Help understanding and choosing plan
I am choosing between two health insurance plans for the next year. This is my first time choosing a health insurance plan. I am a healthcare worker in my 20’s. During the next year, I plan to have my annual physical, well women visit, eye exam, and covered dental cleanings as preventative treatments. I’ve also been having a lot of GI issues and was recommended to receive a colonoscopy and follow up with GI. I’d also like to seek out pelvic floor physical therapy.
Option 1: Hospital-Affiliated PPO
– $125 monthly premium
– $0 deductible for in-network / $1,800 out of pocket maximum
– 0% coinsurance + $50 copay for ER visit, $15 copay for specialist visit, $5 copay per session for approved PT services
– Out-of-network: $300 deductible / $1,800 out of pocket maximum
– All approved providers are affiliated with the hospital system that I’ll be employed at
Option 2: Non-Hospital-Affiliated CMPPO
– $130 monthly premium
– $100 deductible for in-network / $1,100 out of pocket maximum
– 20% coinsurance after deductible for ER visit, approved PT services + $15 copay for specialist visit
– Out-of-network: $100 deductible / $1,100 out of pocket maximum
– Approved provider list is more expansive and covers two different hospital systems in the area
I just moved to a new city and will be finding all new providers. I don’t inherently have a problem with finding providers only within the hospital system that I would be working for. I will need to re-enroll again in January. My thoughts so far is that Option 2 would be the most practical as I’ll be able to keep the same providers for the whole year and have a lower OOPM, as I may reach the OOPM in 2025.
I think though, I’m having difficulty understanding the implications of a 20% coinsurance. When I put these values into cost-calculator spreadsheets, it shows that Option 2 would end up being more costly than Option 1 due to the coinsurance. Am I understanding that the coinsurance will continue to apply, even after I’ve met my OOPM? Does my reasoning in choosing Option 2 make sense? Am I missing something?
