BCN HMO or high deduct PPO in MI and pregnant

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Need to choose a plan at my new job, and I’ve just found out I’m pregnant.

At first glance, I thought I’d go with the HMO because it covers almost all maternity costs. The SBC has a pregnancy coverage example and total estimated cost is just $570.

HMO – Blue Care Network Focus Network

Monthly premium: $69.7

Deductible: $500

Max OOP: $6350

Most services state that the deductible does not apply, just pay a copay.

$20 primary care / $30 specialist / $35 urgent care. Hospital stays, surgery, and diagnostic tests say there is no charge but may require PA. All maternity office visits, childbirth services are no charge / no deductible.

Imaging (I assume this includes pregnancy ultrasounds) is the only common service where the deductible applies, and then the copay is $150.

I know that I have to go through my PCP and have to choose BCN Focus Network providers. All my current providers are in network per the BCBS website. But I feel like I must be missing something. What’s the catch? How are services that cheap? I’ve never had an HMO. Will they just refuse to cover things?

I also would like to use counseling services for anxiety, and while the copay is only $20 a visit, they say PA may be required and some BCBS coordinator will determine what care I need and how much. That kinda freaks me out.

Alternatively, I can go with PPO coverage which is more familiar to me and much more flexible, but has a higher deductible.

BCBS PPO

Monthly premium: $45

Deductible: $3,000

Max OOP: $4,500

Everything after the deductible is 20% coinsurance until the Max OOP.

I’ve done the calculations and I know that the max OOP is something I should consider with unknown medical costs, but when the HMO consists of copays and not coinsurance, would I ever even come close to the max?

Not sure if this is relevant, but we plan on my husband staying on his employer’s coverage. We will save the most on premiums this way, and he generally doesn’t use much insurance. He also has a BCBS high deductible plan and an HSA which both he and his employer contribute to. My employer doesn’t contribute to the HSA if you open one.

I keep leaning towards the PPO because it’s what I know and the “unknowns” of the HMO are freaking me out. But I would feel like an idiot if I ended up spending a few thousand OOP that I didn’t have to if I just picked the HMO. Thank you for reading all this and for any insight/advice you can provide!!!!!!

Edit: age 31 and in southeast Michigan, any other info that may help please let me know.

submitted by /u/itsfebeleventh
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Need to choose a plan at my new job, and I’ve just found out I’m pregnant. At first glance, I thought I’d go with the HMO because it covers almost all maternity costs. The SBC has a pregnancy coverage example and total estimated cost is just $570. HMO – Blue Care Network Focus Network Monthly premium: $69.7 Deductible: $500 Max OOP: $6350 Most services state that the deductible does not apply, just pay a copay. $20 primary care / $30 specialist / $35 urgent care. Hospital stays, surgery, and diagnostic tests say there is no charge but may require PA. All maternity office visits, childbirth services are no charge / no deductible. Imaging (I assume this includes pregnancy ultrasounds) is the only common service where the deductible applies, and then the copay is $150. I know that I have to go through my PCP and have to choose BCN Focus Network providers. All my current providers are in network per the BCBS website. But I feel like I must be missing something. What’s the catch? How are services that cheap? I’ve never had an HMO. Will they just refuse to cover things? I also would like to use counseling services for anxiety, and while the copay is only $20 a visit, they say PA may be required and some BCBS coordinator will determine what care I need and how much. That kinda freaks me out. Alternatively, I can go with PPO coverage which is more familiar to me and much more flexible, but has a higher deductible. BCBS PPO Monthly premium: $45 Deductible: $3,000 Max OOP: $4,500 Everything after the deductible is 20% coinsurance until the Max OOP. I’ve done the calculations and I know that the max OOP is something I should consider with unknown medical costs, but when the HMO consists of copays and not coinsurance, would I ever even come close to the max? Not sure if this is relevant, but we plan on my husband staying on his employer’s coverage. We will save the most on premiums this way, and he generally doesn’t use much insurance. He also has a BCBS high deductible plan and an HSA which both he and his employer contribute to. My employer doesn’t contribute to the HSA if you open one. I keep leaning towards the PPO because it’s what I know and the “unknowns” of the HMO are freaking me out. But I would feel like an idiot if I ended up spending a few thousand OOP that I didn’t have to if I just picked the HMO. Thank you for reading all this and for any insight/advice you can provide!!!!!! Edit: age 31 and in southeast Michigan, any other info that may help please let me know.
submitted by /u/itsfebeleventh [link] [comments]Read Morer/HealthInsurance

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