Questions: Plan Selection Help for Chronic Health Condition

I’m really lost. I have a chronic health condition (Type 1 diabetic) and will be purchasing DME in excess of $3000 next year in January. I want to make sure I’m making the right choices. I’d really appreciate some guidance.

Details: I am in the US and am married. I have a chronic health condition that results in monthly prescriptions, monthly DME (durable medical equipment), 4-ish Primary Care visits, and 6-ish specialists visits per year, with a higher than average likelihood of ER/hospitalization.

In 2021 under the Anthem Base PPO it looks like I will have paid apox. $800 in prescriptions, $300 in office visits, $700 in labs, and $1800 in DME

Question #1: my plan options make the CDHP+HSA look really good, but everything I read says they are not good for those with high health costs. Are my choices just that good or am I missing something?

Question #2: My spouse is on my insurance currently, and I intended to switch to the Anthem CDHP+HSA for both of us, but the survey said we can’t receive any non-CDHP health coverage? He’s a veteran and receives coverage from our state for his health care – it is not Tricare. So we discussed removing him from my benefits. It’s not something he renews or can opt out of – does it really preclude us from the CDHP?

Question #3: Why is health insurance so confusing?

Anthem CDHP +HSA Anthem Base PPO Kaiser CDHP +HSA Kaiser HMO Premiums – Family $91 +$100 per pay period $113 per pay period $60 +$100 per pay period $145 per pay period Premiums – Individual $38 +$100 HSA per pay period $51 per pay period $26 +$100 HSA per pay period $73 per pay period Company Contribution to HSA 1300/Individual, 2600/Family NA 1300/Individual, 2600/Family NA Annual Deductible 2000/Individual, 2800/Individual in Family, 4000/Family 1300/Individual, 2600/Family 2000/Individual, 2800/Individual in Family, 4000/Family None Annual Deductible Note Coinsurance at 85% for most services Coinsurance at 85% for most services Relevant copays after deductible None Out of pocket Max (including deductible) 3000/Individual, 3000/Individual in Family, 6000/Family 6000/Individual, 2600/Family 3000/Individual, 3000/Individual in Family, 6000/Family 1500/Individual, 3000/Family Office Visit/Specialist Office Visit 15% after deductible for both $25 copay / $30 copay $30 copay / $30 copay $20 copay / $20 copay Well Care for Adults/Children No Cost No Cost No Cost No Cost ER/Inpatient Hospital 15% after deductible $150 copay/ 15% after deductible $100 per visit after deductible / $250 per admission after deductible $100 copay/ $250 copay Preventative Care Drugs No Cost Relevant Copay No Cost Relevant Copay Generic Drugs/Preferred Drugs 15% after deductible $10 copay/ $30 copay $10 copay/$30 copay ( + 50% covered expense and any balance) $10 copay /$20 copay

submitted by /u/Hahentamashii
[link] [comments]I’m really lost. I have a chronic health condition (Type 1 diabetic) and will be purchasing DME in excess of $3000 next year in January. I want to make sure I’m making the right choices. I’d really appreciate some guidance. Details: I am in the US and am married. I have a chronic health condition that results in monthly prescriptions, monthly DME (durable medical equipment), 4-ish Primary Care visits, and 6-ish specialists visits per year, with a higher than average likelihood of ER/hospitalization. In 2021 under the Anthem Base PPO it looks like I will have paid apox. $800 in prescriptions, $300 in office visits, $700 in labs, and $1800 in DME Question #1: my plan options make the CDHP+HSA look really good, but everything I read says they are not good for those with high health costs. Are my choices just that good or am I missing something? Question #2: My spouse is on my insurance currently, and I intended to switch to the Anthem CDHP+HSA for both of us, but the survey said we can’t receive any non-CDHP health coverage? He’s a veteran and receives coverage from our state for his health care – it is not Tricare. So we discussed removing him from my benefits. It’s not something he renews or can opt out of – does it really preclude us from the CDHP? Question #3: Why is health insurance so confusing? Anthem CDHP +HSA Anthem Base PPO Kaiser CDHP +HSA Kaiser HMO Premiums – Family $91 +$100 per pay period $113 per pay period $60 +$100 per pay period $145 per pay period Premiums – Individual $38 +$100 HSA per pay period $51 per pay period $26 +$100 HSA per pay period $73 per pay period Company Contribution to HSA 1300/Individual, 2600/Family NA 1300/Individual, 2600/Family NA Annual Deductible 2000/Individual, 2800/Individual in Family, 4000/Family 1300/Individual, 2600/Family 2000/Individual, 2800/Individual in Family, 4000/Family None Annual Deductible Note Coinsurance at 85% for most services Coinsurance at 85% for most services Relevant copays after deductible None Out of pocket Max (including deductible) 3000/Individual, 3000/Individual in Family, 6000/Family 6000/Individual, 2600/Family 3000/Individual, 3000/Individual in Family, 6000/Family 1500/Individual, 3000/Family Office Visit/Specialist Office Visit 15% after deductible for both $25 copay / $30 copay $30 copay / $30 copay $20 copay / $20 copay Well Care for Adults/Children No Cost No Cost No Cost No Cost ER/Inpatient Hospital 15% after deductible $150 copay/ 15% after deductible $100 per visit after deductible / $250 per admission after deductible $100 copay/ $250 copay Preventative Care Drugs No Cost Relevant Copay No Cost Relevant Copay Generic Drugs/Preferred Drugs 15% after deductible $10 copay/ $30 copay $10 copay/$30 copay ( + 50% covered expense and any balance) $10 copay /$20 copay ​ submitted by /u/Hahentamashii [link] [comments]Read Morer/HealthInsurance

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