United Healthcare EPO vs PPO. Which Plan To Pick?
Hello! I started a contract job that offers benefits, albeit a bit pricey. In all my other jobs the health insurance option was PPO vs HDHP with HSA so I am not familiar with an EPO plan. All of the plans offer the same in network providers through United Healthcare. As far as I can tell my PCP, a lot of doctors, and hospitals in my area are in network. From what I understand is that the EPO offers no coverage out of network. However, it does cover emergency room ($150 copay) and urgent care ($25 copay) visits out of network, but no imaging or hospital stay is covered out of network.
I'm relatively healthy and visit my PCP 1-2 times a year for a physical (covered) and if I get a bad cold. No ongoing medication. I don't expect any urgent care or hospital visits. However, I would like to get some nagging elbow pain from working out checked out. I expect this to be 1-2 specialist visits and likely 10-12 physical therapy visits. Possibly some imagining too. I've included these costs in the expected visits row excluding the imaging as I'm not sure if it would be x-ray vs MRI.
Below are the cost highlights of in network services, but let me know if additional details are needed.
Plan Preferred PPO Choice PPO EPO Monthly Premium $390 $281 $250 Deductible $1500 $5900 $1500 Out of Pocket Max $4000 $6350 $5000 Max Cost (Premiums + OOP Max) $8680 $9722 $8000 Primairy Care Physician Copay $30 $35 $25 Specialist Copay $30 $35 $40 Urgent Care $125 Copay 100% after deductible $25 Emergency Room $250 Copay 100% after deductible $150 Diagnostic Tests (xray, blood work) No Charge No Charge No Charge Imaging (CT/MRIs) 20% Coinsurance 0% Coinsurance 30% Coinsurance Physical Therapy Copay $30 $35 $25 Expected Visits Copay $480 $560 $440 Expected Rest of Year Costs (Vists + 6 Premiums) $2820 $2246 $1940
The only thing that could throw a wrench in all my costs is my PCP wanted me to get a colonoscopy due to family history. I'm in my early 30s so I am not at the age of normal screening. The plans do list colonoscopy as 100% covered for preventive screening. I might push it off to next year until I hopefully have better insurance as I am not sure how it would be considered.
I also am offered dental through Cigna for $40/month and vision through VSP for $10/month. These prices seem like a slight premium vs my expected costs for the year, but I guess they are worth having in case those costs go up.
Would it be worth signing up for the FSA? I've heard stories of people losing the money they put in if they didn't spend it. If my costs come in much lower than expected I'd hate to lose that money.
Which plan should I pick? Is the EPO plan worth the slight cost savings? Anything else to consider?
Thanks!
submitted by /u/Stillwater32
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