Need help selecting health plan

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Topic Author
peterwantstosave
Posts: 505
Joined: Fri Nov 24, 2017 7:28 pm

Need help selecting health plan

Post by peterwantstosave »

Friends,

New job starts tomorrow (yay!)

Partner and I each have extremely complicated medical situations. We need the best plan, that covers the most things, even if it is a more expensive plan. Most of our medical care will probably be outside of our local area. We live in a small town in Western Illinois. Coverage options are detailed in full at: mybenefits.illinois.gov

Here are our health plan options:

Aetna HMO (Group Number 285654)
Aetna OAP (Group Number 285650)
Aetna PPO (Group Number 285658) (QCHP and CDHP options)
Blue Advantage HMO (Group Number B06800)
HMO Illinois (Group Number H06800)
Blue Cross Blue Shield OAP (Group Number 263995)
Health Alliance HMO (Group Number 2001688)
Healthlink OAP (Group Number 160000)

I'm leaning toward Aetna PPO CDHP or BCBS OAP. Aetna PPO CDHP does come with an HSA.

Can you help? Local hospital apparently does not take Aetna. What?! Not a huge deal, but seriously. Imagine most medical care will either be in MN or in major cities in IL or IA.

Thanks so much, Peter
deikel
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Joined: Sat Jan 25, 2014 6:13 pm

Re: Need help selecting health plan

Post by deikel »

I think the info is too vague

Anecdotally, I can tell you that my local Aetna is ...lousy. And very few accept it here.

Also, since most your care is outside your area a PPO is probably the thing to do and you probably do NOT want an HSA, because that implies an underlying high deductible plan and you want a 'co-pay plan' to limit your overall cost (assuming you both need visits often)

BCBS is a nationwide system that gets you treatment 'in network' almost anywhere - I would go check the BCBS OAP plan out in more detail and check for the in network and out of network co pay
Everything you read in this post is my personal opinion. If you disagree with this disclaimer, please un-read the text immediately and destroy any copy or remembrance of it.
Topic Author
peterwantstosave
Posts: 505
Joined: Fri Nov 24, 2017 7:28 pm

Re: Need help selecting health plan

Post by peterwantstosave »

Assuming I clicked correctly, here is the BCBS OAP information page:

https://www.bcbsil.com/stateofillinois/ ... co-oap.pdf

Does this information help?

P
deikel
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Joined: Sat Jan 25, 2014 6:13 pm

Re: Need help selecting health plan

Post by deikel »

peterwantstosave wrote: Thu Jun 30, 2022 12:55 pm Assuming I clicked correctly, here is the BCBS OAP information page:

https://www.bcbsil.com/stateofillinois/ ... co-oap.pdf

Does this information help?

P
I guess I don't have much experience with OAP plans, but that looks like the plan changes form a co-pay plan with local doctors to a 90% pay PPO plan for others in network - which you would probably fall under since you said your care is further away form your home - so you need to compare Tier II

It may help to confirm with your doctors that they do indeed accept BCBS and are in BCBS network (or look up BCBS website to google for the Dr name to confirm participation)

In that case, you do have to compare with a high deductible plan since the 90% payout is effectively a deductible plan - just at a higher payout and presumable lower max deductible (for a higher premium)

If you have previous years actual medical cost data, you can use that to model against the available plans to have an idea which will be beneficial to you or what max costs you should plan for.
Everything you read in this post is my personal opinion. If you disagree with this disclaimer, please un-read the text immediately and destroy any copy or remembrance of it.
Topic Author
peterwantstosave
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Joined: Fri Nov 24, 2017 7:28 pm

Re: Need help selecting health plan

Post by peterwantstosave »

Thanks so much.

I welcome all opinions.

More thoughts?
jeam3131
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Joined: Sun Aug 26, 2018 2:48 pm

Re: Need help selecting health plan

Post by jeam3131 »

each of these plans should come with a summary document that describes how they work, what they cover etc.
read it, get to know the language. its important that you understand the basics of health insurance
Katietsu
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Re: Need help selecting health plan

Post by Katietsu »

Out of network with almost every provider is basically useless, in my experience. Notice it says % of allowable charges. Allowable charges sometimes might only be 10% of what you are billed. So 60% coverage can become 6% coverage. And the 90% that is not allowable charges does not count towards your out of pocket maximum in my experience.

So, one of the most important factors is always to assess network and how it fits your needs. Along with network would be the prescription drug benefit and how the formulary meets your needs.

