Hi! Thanks in advance for the help, I’m completely lost. Plan 1 is our current plan. Spouse got a new job which has decent coverage (Plan 2) but it’s like comparing apples and oranges to me!
Family Coverage: 2 adults, 2 children. No more anticipated.
1 adult and 1 child have a heart condition; currently on maintained well with medication. Anticipate surgery in future. Child also has respiratory issues; hopefully maintained now. Does have history of 5+ day PICU stays. I know Plan 2’s deductibles and monthly premiums are so much lower but the unlimited max out of pocket for out of network scares me. With a child with a history of hospitalization, I’m just fearful we are on vacation, out of network and get slammed with a high bill! I know I have to check current medication for new plan. All input is helpful! In NJ if that matters.
Plan 1: Horizon BCBS – PPO
Monthly Premium: $392
HDHP – Employer funds HSA $2,500/calendar year
Currently maxing out HSA additional $437.50/month
In-Network:
· Deductible: $2,000/$4,000
· Max Out of Pocket: $5,100/$10,200
· Coinsurance: 20% after deductible
· PCP Visit: 20% after deductible
· Specialist Visit: 20% after deductible
· Emergency Room: 20% after deductible
· Urgent Care: 20% after deductible
· Careonline: $0 after deductible
· Prescription:
o Generic: 15% after deductible
o Preferred Brand Name: 15% after deductible
o Non-Preferred Brand Name: 30% after deductible
Out of Network:
· Deductible: $2,000/$4,000
· Max Out of Pocket: $5,100/$10,200
· Coinsurance: 40% of R&C after deductible
· PCP Visit: 40% after deductible
· Specialist Visit: 40% after deductible
· Emergency Room: 20% after deductible
· Urgent Care: 40% after deductible
· Careonline: N/A
· Prescription:
o Generic: 40% after deductible
o Preferred Brand Name: 40% after deductible
o Non-Preferred Brand Name: 40% after deductible
Plan 2: Cigna Open Access Plus
Monthly Premium: $192
In-Network:
· Deductible: $400/$800
· Max Out of Pocket: $1,500/$3,500
· Coinsurance: 10% after deductible
· PCP Visit: 10% after deductible
· Specialist Visit: 10% after deductible
· Emergency Room: $50 copay; 10% after deductible
· Urgent Care: 10% after deductible
· Careonline: N/A
· Prescription (deductible does not apply):
o Generic: $30 copay/prescription (90 day)
o Preferred Brand Name: $60 copay/prescription (90 day)
o Non-Preferred Brand Name: $100 copay/prescription (90 day)
Out of Network:
· Deductible: $5,000/$10,000
· Max Out of Pocket: unlimited
· Coinsurance: 50%
· PCP Visit: 50% after deductible
· Specialist Visit: 50% after deductible
· Emergency Room: $50 copay; 10% after deductible
· Urgent Care: 50% after deductible
· Careonline: N/A
· Prescription:
o Generic: not covered
o Preferred Brand Name: not covered
o Non-Preferred Brand Name: not covered
Family Coverage: 2 adults, 2 children. No more anticipated.
1 adult and 1 child have a heart condition; currently on maintained well with medication. Anticipate surgery in future. Child also has respiratory issues; hopefully maintained now. Does have history of 5+ day PICU stays. I know Plan 2’s deductibles and monthly premiums are so much lower but the unlimited max out of pocket for out of network scares me. With a child with a history of hospitalization, I’m just fearful we are on vacation, out of network and get slammed with a high bill! I know I have to check current medication for new plan. All input is helpful! In NJ if that matters.
Plan 1: Horizon BCBS – PPO
Monthly Premium: $392
HDHP – Employer funds HSA $2,500/calendar year
Currently maxing out HSA additional $437.50/month
In-Network:
· Deductible: $2,000/$4,000
· Max Out of Pocket: $5,100/$10,200
· Coinsurance: 20% after deductible
· PCP Visit: 20% after deductible
· Specialist Visit: 20% after deductible
· Emergency Room: 20% after deductible
· Urgent Care: 20% after deductible
· Careonline: $0 after deductible
· Prescription:
o Generic: 15% after deductible
o Preferred Brand Name: 15% after deductible
o Non-Preferred Brand Name: 30% after deductible
Out of Network:
· Deductible: $2,000/$4,000
· Max Out of Pocket: $5,100/$10,200
· Coinsurance: 40% of R&C after deductible
· PCP Visit: 40% after deductible
· Specialist Visit: 40% after deductible
· Emergency Room: 20% after deductible
· Urgent Care: 40% after deductible
· Careonline: N/A
· Prescription:
o Generic: 40% after deductible
o Preferred Brand Name: 40% after deductible
o Non-Preferred Brand Name: 40% after deductible
Plan 2: Cigna Open Access Plus
Monthly Premium: $192
In-Network:
· Deductible: $400/$800
· Max Out of Pocket: $1,500/$3,500
· Coinsurance: 10% after deductible
· PCP Visit: 10% after deductible
· Specialist Visit: 10% after deductible
· Emergency Room: $50 copay; 10% after deductible
· Urgent Care: 10% after deductible
· Careonline: N/A
· Prescription (deductible does not apply):
o Generic: $30 copay/prescription (90 day)
o Preferred Brand Name: $60 copay/prescription (90 day)
o Non-Preferred Brand Name: $100 copay/prescription (90 day)
Out of Network:
· Deductible: $5,000/$10,000
· Max Out of Pocket: unlimited
· Coinsurance: 50%
· PCP Visit: 50% after deductible
· Specialist Visit: 50% after deductible
· Emergency Room: $50 copay; 10% after deductible
· Urgent Care: 50% after deductible
· Careonline: N/A
· Prescription:
o Generic: not covered
o Preferred Brand Name: not covered
o Non-Preferred Brand Name: not covered