Help!

[unclegweedoe]

Just got a new job this month and have been putting off enroll/waive coverage. They have 4 options and it’s very overwhelming, I’ve been on state insurance my entire adult life and have zero clue what any of it means — I checked out the pinned post and I don’t even know how to understand it in the first place.

Provider will be Blue Cross/Blue Shield of MA. My employer offers HMO and PPO types, with optional FSA. It’ll be ~$70-80/paycheck (biweekly) for any of the 4.

The names they have are: ‘HMO Blue 2000 w/HCCS’, ‘PPO Saver w/HSA’, ‘HMO Blue Deductible’, and ‘Blue Care Elect PPO Deductible’. I did the plan comparison thing they have and I don’t really understand per se still! I tried to look on the provider website too but couldn’t find these specific plans.

I have pre-existing conditions that have required specialists in the past, since I was a teen. I’d need an allergist, nutritionist, and neurologist at the very least. I would assume that not needing referrals (aka the PPO options) would make it easier due to that, but I don’t know if I’m understanding correctly.

For the two PPOs, I’ve listed the majority of important-to-me-things: the Saver one has a $500 higher deductible but the visit cost after deductible is satisfied is $5-10, medications being $15-30, imaging (CT/MRI) is $0, outpatient/inpatient also $0, and mental health care $0-$5; the Blue Care post-deductible visit cost is $25-40, medications are $20-40, imaging/outpatient/inpatient costs $100-250, mental health is $20/$250 inpatient.

I’ve never done nor needed inpatient mental health care, but I really do need therapy and I think will easily rack up costs to satisfy the deductible. I just don’t know if the Saver w/HSA is worth it (I do understand it’s a health saving account but beyond that I’m clueless— do I have to contribute more than what’s taken from my paycheck with the HSA?)

I have no one in y life that is knowledgable on this topic, thus the post here. Thank you in advance, sorry if formatting is wonky (mobile). Sorry if this is the wrong flair too.

 

[christhasrisen2000]

@unclegweedoe If all 4 plans are roughly the same premiums and you expect to see a lot of specialists, then yes, I would stick to the PPO options. Unless the HMOs have crazy good benefits.

What are the actual deductible and OOPs for the two PPO plans?

 

[unclegweedoe]

@christhasrisen2000 The Saver one has a deductible of $1750, OOP limit $5000; Blue Care is $1250 with the same OOP limit.

Theres nothing that stands out with the HMOs, but I’m also not sure what to look for. The one HMO is pretty much identical to the Blue Care (same deductible, OOP limit, same or bit more expensive for the costs) while the w/HCCS HMO has a $2k deductible, the $5000 OOP limit, and costs look to be higher overall (which looks like it would be best for, say, a diabetic who has a lot of pricy medical expenses)

 

[signi]

@unclegweedoe Do you have a couple of current doctors that you like? You could call the office (during a non-busy hour like maybe 2:30pm) and ask the accounting rep which of the plans they accept or what they recommend/have good history with.

 

[unclegweedoe]

@signi Not particularly as I don’t really have that sort of relationship with my doctors — CT state insurance has been better than nothing, but I found the doctors treating me were always leaving for better practices (not that I blame them, just has made it difficult).

Luckily, the conditions I have are relatively low-maintenance now that they’re managed — basically just need to continue pre-established treatment plans.

 

[signi]

@unclegweedoe There's a video with some explanation about PPO here: https://www.bu.edu/hr/health-wellness/health/blue-cross-blue-shield-ppo/

There's a discussion of Blue Care Elect PPO here: https://www.boston.gov/sites/default/files/file/2021/11/BCBS PPO Member Education_0.pdf

 

[signi]

@unclegweedoe With the HMO plans, you are restricted to the doctors in the network. You will almost always have to see your Primary Care doctor before you can see any kind of specialist. For instance if you have a strange lesion on your face, you can't go to a dermatologist, you have to first make an appt with your pcp (who it might take 3 weeks to get in to see) and he/she refers you to a dermatologist (that you might have to wait another 3 or 4 weeks to see. ) So if it's a small possibly cancerous lesion you've just doubled the time that it gets to grow and fester.

With the PPO plan (check the details but usually.....) you can see a specialist just by making an appointment yourself. You still probably have to mostly stick to "in network" doctors, but you can use out-of-network doctors if you don't mind paying more. And you will pay more at each visit then you will with the HMO, so if money is always tight then the HMO can be a better decision.

HMO usually means you are restricted to certain hospitals too. If it's an emergency, you can go to the nearest hospital, but as soon as you're no longer considered emergent you will be transferred to the HMO hospital. So you'd want to check how close you live to the HMO hospitals on the HMO list.

 

[unclegweedoe]

@signi Yeah, I had CT state insurance and it seems like it was an HMO plan from your description — I hated it. I think I definitely want to be able to just make appointments myself if necessary, rather than fighting to get an appointment with a PCP and then also get an appointment with the specialist after the PCP makes the referral.

I do have to check out what hospitals are on the list regardless, but definitely think I’m gonna avoid the HMO plans.