After that you can compare premiums, co pays, deductibles and out of pocket maximums. If you could predict ahead of time the care you will need, you could pick the right one. But otherwise, the variability between the best and worst is usually not as great as it might initially seem.
Topic Author
peterwantstosave
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Joined: Fri Nov 24, 2017 7:28 pm

Re: Need help selecting health plan

Post by peterwantstosave »

jeam3131 wrote: Thu Jun 30, 2022 2:58 pm each of these plans should come with a summary document that describes how they work, what they cover etc.
read it, get to know the language. its important that you understand the basics of health insurance
You're correct, it Is important to understand the basics of health insurance. I'm just trying to make the best decision for me and my dear ones.

P
Topic Author
peterwantstosave
Posts: 505
Joined: Fri Nov 24, 2017 7:28 pm

Re: Need help selecting health plan

Post by peterwantstosave »

Katietsu wrote: Thu Jun 30, 2022 3:06 pm Out of network with almost every provider is basically useless, in my experience. Notice it says % of allowable charges. Allowable charges sometimes might only be 10% of what you are billed. So 60% coverage can become 6% coverage. And the 90% that is not allowable charges does not count towards your out of pocket maximum in my experience.

So, one of the most important factors is always to assess network and how it fits your needs. Along with network would be the prescription drug benefit and how the formulary meets your needs.

After that you can compare premiums, co pays, deductibles and out of pocket maximums. If you could predict ahead of time the care you will need, you could pick the right one. But otherwise, the variability between the best and worst is usually not as great as it might initially seem.
well stated, thank you
jeam3131
Posts: 268
Joined: Sun Aug 26, 2018 2:48 pm

Re: Need help selecting health plan

Post by jeam3131 »

peterwantstosave wrote: Thu Jun 30, 2022 3:32 pm
jeam3131 wrote: Thu Jun 30, 2022 2:58 pm each of these plans should come with a summary document that describes how they work, what they cover etc.
read it, get to know the language. its important that you understand the basics of health insurance
You're correct, it Is important to understand the basics of health insurance. I'm just trying to make the best decision for me and my dear ones.

P
yup, and no one else is going to a better job at that than you
mkc
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Re: Need help selecting health plan

Post by mkc »

deikel wrote: Thu Jun 30, 2022 2:48 pm
It may help to confirm with your doctors that they do indeed accept BCBS and are in BCBS network (or look up BCBS website to google for the Dr name to confirm participation)
The doctors themselves likely won't know the specifics of the networks - they might know they are in one of BCBS's networks, but there is a good chance they are not in all of them. The best bet is the provider directory which should be accessible via the insurer website. OP will need to know (and apparently has) the exact plan info and can select the network used by that plan.

Insurers have many networks each with a set of providers. There will be some overlap, but even within a zip code there can be different networks with different subsets of providers, depending on the plan itself.

Also look at out-of-network coverage. The HMOs likely don't have any. PPOs often do. Since OAPs can be both HMO-like (everything must go through PCP and get approved, even if it is from a pre-approved specialist, say physical therapy prescribed by an orthopedic doc) and PPO-like, you'll need to drill down into the details of those.
furwut
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Re: Need help selecting health plan

Post by furwut »

Most of our medical care will probably be outside of our local area.
This may sound shocking but, if you have predictable expensive medical needs, you may have to consider moving and taking a job where you can receive the services at a contracted in-network price. Out-of-network charges will quickly financially ruin almost anyone.
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quantAndHold
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Location: West Coast

Re: Need help selecting health plan

Post by quantAndHold »

Presumably you have a list of providers you already see. Call each of them and ask if they’re in network on any of the plans. Create a spreadsheet. Run the numbers using your last couple of year’s costs. What would the premiums be, and what would your out of pocket be with each plan.

Note that if you have providers that are out of plan, you may be changing providers. Out of network coverage is only really meant to be used as a last resort.
AnEngineer
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Re: Need help selecting health plan

Post by AnEngineer »

peterwantstosave wrote: Thu Jun 30, 2022 12:36 pm We need the best plan, that covers the most things, even if it is a more expensive plan.
I don't see how you could possibly know this without having already gone through the analysis of every plan available to you. Some plans are both more expensive and have higher maximum total expenditures, it really depends on the details. High deductible plans can be surprisingly good in such cases.
Topic Author
peterwantstosave
Posts: 505
Joined: Fri Nov 24, 2017 7:28 pm

Re: Need help selecting health plan

Post by peterwantstosave »

thanks all

went with BCBS OAP

fondly, Peter
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