Traditional Blue Cross Blue Shield PPO plan or high deductible health plan?
LIKE OR DISLIKE:
It's a health plan with a high deductible. It's designed for younger healthy people so they can pay smaller premiums.
I will try and make this simple.The 1st thing most people do is check (each) plan to see what doctors/specialists they have. So if one does not list your family doctor or a specialist you need to see as (in network), then that means (if) you need to see them, would cost more since (out of network).Now (each) plan has a deductible, so you need to note how much the deductible in each plan.If this is a employer plan, then the high deductible plan will be a (minimum) of $2,500, or if you buy privately could be as high as $6,500. Now the other plan may have a deductible of $500, $1000 or anything else in between. The deductible is what you pay for any medical treatment out of your own pocket (before) insurance pays each year.Then the last thing you do is look at the premium you pay monthly if privately, or how much will (your) employer (deduct) from your paychecks to pay for (each) plan.1-Verify doctors/specialist2-Verify (each) deductible3-Verify the costsOnce you figure out the difference between the 2 will most likely be your choice.
A PPO usually is a HDHP. Don't worry too much about the names.Start your comparison by making sure all of the doctors you want to visit accept both insurance plans.Then draw up three scenarios:(1) You have no injuries or illnesses other than conditions you already have.(2) You break your leg and get a $10,000 hospital bill.(3) You get a serious illness that results in several doctor visits and a high ongoing medication cost.For each scenario, see what your total cost will be. Include insurance premiums, deductible, and copays. Go through the whole page of the plan comparison (xrays, prescriptions, etc).If one plan is always better than the other, go with that one. Otherwise, decide whether you'd prefer a lower most-likely cost or a lower worst-case case.
You compare networks, deductibles, monthly costs and you estimate no bills, moderate bills, and extensive bills to see how they hypothetically might pan out for you. No way for anyone to guess which is better without costs.
high deductable means just that, you have to pay thousands of dollars up front before the insurance kicks in
High Deductible Health Plans (HDHP) are a scam. They sound good in theory...but in practice they will end up costing you more than a PPO if you ever get a serious injury.In a PPO, you're paying for health care coverage (the premium) every month if you use it or not. PPO's also have a deductible. This is similar to the deductible from your car insurance. If you need health care, you pay 100% until you hit your deductible. Then your coverage kicks in and covers the rest. For instance, say your deductible is $100, and you break your arm. The bill comes to $200. So you pay $100 as part of your deductible. The rest ($100) is paid by insurance. Any other costs from health care are also paid by the insurance (up to some annual maximum.) Most services will have a co-pay, which basically means this is the cost to you. Examples include office visits, and emergency room treatments.In a HDHP, you are allowed to set aside money, pre-tax, for your health care. There are no co-pays, so you pay the full price for everything. So if you get a check-up, you pay out of this account. The upside is, if you never use health care (e.g. you never get sick) you aren't paying money. But keep reading...Like the PPO you also have a deductible but unlike the PPO where the deductible is maybe $2000 or so, in a HDHP, it's $10,000 or more. This means you are responsible for paying for your costs up to $10,000 before the insurance kicks in. For this reason alone, HDHPs are a bad idea. A trip to the emergency room can easily cost over $10,000 - and you'll be responsible for your deductible which is generally much higher than what the premium + co-pays + deductible you'll have with the PPO.Proponents of HDHP's also like to tell you how you can "shop around". For instance you need some sort of non-emergency surgical procedure, so you can inquire how much it costs at different hospitals, and make your choice. Don't be fooled though. Hospitals are under no obligation to tell you how much a procedure will cost. In fact they'll all just tell you "Well, it depends..." Insurance billing is basically a mixture of black magic, and extortion. They'll always charge as much as they can, based on how much they think your insurance will pay for. In the case of a HDHP, they'll charge you "full price" - you're paying for it.Meanwhile if you need emergency care (e.g. car accident) you're not going to "shop around"...you're just going to go to the nearest hospital.
The term "HDHP" means that you have to pay the first few thousand dollars on medical bills (except preventative care) yourself, but you can contribute to an HSA if you want.
A HDHP is a "traditional" PPO.The only difference is that it has a higher deductible. Although, the deductible might be as low as $2000 for an individual or as high as $6800 in-network.How would you compare? Do you use a lot of medical treatment. Do you have money to pay the deductible, if needed. Would you rather have a lower premium although you might not use the medical treatment to justify the cost.
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