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0% coinsurance with a high out of pocket max?

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0% coinsurance with a high out of pocket max?

Postby donn » Wed Mar 07, 2012 4:36 am

I just started a new job and am looking at my health insurance options.
Plan A:
$1500 deductible
0% coinsurance
$8000 out of pocket max

Plan B:
$6000 Deductible
0% coinsurance
$10,000 out of pocket max

2 things I'm confused on. If there is a 0% coinsurance, how would you ever hit your out of pocket max? And, how is it possible that both plans cost the same amount, when one is clearly 4x better then the other?
donn
 
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0% coinsurance with a high out of pocket max?

Postby omet65 » Wed Mar 07, 2012 4:45 am

This is like asking which is better, the car on the left or the car on the right. Not enough information to base any decision on.

What type of plans are they? HMO? PPO? EPO? Is one of them an HSA? Do you have HRA options with either?

How much are the co-pays? What procedures go toward the deductible and what procedures don't. Do the co-pays go toward the OOP max? Is the deductible family or individual? Is the OOP max family or individual? Is the OOP in or out of network or both? Is there a separate deductible for out of network?
omet65
 
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0% coinsurance with a high out of pocket max?

Postby rousse » Wed Mar 07, 2012 4:53 am

Poster Zarnav hit it right on the money with his answer.

Where most people could get the out of pocket max is getting care with an out of network provider. All insurance companies have "negotiated" rates they will pay for services, which they will call "in network". But if out of network, you then become stuck paying more, since the insurance wont.

Another consideration is to see if the doctors you see are on both plans. Many times, a person will choose one over the other since if their doctor is not on one, they will then be forced to find another doctor.

good luck
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0% coinsurance with a high out of pocket max?

Postby baldwinn » Wed Mar 07, 2012 4:56 am

Through copayments, is all I can think of.

The only way the plans would cost the same, and make sense, is if one is attached to a Health Savings Account that your employer is contributing to.
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0% coinsurance with a high out of pocket max?

Postby sawyers29 » Wed Mar 07, 2012 5:00 am

The high deductible health plans can be confusing. Your best route would be to sit down with your HR department and have them review the health plan options with you to determine which would be best for your situation.
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0% coinsurance with a high out of pocket max?

Postby dedrik » Wed Mar 07, 2012 5:11 am

If the only info that counted was what you provided, then the choice would be clear. But you need to consider these options in more detail. What are the copays on each plan, for example? You may have copays for office visits, Rx, emergency room care, etc. And which benefits on each plan are applied toward the deductible? That can vary too. Ask your HR department or benefits manager for more information on the two plans to help you make your choice.
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