seatpost12
New member
Just a bit of background. I have a son who has been going to specialist, ENT, allergist, and now going to endo. I have a baby due in June.
Questions:
Looking at the table below, if there is no coinsurance after I hit my deductible; why is there still an Out-of-pocket maximum? So for the PPO I guess the only things going to contribute to out-of-pocket max is my copay, but for the QHDHP what contributes to the out-of-pocket max other than ER copay? Am i missing something? Theoretically would I ever hit my out-of-pocket max with just copays, that is a lot of doctor visits?
Also, for the QHDHP, from the wording if my wife gives birth, if she has medical bills of $4,000, we still have to pay $4,000 since I did not hit the family deductible? Will the $4,000 bill actually count towards the $7,000; or is the $3,500 the only part that counts and the other family members will have to make up the other $3,500. This is why I am leaning towards PPO since if she hits the $3,000, it seems like I don't have to pay anything pass $3,000.
I think even with the HSA plan under the QHDHP, I will still be cheaper in the long run for the PPO this year due to medical bills associated with delivering a child.
Two plans that is offered through my potential company.
QHDHP 3500/0/0
PPO 3000/0/30
Deductible (I/F)
I: 3,500 F: 7,000 (If you enroll in family plan, the overall family deductible must be met before the plan begins to pay)
I: 3,000 F: 6,000
Coinsurance
No member coinsurance
No member coinsurance
Out-of-pocket maximum (I/F)
I: 6,900 F: 13,800
I: 8,550 F: 17,000
Services
No charge after deductible
Copay between 30 - 50
Questions:
Looking at the table below, if there is no coinsurance after I hit my deductible; why is there still an Out-of-pocket maximum? So for the PPO I guess the only things going to contribute to out-of-pocket max is my copay, but for the QHDHP what contributes to the out-of-pocket max other than ER copay? Am i missing something? Theoretically would I ever hit my out-of-pocket max with just copays, that is a lot of doctor visits?
Also, for the QHDHP, from the wording if my wife gives birth, if she has medical bills of $4,000, we still have to pay $4,000 since I did not hit the family deductible? Will the $4,000 bill actually count towards the $7,000; or is the $3,500 the only part that counts and the other family members will have to make up the other $3,500. This is why I am leaning towards PPO since if she hits the $3,000, it seems like I don't have to pay anything pass $3,000.
I think even with the HSA plan under the QHDHP, I will still be cheaper in the long run for the PPO this year due to medical bills associated with delivering a child.
Two plans that is offered through my potential company.
QHDHP 3500/0/0
PPO 3000/0/30
Deductible (I/F)
I: 3,500 F: 7,000 (If you enroll in family plan, the overall family deductible must be met before the plan begins to pay)
I: 3,000 F: 6,000
Coinsurance
No member coinsurance
No member coinsurance
Out-of-pocket maximum (I/F)
I: 6,900 F: 13,800
I: 8,550 F: 17,000
Services
No charge after deductible
Copay between 30 - 50