CMM Plan PPO vs Plus Plan PPO
We are currently on COBRA, but will be eligible for an employer-sponsored plan on Sept 1 and are trying to choose between two plans. I've attempted to call the insurance company (Anthem BCBS), but the phone number they list for assistance with choosing employer plans is out of service (last one listed here), so I wanted to ask the community here for help.
Our two options are 1) Plus Plan PPO and 2) CMM Plan PPO. The options are almost identical (including identical cost to us, the deductible ($1,000 ind / $3,000 family), and out-of-pocket limits ($5,000 ind / $10,000 family)) EXCEPT for the following:
The Plus Plan PPO has "deductible then 20% coinsurance" for all in-network services and 40% coinsurance for out-of-network services. The CMM Plan PPO has "deductible then 20% coinsurance" for all in-network and out-of-network services. – I don't anticipate using any out-of-network services, but I wonder if it would better to choose the CMM just in case we need to use providers that are out-of-network in the future? The CMM Plan has a note that says: "In-network and out-of-network charges in the CMM Plan PPO option count towards the same deductible and out-of-pocket limits." I believe this would mean we would have one combined deductible for in-network and out-of-network, rather than separate deductibles for each, but I'm not sure who to ask to confirm. The Plus Plan PPO has a $30 copay for PCP, specialist visits and urgent care visits, where the CMM Plan PPO has "deductible then 20% coinsurance" for those visit types.
Some info on our family – couple in our 30s, two young children; possible future pregnancies with c-section delivery and likely future kidney stone procedures (I've had multiple ones in the past).
Which plan would be better for us? Or any suggestions on how to reach the insurance company to ask about plan comparisons?
Note – We are located in PA, but the employer's headquarters is in Ohio so I believe we are dealing with Anthem BCBS of Ohio.
Thanks in advance for sharing your thoughts on this confusing decision!
submitted by /u/ps3114
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