I’m in a bit of a unique situation and could really use some help before everything goes to hell. Currently 30 years old with a rare type of cancer being seen at a major cancer center MSKCC and currently have United Healthcare Oxford PPO OHI with a 1200 ded and 2400 max oop. I’m disabled and cannot work and also have medicare part a. I’ve been disabled for over 2 years now. My wifes new job will offer Oxford Metro “G MTRO GT 25/40/1250/80 EPO 21 CNT” which apparently MSKCC accepts according to their online system. But the “gated” part concerns me, does this mean I can be denied coverage due to my condition or that I need a referral to get back into being treated at MSK? I am currently getting MRI’s everything 2-3 months and am on a tier 3 siezure medication Briviact and only pay about $40/month and the new plan says something along the lines of full price until deductible then $95/refill. The MRI’s are similar, its “Full price until the deductible, then $150 per scan. “
The basics I see online about this specific plan is :
Plan Network MetroNetwork
Type EPO
Deductible $1,250 per individual, $2,500 per family
Annual Out-of-Pocket Limit $5,500 per individual, $11,000 per family
Coinsurance 20%
Health Savings Account (HSA) Eligible No
I think my current is the same deductible/out of pocket but with a 0% coinsurance. I tend to max out everything within the first few months with one scan and one refill.
Is this plan significantly worse or going to screw me over? Or is it acceptable for my condition? Can someone really help break down the entire cost process and definitions for someone like me? (Brain Cancer so I’m a bit slower than I used to be)
submitted by /u/tehunderdoge
[link] [comments]
I’m in a bit of a unique situation and could really use some help before everything goes to hell. Currently 30 years old with a rare type of cancer being seen at a major cancer center MSKCC and currently have United Healthcare Oxford PPO OHI with a 1200 ded and 2400 max oop. I’m disabled and cannot work and also have medicare part a. I’ve been disabled for over 2 years now. My wifes new job will offer Oxford Metro “G MTRO GT 25/40/1250/80 EPO 21 CNT” which apparently MSKCC accepts according to their online system. But the “gated” part concerns me, does this mean I can be denied coverage due to my condition or that I need a referral to get back into being treated at MSK? I am currently getting MRI’s everything 2-3 months and am on a tier 3 siezure medication Briviact and only pay about $40/month and the new plan says something along the lines of full price until deductible then $95/refill. The MRI’s are similar, its “Full price until the deductible, then $150 per scan. ” The basics I see online about this specific plan is : Plan Network MetroNetwork Type EPO Deductible $1,250 per individual, $2,500 per family Annual Out-of-Pocket Limit $5,500 per individual, $11,000 per family Coinsurance 20% Health Savings Account (HSA) Eligible No I think my current is the same deductible/out of pocket but with a 0% coinsurance. I tend to max out everything within the first few months with one scan and one refill. Is this plan significantly worse or going to screw me over? Or is it acceptable for my condition? Can someone really help break down the entire cost process and definitions for someone like me? (Brain Cancer so I’m a bit slower than I used to be)
submitted by /u/tehunderdoge [link] [comments]Read Morer/HealthInsurance