Good Morning!
I am located in Indiana. I have filled out our ACA application and have narrowed down our choices to three plans (all Silver level plans). My children are covered through state insurance, so the following only relates to myself and my husband.
I have Type 1 Diabetes and need three prescriptions filled monthly. I have already determined that each of these plans covers my prescription medicine (insulin-Humalog as a Tier 2 preferred medicine costing $40 per month) and have the same details concerning Durable Medical Equipment (10% coinsurance after deductible), which I need for my insulin pump and continuous glucose monitor. My doctors are also considered in network. The following plans are the only choices in the Silver range that cover my insulin and consider my doctors in network.
The three plans are all offered through CareSource.
First Plan: CareSource Low Premium Silver 2. $340.13 per month/$4,081.56 for the year
Individual Deductible: $1,300/ Family Deductible $2,600.
Individual Out of Pocket Maximum $2,800/ Family Out of Pocket Maximum $5,600
Second Plan: CareSource Standard Silver 2. $381.24 per month/$4,574.88 for the year
Individual Deductible: $1,200/ Family Deductible $2,400.
Individual Out of Pocket Maximum $2,600/Family Out of Pocket Maximum $5,200
Third Plan: CareSource Low Deductible Silver 2 $405.35 per month/$4,864.20 for the year
Individual Deductible: $900/ Family Deductible: $1,800
Individual Out of Pocket Maximum $2,500/Family Out of Pocket Maximum $5,000
My first question concerns the language in the plan documents. The plan details for each of the listed plans states in regards to the overall deductible, “Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay. If you have other family members on the plan, each family member must meet their own individual deductible until the total amount of deductible expenses paid by all family members meets the overall family deductible.”
In terms of out of pocket maximum, each plan states, “The out-of-pocket limit is the most you could pay in a year for covered services. If you have other family members in this plan, they have to meet their own out-of-pocket limits until the overall family out-of-pocket limit has been met.” Does this mean that if my husband doesn’t meet his individual deductible the plan won’t begin covering my Durable Medical Equipment at 90% (which is what 10% coinsurance means, correct?)? If that is the case, I need to go back and look through the gold tier plans because the costs of my supplies out of pocket for the year would be crippling.
If I only need to meet my individual deductible (or individual out of pocket maximum) before these plans cover my durable medical equipment, then I have a follow up question. If I know I will always reach my individual deductible within the first month of having the insurance, does it make the most sense to pick the plan that has the cheaper monthly charge or the plan with the lowest deductible? After I pay my individual deductible, my monthly cost for prescriptions will be around $100. If our family has to pay the entire family deductible before the plans cover Durable Medical Equipment costs then the third plan, with the yearly premium added to the family deductible, is the cheapest option at $6,664.2. If I only need to pay my individual deductible before the plans cover Durable Medical Equipment costs then the first plan, with the yearly premium added to the individual deductible, is the cheapest option at $5,381.56.
We have only ever had health insurance through my husband’s job (always UnitedHealth Care) and always chose the most expensive/gold plan because of the amount of prescription costs associated with being diabetic. Trying to understand all of the language in the plan documents feels overwhelming and I do not want to saddle us with all of the costs associated with diabetes because I didn’t understand which choice to pick. I just want to make sure that I understand what CareSource is offering through these plans.
I apologize for the length of the post but am so grateful for any help and advice you can provide!
submitted by /u/Frequent_Coffee_3148
[link] [comments]
Good Morning! I am located in Indiana. I have filled out our ACA application and have narrowed down our choices to three plans (all Silver level plans). My children are covered through state insurance, so the following only relates to myself and my husband. I have Type 1 Diabetes and need three prescriptions filled monthly. I have already determined that each of these plans covers my prescription medicine (insulin-Humalog as a Tier 2 preferred medicine costing $40 per month) and have the same details concerning Durable Medical Equipment (10% coinsurance after deductible), which I need for my insulin pump and continuous glucose monitor. My doctors are also considered in network. The following plans are the only choices in the Silver range that cover my insulin and consider my doctors in network. The three plans are all offered through CareSource. First Plan: CareSource Low Premium Silver 2. $340.13 per month/$4,081.56 for the year Individual Deductible: $1,300/ Family Deductible $2,600. Individual Out of Pocket Maximum $2,800/ Family Out of Pocket Maximum $5,600 Second Plan: CareSource Standard Silver 2. $381.24 per month/$4,574.88 for the year Individual Deductible: $1,200/ Family Deductible $2,400. Individual Out of Pocket Maximum $2,600/Family Out of Pocket Maximum $5,200 Third Plan: CareSource Low Deductible Silver 2 $405.35 per month/$4,864.20 for the year Individual Deductible: $900/ Family Deductible: $1,800 Individual Out of Pocket Maximum $2,500/Family Out of Pocket Maximum $5,000 My first question concerns the language in the plan documents. The plan details for each of the listed plans states in regards to the overall deductible, “Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay. If you have other family members on the plan, each family member must meet their own individual deductible until the total amount of deductible expenses paid by all family members meets the overall family deductible.” In terms of out of pocket maximum, each plan states, “The out-of-pocket limit is the most you could pay in a year for covered services. If you have other family members in this plan, they have to meet their own out-of-pocket limits until the overall family out-of-pocket limit has been met.” Does this mean that if my husband doesn’t meet his individual deductible the plan won’t begin covering my Durable Medical Equipment at 90% (which is what 10% coinsurance means, correct?)? If that is the case, I need to go back and look through the gold tier plans because the costs of my supplies out of pocket for the year would be crippling. If I only need to meet my individual deductible (or individual out of pocket maximum) before these plans cover my durable medical equipment, then I have a follow up question. If I know I will always reach my individual deductible within the first month of having the insurance, does it make the most sense to pick the plan that has the cheaper monthly charge or the plan with the lowest deductible? After I pay my individual deductible, my monthly cost for prescriptions will be around $100. If our family has to pay the entire family deductible before the plans cover Durable Medical Equipment costs then the third plan, with the yearly premium added to the family deductible, is the cheapest option at $6,664.2. If I only need to pay my individual deductible before the plans cover Durable Medical Equipment costs then the first plan, with the yearly premium added to the individual deductible, is the cheapest option at $5,381.56. We have only ever had health insurance through my husband’s job (always UnitedHealth Care) and always chose the most expensive/gold plan because of the amount of prescription costs associated with being diabetic. Trying to understand all of the language in the plan documents feels overwhelming and I do not want to saddle us with all of the costs associated with diabetes because I didn’t understand which choice to pick. I just want to make sure that I understand what CareSource is offering through these plans. I apologize for the length of the post but am so grateful for any help and advice you can provide!
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