Marketplace plan too good to be true?
My wife and I just had a newborn. I expect to get a bill of $2-3k for the labor and delivery, as part of my wife’s coverage.
My son needed followup inpatient care at a separate children’s hospital for 2 days. I understand that to mean that he will be billed separately from his mother. I expect that total to possibly be in the tens of thousands.
That said, I was shocked to find that adding him to my employer-sponsored plan would increase our premium by 66%. I naively assumed it’d simply cost 33% more. But it is what it is.
Anyway, apparently I can purchase a cheaper, separate plan for him through the healthcare marketplace. The strange thing is that the cheaper plan actually seems better. Ironically, that has me worried. What’s the catch? It seems too good to be true.
Employer plan: UnitedHealthcare OHI EPO Non Gated
Marketplace plan: Healthmark Blue Cross Blue Shield; my Blue Access PPO Gold 0
Adds $580 to the existing premium
$380 premium
$1500 individual deductible
$0 individual deductible
$6000 individual OOM
$7500 individual OOM
$3000 family deductible
$12000 Family OOM
ER $300 copay
ER $300 copay
Ambulance $0
Ambulance 30% coinsurance
Hospital Inpatient 20% coinsurance
Hospital Inpatient $725 copay
Surgeon Fees 20% coinsurance
Surgeon Fees $20 copay
Labwork 50% coinsurance
Labwork $20 copay
XRays 20% coinsurance
XRays $20 copay
MRI/CT Scans 20% coinsurance
MRI/CT Scan $450 copay
No child vision care or dental care
Child vision care and dental care covered
The coinsurance has been killing me when it came to my wife’s pregnancy, hence why I’m trying to avoid it.
All other things are comparable or negligible (primary care copay, immunizations, etc.), including the network of providers in our area.
Any advice or experience? As much as I’ve been disappointed with the UHC plan, they’ve never really let me down and are somewhat predictable. I don’t know anything about BCBS though.