Hello! I’m trying to decide between 2 health plans. I’d like to consider myself pretty knowledgeable about health plans since I work at a durable medical equipment facility and I’m pricing people’s medical equipment off of their plans all day long, So it’s a bit embarrassing that I’m stumped right now haha. I have two plans that I’m looking at where the monthly premiums and even the deductible and out of pocket maximum are somewhat close to each other (plan A is $1,000 deductible, plan b is $1,750 deductible) both cover general doctor visits 100% along with medications that we take 100%. But for some other services such as facility fees and outpatient visits there’s a difference in how they pay. Plan A does the deductible and then 30% coinsurance. Plan b does deductible and then either a 300 or a $450 copay per day (with a limit of $2,250 per admission). But what I can’t seem to figure out is an example of a allowable amount/fee schedule of what’s an expected amount for a facility fee or a hospital stay etc. The insurance is Maryland Care first Blue Cross Blue shield through the state exchange. If I just knew what their fee schedule is for these things I would be able to very easily calculate the differences and know which plan would work best for us but does anybody have any example prices of how much these stays tend to be so that I know which one is gonna be best? My spouse is Trans and is wanting to have some gender affirmation surgeries and I’m looking into some fertility treatments and (hopefully!) Child birth down the road.
If it helps for you to look up the exact plans plan A is blue choice HMO value gold 1000, and plan B is blue choice HMO gold 1750.
(I also noticed on the summary of benefits and coverage thing plan B mentions under the list of “are there services covered before you meet your deductible” that it mentions outpatient surgery does that refer to any/all outpatient surgery? Or Just certain preventative procedures?)
submitted by /u/fme222
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Hello! I’m trying to decide between 2 health plans. I’d like to consider myself pretty knowledgeable about health plans since I work at a durable medical equipment facility and I’m pricing people’s medical equipment off of their plans all day long, So it’s a bit embarrassing that I’m stumped right now haha. I have two plans that I’m looking at where the monthly premiums and even the deductible and out of pocket maximum are somewhat close to each other (plan A is $1,000 deductible, plan b is $1,750 deductible) both cover general doctor visits 100% along with medications that we take 100%. But for some other services such as facility fees and outpatient visits there’s a difference in how they pay. Plan A does the deductible and then 30% coinsurance. Plan b does deductible and then either a 300 or a $450 copay per day (with a limit of $2,250 per admission). But what I can’t seem to figure out is an example of a allowable amount/fee schedule of what’s an expected amount for a facility fee or a hospital stay etc. The insurance is Maryland Care first Blue Cross Blue shield through the state exchange. If I just knew what their fee schedule is for these things I would be able to very easily calculate the differences and know which plan would work best for us but does anybody have any example prices of how much these stays tend to be so that I know which one is gonna be best? My spouse is Trans and is wanting to have some gender affirmation surgeries and I’m looking into some fertility treatments and (hopefully!) Child birth down the road. If it helps for you to look up the exact plans plan A is blue choice HMO value gold 1000, and plan B is blue choice HMO gold 1750. (I also noticed on the summary of benefits and coverage thing plan B mentions under the list of “are there services covered before you meet your deductible” that it mentions outpatient surgery does that refer to any/all outpatient surgery? Or Just certain preventative procedures?)
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