Help us decide best option
Insurance question relating to coordination of benefits and NICU stay for new family members.
We are having tough time deciding which is the best option for insurance coverage for twins who requires prolonged NICU stay
Goal is to consolidate the plans to Plan 1 in Jan 2025, but to see which option is best to minimize the costs of the long NICU stay. The hospital is in network for both plans but we are finding conflicting information about individual providers being in- vs. out-of-network, which is our fear.
The plans: Plan 1) BCBS (federal) Premium $800/month Deductible $700 OOP max in network $12,000 OOP max out of network $16,000 The maxes overlap I believe, such that in-network payments count toward out of network max, and vice versa.
Plan 2) CA Blue Shield (cobra) Premium $1800/month (as it's cobra) Deductible: $500 more when add fam OOP max in network $4500 ($2k met) OOP max out of network: no max, so limitless in theory
Plan 1 would be primary plan by date of birth rule if coordination of benefits.
Option 1: Solo plan 1. Total premium = $800×7 months = $5600 Max out of pocket =16000 Total = $21600
Option 2: Solo plan 2. Total premium = $1800 x7 months =$12600 Max out of pocket: $2500 remaining (in network) + ?unlimited out of network (plan has no OOP max) Total = $15100 + ?out of network non-capped?
Option 3 Double cover x2 months (to span NICU stay), then drop plan 2. Premium = $5600 + $3600 Deductibles: $700 +500? Max OOP: since plan 1 is primary, does that mean we would have to hit plan 1's oop max ($16k) before plan 2 starts to cover anything? So $16000? Ish? Total: $26400? (Been reading that more coverage may not always be better?)
1) Is there any benefit to having the 2nd insurance, as in option 3?
2) is the value of the unknown oop max out-of-netwo4k from option 2 worth ~$7k to warrant going with option 1?
3) do I need to nitty gritty compare coinsurance rates? In general, plan 1 is good in-network and okay out of network. Plan 2 is good in both.
4) is there a chance we don't hit them oop max for option 1, thus reducing the cost of that option?
Really hard to estimate overall costs.
Thank you so much for reading. We are new parents and don't want to risk financial ruin by making a wrong decision
Edit: we are mid 30s. Gross income this year ~300k. Live in CA but hospital is in FL.
submitted by /u/Dr_A_Wesome
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