Went from no medical cost to a ton – want to make sure I have the best plan
I don’t know much about the healthcare end but everyone at my job complains that my job’s healthcare plans aren’t great. This year I started seeing a mental health specialist weekly, another one every 1-2 months, and I spend about $50 on prescription drugs about every other month. These plan to continue indefinitely.
I’ve also started the process for bariatric surgery and have a ton of doc visits scheduled early next year (learned the hard way the.. $500 bill counting towards my deductible that will reset in a month 🙁 lol) So I’d like to make sure I pick the best plan for this upcoming year. I think the EPO plan is still probably the best option but I’m not 100% sure of how some of these things work. Some co-pays are lower on PPO. So if I continue my weekly mental health that’s at least $260 savings for the year. but that alone is not worth it for the difference in premium. How do I know which plan will ultimately be cheaper for the surgery
Choice Choice Plus In NetworkOut of Network In NetworkOut of NetworkCost per pay prd.$56.23N/A $112.19N/APlan TypeEPON/A PPOPPOOffice Visit for Primary Doctor$25N/A $2040% co-insuranceOffice Visit for Specialist$40N/A $4040% co-insuranceCoinsurance$0N/A 15%[Blank]Annual Deductible$1,500 Individual/$3,000 FamilyN/A $600 Indivdual/$1200 Family$1000 Individual/$3000 FamilyAnnual Out of Pocket Limit$3,000 Individual/$6,000 FamilyN/A $3,000 Individual/$6,000 Family$7,000 Individual/Family $14,000Out of Country CoverageYesN/A YesN/APeriodic Health Exam Annual100%40% Co-insurance 100%40% Co-insuranceGeneric Prescription Drugs$10N/A $10See SPDBrand Prescription Drugs$35N/A $35See SPDNonprefered Brand Prescription Drugs$50N/A $50See SPDMail Order for Prescription DrugsTier 1 $20, Tier 2 $70, Tier 3 $100N/A Tier 1 Mail Order $20 Tier 2 $70 Tier 3 $100[Blank]Emergency Room$300N/A $150$150Outpatient Lab/X-RaySubject to DeductibleN/A 15%40% Co-insuranceOutpatient SurgerySubject to DeductibleN/A 15%40% Co-insuranceHospitalizationSubject to DeductibleN/A 15%40% Co-insuranceMental Health Coverage – Outpatient Services$25 CopayN/A $20 co-pay40% coinsuranceSubstance Abuse Coverage – Outpatient Services$25 CopayN/A $20 co-pay40% coinsuranceOut of Network Authorization RequiredN/AN/A Pre-Authorization is Required for Certain ServicesPre-Authorization is Required for Certain Services