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@dabomb79 Sounds like a Medicare Advantage D-SNP plan. My company sells them and we do indeed give tons of additional benefits like dental, vision, hearing, $0 copays on basically everything that is covered, and we even give members a pre-paid debit card that they can use for groceries, otc...

@jamiee When the provider is out of network, you will not necessarily be reimbursed 70% of what you paid. You will be reimbursed the lower of 70% of what you paid or 70% of what they deem the allowable charge, which is roughly what they would pay an in-network provider for the same service. It’s...

@fmontanay2 This is a good question, or meds could just be subject to the overall deductible (possibly only applicable to certain tiers). OP - you should know that in insurance, “covered” is not necessarily the same as “paid.” There are plenty of circumstances where insurance covers something...

@jacquelinedeane55 Yes, it’s common for you to only receive credit for the allowable charge rather than the amount you paid. One of many reasons why it’s better to stay in network whenever possible.

@kimmiediscovery Nope. The excess would ordinarily be written off by a contracted provider. Since the provider is not contracted, that means OP eats it instead.

@markwilliams You’re not going to find decent coverage cheaper than that. You won’t qualify for any subsidies on the marketplace so you’d be looking at several hundred a month easy.

@scottd It depends on whether the deductible is “embedded” or “aggregate.” Embedded means that you would only have to meet your individual deductible before your expenses are paid. Aggregate means the whole family has to meet it first.

@leafbyniggle Some plans carve certain services out of the deductible. For instance, my deductible only applies to services that have a percentage cost share. Anything with a flat copay is covered from day 1 regardless of where I am in the deductible.