PPO, HDHP Base, or HDHP Premium? (poor T1D couple)
We have just moved to the USA from the UK (to be with my family for a year or so) and are having a hard time deciding which medical plan is right for our circumstances. It is difficult to calculate what our yearly expenses will be with no previous experience in the US healthcare market. Any guidance would be much appreciated.
We are a family of 2 going on my job's medical insurance (BCBSTX). I (25f) have no active medical issues. My husband (24m) is a type 1 diabetic and has Bartter syndrome, a kidney disorder that causes chronic hypokalemia. He hasn't been hospitalised in years and only sees a doctor yearly for regular diabetic checkups. He currently takes Tresiba, NovoLog, and Sando-K (effervescent tablets containing potassium chloride & potassium bicarbonate). Sando-K doesn't seem to exist in the US so we are at a loss as to what he will be taking for his hypokalemia. He also uses the FreeStyle Libre 2 CGM. (He was on an insulin pump for years but went off it in 2019 as he preferred to give his own injections. He would be open to going back on a pump or trying any other new technologies.)
He has yet to see a doctor here – we have been getting by for 2 months with a stock of supplies from the UK. He will need to see a doctor (GP? specialist?) as soon as our coverage starts next week to get his formal diagnoses and prescriptions sorted.
We live in Chicago and are not very well off financially. For this reason, a PPO seems most feasible for us (lowest out-of-pocket costs), but it seems like the more research I do, the more unsure I become.
Any advice would be much appreciated. Thank you in advance for your help! Plan details below.
MEDICAL PLANS
PPO
Annual deductible: $1,500 Coinsurance: 80% covered Out-of-pocket max: $5,000 Preventative care: 100% Primary care: $30 copay Specialist services: $30/$60 copay Diagnostic care: 100% after applicable copay Urgent care: $75 copay Emergency room: $350 copay
HDHP Premium
Annual deductible: $4,000 Coinsurance: 90% covered Out-of-pocket max: $8,000 Preventative care: 100% Primary care: 90% Specialist services: 90% Diagnostic care: 90% Urgent care: 90% Emergency room: 90%
HDHP Base
Annual deductible: $5,000 Coinsurance: 80% covered Out-of-pocket max: $10,000 Preventative care: 100% Primary care: 80% Specialist services: 80% Diagnostic care: 80% Urgent care: 80% Emergency room: 80%
PRESCRIPTION DRUG COVERAGE
PPO
Rx deductible: $150 (does not apply to generics) Generic: $10 copay Preferred: $35 copay Non-preferred: $100 copay Specialty drugs: $250 copay
Both HDHP plans
Rx deductible: N/A Generic: 10% Preferred: 20% Non-preferred: 30% ($100 max) Specialty drugs: 40% ($250 max)
submitted by /u/AnimatorObjective253
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