Help compare to current plan?

Hi! Thanks in advance for the help, I’m completely lost. Plan 1 is our current plan. Spouse got a new job which has decent coverage (Plan 2) but it’s like comparing apples and oranges to me!

Family Coverage: 2 adults, 2 children. No more anticipated. 1 adult and 1 child have a heart condition; currently on maintained well with medication. Anticipate surgery in future. Child also has respiratory issues; hopefully maintained now. Does have history of 5+ day PICU stays. I know Plan 2’s deductibles and monthly premiums are so much lower but the unlimited max out of pocket for out of network scares me. With a child with a history of hospitalization, I’m just fearful we are on vacation, out of network and get slammed with a high bill! I know I have to check current medication for new plan. All input is helpful! In NJ if that matters.

Plan 1: Horizon BCBS – PPO Monthly Premium: $392 HDHP – Employer funds HSA $2,500/calendar year Currently maxing out HSA additional $437.50/month In-Network: · Deductible: $2,000/$4,000 · Max Out of Pocket: $5,100/$10,200 · Coinsurance: 20% after deductible · PCP Visit: 20% after deductible · Specialist Visit: 20% after deductible · Emergency Room: 20% after deductible · Urgent Care: 20% after deductible · Careonline: $0 after deductible · Prescription: o Generic: 15% after deductible o Preferred Brand Name: 15% after deductible o Non-Preferred Brand Name: 30% after deductible Out of Network: · Deductible: $2,000/$4,000 · Max Out of Pocket: $5,100/$10,200 · Coinsurance: 40% of R&C after deductible · PCP Visit: 40% after deductible · Specialist Visit: 40% after deductible · Emergency Room: 20% after deductible · Urgent Care: 40% after deductible · Careonline: N/A · Prescription: o Generic: 40% after deductible o Preferred Brand Name: 40% after deductible o Non-Preferred Brand Name: 40% after deductible

Plan 2: Cigna Open Access Plus Monthly Premium: $192 In-Network: · Deductible: $400/$800 · Max Out of Pocket: $1,500/$3,500 · Coinsurance: 10% after deductible · PCP Visit: 10% after deductible · Specialist Visit: 10% after deductible · Emergency Room: $50 copay; 10% after deductible · Urgent Care: 10% after deductible · Careonline: N/A · Prescription (deductible does not apply): o Generic: $30 copay/prescription (90 day) o Preferred Brand Name: $60 copay/prescription (90 day) o Non-Preferred Brand Name: $100 copay/prescription (90 day) Out of Network: · Deductible: $5,000/$10,000 · Max Out of Pocket: unlimited · Coinsurance: 50% · PCP Visit: 50% after deductible · Specialist Visit: 50% after deductible · Emergency Room: $50 copay; 10% after deductible · Urgent Care: 50% after deductible · Careonline: N/A · Prescription: o Generic: not covered o Preferred Brand Name: not covered o Non-Preferred Brand Name: not covered

submitted by /u/SchuSchu8
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