | #4 | ||||
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Quote:
Quote:
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02-18-2010, 02:17 PM | #5 |
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Both plans have dr's that are called a "network". All you have to do is make sure that you have doctors that you like in your area.
HMO=you pick a primary care dr, then when you need to see a specialist you need to get a referal from the primary care dr's office. then it is sent electronically to the specialist office. PPO=same as HMO except you dont need to get referals. generally more expensive. You will have to to do the math to figure out if its cheaper for you in the long run. If you are sickly then you want low deductible. If you plan on seeing the dr only in extreme cases, then you can want to keep your monthly costs low and decductible high. figure out what works better for you. I am not sure but i think that medical expenes are tax decductible. Last edited by angdefeo; 02-18-2010 at 02:20 PM. |
02-18-2010, 02:17 PM | #6 |
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With an HMO, you would need to select a Primary Care Physician (PCP) who is responsible for all your medical care. As a woman, you should see if this includes a gynecologist or if you can find a "full service" PCP that provides female care, before you enroll. Also with an HMO, you would need a referral from your PCP for any services they do not provide (labs, xrays, specialists) The copay/coinsurance/annual out of pocket limit: You will pay $20 for each visit to your PCP, this is your copay. Coinsurance: your insurance plan pays for a percentage of your eligible medical expenses and you’re responsible for the remaining balance (IE: you pay 20% they pay 80%). You don't have to worry about that with this plan. There is no limit on your annual out of pocket expense. Some insurance plans cap the amount per individual and family, once you have met this limit, the plan covers 100% of the eligible expenses. It also doesn't cover anything out of network, so any cost incurred from visiting a non-participating provider will be 100% your responsibility.
All in all, it doesn't seem like a bad plan, and at least it's insurance. I deal with employee benefits at my job, so if you have any questions, just let me know; I'll be happy to look into something for you. |
02-19-2010, 02:35 AM | #7 | |
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I am pretty dumb on this subject as well. The plan she posted seems pretty legit, but can someone run how a deductible works again in lay-mans terms. I always get psyched out when I see "$250 deductible" or some high dollar thing like that because I feel like I have to pay that up front? I take generic drugs 9 times out or 10.
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02-19-2010, 09:19 AM | #8 | ||
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Quote:
But the parts by SiR about caps are not quite right...caps are usually referred to as the most the INSURANCE will pay. Quote:
In vs out of network, this depends on the carrier. Keystone is a big plan and they have a big network from what I hear. The important thing is that the ER and emergencies are 100% covered out of network. So if you are traveling to california and get hit by a truck or come down with the swine flu you are not getting 20% of the $150,000 bill. If you go the HMO route don't worry about getting a PCP that does OB as well, you should only need one referral to an OB and from then on you can just see them as you like. I'm interested to hear what its going to end up costing you though, it was 400 to COBRA mine almost 10 years ago now, and that's at like half of what it actually cost...
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02-19-2010, 09:23 AM | #9 | |
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Quote:
There are comprehensive and non-comprehensive deductibles. The deductible is the amount you are responsible for before your insurance pays. (Think car insurance.) Say your annual deductible is $250, you pay the first $250 of medical bills then your insurance company will pay the remainder of your health care costs based on your policy terms. A non-comprehensive deductible doesn't include services, usually such doctor's visits or prescriptions, in the annual amount, while a comprehensive deductible includes all services. However, prescriptions sometimes have a separate deductible. This often works in conjunction with your coinsurance. With a $250 deductible and 82/20 coinsurance, if you had a $1000 medical bill, you would pay the $250 deductible, then 20% of the remaining $750 (or covered services) so your minimum out of pocket cost is $400 ($250-$150.) EDIT: mann, you are correct, but there is nothing about such a limit in the original post. If you read it again, I was referring to the annual out of pocket expense, which has no cap set in this particular plan, not the insurance max-out. Last edited by Yes SiR; 02-19-2010 at 09:29 AM. |
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02-19-2010, 09:51 AM | #10 | ||
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So what does this mean?
Annual Out-of-Pocket Limit None Lifetime Maximum Unlimited Does that mean there is no limit to how much I pay out of pocket?
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02-19-2010, 10:25 AM | #11 | |
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for example with my benefits the company pays 90% of a medical bill (non routine i.e. emergency room visit)
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02-19-2010, 10:54 AM | #12 | |
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Quote:
I know you had some health concerns, which I assume is why you are looking into this. I don't know if you currently have insurance, but in NY, any pre-existing conditions must be covered if you have been uninsured for a period of 11 months or longer. I would look into any plan's policy on pre-existing conditions, regardless of your current insurance status. Insurance companies are doing anything they can to disqualify people from being covered. |
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02-19-2010, 07:05 PM | #13 |
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Move to Canada, become citizen, problem solved
What is the monthly or weekly fee?
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02-19-2010, 07:12 PM | #14 | |
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ah, thanks for the info guys. It just didn't make sense when I first read it because I cant see ever needing $250 in prescriptions haha
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02-19-2010, 07:18 PM | #15 |
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02-19-2010, 07:21 PM | #16 | |
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yeah I understand.. just never saw it like that I guess
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02-19-2010, 08:14 PM | #17 | ||
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$166/mo
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02-19-2010, 08:34 PM | #18 |
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Ugh, something I need to look into before June when I become less than a full time student. I need to get a new insulin pump and stock up on supplies to mooch of my parents sweet plan as much as possible then.
But seriously, ugh. Lots of research.
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02-20-2010, 10:44 AM | #19 |
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166/month for that plan is very not bad. Looks like everyone here has covered a lot of the points that need covering. Couple things though:
Not to ask for specifics, but do you take a lot of medications? If not, then you could probably get a plan with higher co-pays on prescriptions and that could lower your monthly. The prescription co-pays listed on that plan are actually pretty good for these days, and it is a nice low annual deductible. Same deal for your office visits, the 20/primary and 30/specialists is pretty decent, so the question is do you go to lots of appointments? I think someone else already mentioned this but, the way that plan is set up your co-pays are pretty good, but if you go to lots of appointments each year you will be paying a lot since there is no deductible. Choosing a plan is all about the long view. Balancing out your co-pays/deductibles with your monthly payment based on how often you go to the dr. For example, I rarely go to the doctor so my plan has relatively high co-pays/deductibles but a low monthly cost. And again, if you DO go to a lot of appointments, you want some kind of deductible on those or you can end up paying a LOT over the course of a year despite low co-pays. Two more things you need to investigate. As others have mentioned, you need to get a network booklet from Keystone, or search for your current doctor on their website. Go Here and click on "Find Participating Doctors, Hospitals, and Ancillary Providers." With an HMO, you have to choose a primary doctor who belongs to their network, and whenever you see a specialist (also in network) you'll need a referral from your primary. Thankfully, this has gotten easier than it used to be as it is all electronic now. Although that doesn't mean they still don't forget to send em sometimes, they can send another one easily with a phone call. Finally, I noticed you didn't list the emergency coverage. With any plan, you should see what kind of financial mess you can get in to if you have to go to the hospital. That info should have been listed with the other stuff you quoted in the original post.
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