Help with understanding best pick of these 2 tiers

[edmondsimon]

So comparing the two plans I’ve been provided (see info on both below). The first one called “lower deductible” is $71/ biweekly and second In network only, $109/biweekly. With that information I read it as that the higher tier (In network only) costs me an additional $912/year to save $250 in possible deductible. That doesn’t make sense to me, having in the end paid $662 extra for the higher tier if I end up paying full deductible. Am I missing something very important here?

Also, please let me know if I’m going at this completely wrong. This is my first time choosing my own medical insurance.

• Anthem Lower Deductible Plan $71/Biweekly

In-Network Annual Deductible Individual $500
In-Network Annual Deductible Family $1,000
Out-of-Network Annual Deductible Individual $1,000
Out-of-Network Annual Deductible Family $2,000
In-Network Annual Out-of-Pocket Limit Individual $1,500
In-Network Annual Out-of-Pocket Limit Family $3,000
Out-of-Network Annual Out-of-Pocket Limit Ind $3,000
Out-of-Network Annual Out-of-Pocket Limit Family $6,000

Office Visits General Practitioner:
In-Network: $30 copay per visit
Out-of-Network: 40% coinsurance

Office Visits Specialists:
In-Network: $40 copay per visit
Out-of-Network: 40% coinsurance

Physical Exams - One per Year:
In-Network: No charge
Out-of-Network: 40% coinsurance


• Feature Anthem In-Network Only Plan $109/Biweekly

In-Network Annual Deductible Individual $250
In-Network Annual Deductible Family $500
Out-of-Network Annual Deductible Individual N/A
Out-of-Network Annual Deductible Family N/A
In-Network Annual Out-of-Pocket Limit Individual $1,000
In-Network Annual Out-of-Pocket Limit Family $2,000
Out-of-Network Annual Out-of-Pocket Limit Ind N/A
Out-of-Network Annual Out-of-Pocket Limit Family N/A

Office Visits General Practitioner
In-Network: $30 copay per visit
Out-of-Network: Not covered

Office Visits Specialists
In-Network: $40 copay per visit
Out-of-Network: Not covered

Physical Exams - One per Year
In-Network: No charge
Out-of-Network: Not covered

 

[samuelc]

@edmondsimon The big difference between the two plans in your link is that the more expensive one has OON benefits. The cheaper one is IN only. You have to decide if that's important to you.

 

[edmondsimon]

@samuelc Thanks for your reply. Sorry I think I might have confused everyone with my initial post. So the left plan “lower deductible” is $71 while the right In network only is $109. Does that change your answer?

 

[samuelc]

@edmondsimon Lol now I'm confused. The in network plan has a lower deductible than the "lower" deductible plan, right? It's a little hard to see it on the image from mobile. If you want to type out Plan A vs Plan B and list the ANNUAL premium, deductible, OOPM and network options for both, you may get more answers just because some people won't try to figure out the link.

 

[edmondsimon]

@samuelc Just updated main post. I did clean it up but when posting the formatting goes crazy. Hope you can still read.

 

[samuelc]

@edmondsimon Ok, mathematically I agree with you that the cheaper plan, even with the higher deductible, is definitely better ($1704+500 = $2204) vs (2616 + 250 = $2866). When you add to that the fact that the cheaper plan also gives you OON access, I wonder why anyone would choose the more expensive plan. Sometimes there just isn't a logical explanation. Sometimes there is a difference in the details. For instance, do both plans require you to meet the deductible before they cover anything or does one plan waive the deductible for certain services (office visits, hospitalization, etc.)? There could be differences that make a difference, but based on this overview definitely 100% the out of network plan is better.

 

[edmondsimon]

@samuelc Yeah, they’re not supplying me with more information and when I’ve called in they don’t seem to have more information either. But hearing someone else confirm my thoughts is very helpful and I’m super grateful for you taking time to respond. I will do a last push to call them asking some of the questions you provided. Again, thank you!!

 

[samuelc]

@edmondsimon You have a right to see the plan details. No way they don't have that. It's a boring long PDF that details the terms and conditions of the policy. It's possible that the other plan has some advantages, but the fact that you get OON access for cheaper is hard to beat