Federal Insurance anyone?

[mustardseed2007]

We're trying to figure out if we'll be better off with BCBS basic, BCBS standard, or Aetna. We see a lot of specialists and may end up needing specialty drugs although, approval for that under any plan is not certain at all.


BCBS Basic requires you see preferred providers and has co pays. 


BCBS Standard has coinsurance of the BCBS rate, and the amount you pay is lower if you go to preferred providers.


We have been fine with sticking with the preferred provider network, and I've always assumed we're better off with paying a copay but the examples they give as the cost for office visits in the literature makes me wonder if our costs would be lower with standard....


I'm sorry, I know that's super specific and if you don't have federal insurance, you'll have no idea. The people at the health fair just told H to buy the most expensive plan and you'll have the best coverage. I mean...that's an approach I guess... 


 

[waverly]

I don't have federal but I usually decide based on the deductibles, max out of pocket amount, and co-pays. Since we have a lot of medical expenses, it works out way better for us to have a low deductible plan with co-pays rather than a high deductible plan. ETA- I also check to make sure the doctors I like are still covered at the minimum cost. 

If you know the name of the drug I may check that as well. When we needed DS's hearing aids, I had to pick the only low deductible plan that covered hearing aids.

The one and only time I was on an HMO, I hated every second of it because of the administration of it, but it's totally insurance company and plan specific.

[186momx]

Can you find an insurance agent to help you look at plans. I'm private pay but I meet with an agent each year in November to look at plans and see what is most cost effective. Always before DD had her own plan with a co-pay and a okay deductible while I had the high deductible HSA plan. This year the only option for DD was a co-pay plan that was $300 a month in premium or an HSA plan which makes no sense for a minor. This is the first year in 6 years that we are on a family HSA plan that is $475 a month in premiums. Neither of us have any medical issues going on so the high deductible HSA plan is okay. (Knock on wood)

[phdmomma]

We have an HMO (not federal, state employee), because for a low deductible plan for the family, the HMO is about $250 per month, while the PPO is $1,000 per month. I don't mind our HMO, but its part of the large hospital system at the university that I work at. If it wasn't a great HMO with great specialists I wouldn't probably like it so much.

[supertrooper1]

I have Federal BCBS. When I first started, I had the basic because I never used it. Them I switched to standard and will stay there. It's expensive but everyone tells me it's the Cadillac of insurance plans. In my area, it's hard to find someone that is NOT on the preferred list. It's very expansive. And if they're out of your network, I think less is covered, so you could keep a provider if you didn't want to switch.

[mommyatty]

When I worked for the feds, I never understood why anyone used BCBS. They were more expensive and covered less than anyone else. We had Aetna and NALC.

[mustardseed2007]

Dec 7, 2017 15:50:49 GMT -5 supertrooper1 said:

I have Federal BCBS. When I first started, I had the basic because I never used it. Them I switched to standard and will stay there. It's expensive but everyone tells me it's the Cadillac of insurance plans. In my area, it's hard to find someone that is NOT on the preferred list. It's very expansive. And if they're out of your network, I think less is covered, so you could keep a provider if you didn't want to switch.

Yes because almost everyone is in Network, it has not been a big deal to be on basic. What do you pay when you have a sick visit with the doctor supertrooper1? I was assuming a coinsurance was going to be higher than a copay but with the examples they give, it's not. 

On the other hand, we'd have to visit the doctor a lot to make up the 200 per month difference in premium. If both kids were on Growth Hormones now, we'd come out ahead b/c a 30 day supply would be 100 dollars cheaper per kid and the copay for specialists is lower, but I don't think we'll be on GH for another full year probably. 

I wonder if things have changed k3am? We haven't ever had something that wasn't covered. 

[jlaok]

We have federal insurance and had BCBS standard for years. It is expensive but also, like supertrooper1 said, is the Cadillac of insurance. We chose it because I was seeing a lot of specialist and we were going to try to get pregnant and didn't mind paying extra for great coverage. For example, I payed a $30 copay for the all the maternity care + delivery costs for each of my kids.

Last year we made a big switch from BCBS standard to GEHA standard. We did a huge comparison and the coverage is much the same, the only difference is that some of the fees are a percentage instead of a copay. We are saving almost $300/month in premiums so we figured that we'd still end up money ahead even if we had to see a specialist. DH ended up going to PT this calendar year and while each visit was more expensive we still ended up money ahead. Another thing to mention is that since we pay percentage instead of copay we hit our deductible earlier which reduced our out of pocket for the remainder of the year. Just something to consider.

I have never used BCBS basic but I have a friend who is on it with her and her family and really loves it.

[supertrooper1]

mustardseed2007, I've never reached my deductible, so I'm probably not the best person to answer your question about coinsurance vs. copay. Almost everything we've gone to the doctor for has been covered with just the copay. The exception has been my dermatologist, where she did some stuff that wasn't covered. That was a copay and coinsurance.

[k3am]

Dec 8, 2017 9:47:21 GMT -5 mustardseed2007 said:

Dec 7, 2017 15:50:49 GMT -5 supertrooper1 said:

I have Federal BCBS. When I first started, I had the basic because I never used it. Them I switched to standard and will stay there. It's expensive but everyone tells me it's the Cadillac of insurance plans. In my area, it's hard to find someone that is NOT on the preferred list. It's very expansive. And if they're out of your network, I think less is covered, so you could keep a provider if you didn't want to switch.

Yes because almost everyone is in Network, it has not been a big deal to be on basic. What do you pay when you have a sick visit with the doctor supertrooper1 ? I was assuming a coinsurance was going to be higher than a copay but with the examples they give, it's not. 

On the other hand, we'd have to visit the doctor a lot to make up the 200 per month difference in premium. If both kids were on Growth Hormones now, we'd come out ahead b/c a 30 day supply would be 100 dollars cheaper per kid and the copay for specialists is lower, but I don't think we'll be on GH for another full year probably. 

I wonder if things have changed k3am ? We haven't ever had something that wasn't covered. 

I think this is an erroneous tag. 

[mustardseed2007]

k3am, yes it was. Whoops! Sorry.

[mommyatty]

mustardseed2007, I think you meant me. When we were on it, with a lot of the plans, you got dental and vision benefits with your coverage, except for BCBS. So everything else was the same in terms of what was covered, but BCBS had no additional benefits. Since we were two adults and no kids, very healthy, we didn’t need much beyond check ups and an occasional sick visit for a sinus infection. But we both wore glasses and have teeth, so the vision and dental were huge. And BCBS was always, always by far the most expensive.

I’m insane about how I compare health benefits. I run scenarios: 1) unexpected pregnancy, 2) terrible accident with a hospitalization, 3) emergency surgery like appendectomy, and 4) no major medical issues. Then I look at total out of pocket for each scenario (premiums plus copays or Co insurance plus deductible plus out of pocket max). Then I choose what makes sense. BCBS was never even close to being in the running. It was always among the highest in terms of total cost because of the premiums.

My in laws never had anything but BCBS. They loved it, but they also never analyzed how much they were spending for what they were getting.

[mustardseed2007]

mommyatty, thanks!!