My employer uses the Aon exchange, but the premiums for the different tiers and providers within each tier have changed significantly since last year making my current gold tier Aetna plan much more expensive.
My current plan has a $3600 out of pocket max, which I hit a couple months ago. If I switch to a silver level plan with Aetna, my premiums will basically be cut in half, and the out of pocket max is only $200 more. I could also switch to a silver tier plan with BCBS, which they’re referring to as the “low cost provider” for 2022 which would have the same out of pocket max as the Aetna silver plan, but the premiums are even lower (approx 25% of what I pay currently).
The high level summary info makes it sounds like all the plans within the same tier cover the same procedures, and all of my current doctors and prescriptions are listed as in network for both providers.
With all that said, I have several questions that I haven’t been able to find clear answers to so far:
1) Why would BCBS, which was one of the most expensive options last year, suddenly become dirt cheap this year (for bronze/silver plans, their gold option is still crazy expensive)? Should I be concerned that they’re going to find excuses to not cover anything to justify the price difference?
2) If there’s only a $200 difference between the out of pocket max for silver plans vs gold, is there any downside to choosing the silver plan other than planning to pay full price for my medications early in the year until I hit the $1500 deductible? I can also contribute to a HSA with the silver plan but not gold, and the silver plan would save me almost $2000 in lower premiums.
Note: I had a few one-time medical procedures/tests this year, but normally I’d expect to mainly just have medications and routine appointments as my primary medical expenses.
3) Within the same provider, can they selectively cover certain procedures or medications at the higher gold tier plan that wouldn’t be covered in the lower silver plan?
4) I’m having trouble figuring out if the plans offered are PPOs, HMOs or something else. Everything I’ve read just refers to the tier but not the plan type. Any idea where I could find that info? For example, another option is Kaiser, which I’ve heard doesn’t cover anything outside their own facilities, but none of the comparisons on the enrollment site suggest that Kaiser covers less or might be a different type of plan than the other providers…
5) Is there anything else I’m just totally missing here that would make it worth paying an extra $150 per paycheck just to reduce my out of pocket max by $200? Obviously I want to pay as little as possible, but my top priority is ensuring that an unexpected medical expense won’t put me $20k in debt because insurance won’t cover it.
submitted by /u/catqueen69
[link] [comments]My employer uses the Aon exchange, but the premiums for the different tiers and providers within each tier have changed significantly since last year making my current gold tier Aetna plan much more expensive. My current plan has a $3600 out of pocket max, which I hit a couple months ago. If I switch to a silver level plan with Aetna, my premiums will basically be cut in half, and the out of pocket max is only $200 more. I could also switch to a silver tier plan with BCBS, which they’re referring to as the “low cost provider” for 2022 which would have the same out of pocket max as the Aetna silver plan, but the premiums are even lower (approx 25% of what I pay currently). The high level summary info makes it sounds like all the plans within the same tier cover the same procedures, and all of my current doctors and prescriptions are listed as in network for both providers. With all that said, I have several questions that I haven’t been able to find clear answers to so far: 1) Why would BCBS, which was one of the most expensive options last year, suddenly become dirt cheap this year (for bronze/silver plans, their gold option is still crazy expensive)? Should I be concerned that they’re going to find excuses to not cover anything to justify the price difference? 2) If there’s only a $200 difference between the out of pocket max for silver plans vs gold, is there any downside to choosing the silver plan other than planning to pay full price for my medications early in the year until I hit the $1500 deductible? I can also contribute to a HSA with the silver plan but not gold, and the silver plan would save me almost $2000 in lower premiums. Note: I had a few one-time medical procedures/tests this year, but normally I’d expect to mainly just have medications and routine appointments as my primary medical expenses. 3) Within the same provider, can they selectively cover certain procedures or medications at the higher gold tier plan that wouldn’t be covered in the lower silver plan? 4) I’m having trouble figuring out if the plans offered are PPOs, HMOs or something else. Everything I’ve read just refers to the tier but not the plan type. Any idea where I could find that info? For example, another option is Kaiser, which I’ve heard doesn’t cover anything outside their own facilities, but none of the comparisons on the enrollment site suggest that Kaiser covers less or might be a different type of plan than the other providers… 5) Is there anything else I’m just totally missing here that would make it worth paying an extra $150 per paycheck just to reduce my out of pocket max by $200? Obviously I want to pay as little as possible, but my top priority is ensuring that an unexpected medical expense won’t put me $20k in debt because insurance won’t cover it. submitted by /u/catqueen69 [link] [comments]Read Morer/HealthInsurance