Change from HMO to High Deductible?I am currently enrolled in my company's HMO plan but am deciding if i should switch to their High Deductible Plan now that I am pregnant. Below are the plan details:
HMO: $ 146.82 (Self Only) In Monthly Premiums
High Deductible: $ 121.34 (Self Only) In Monthly Premiums
HMO PLAN:
o Copayments: $ 20 for Primary Care and $ 40 for Specialty Care
o No Deductible applies
o Coinsurance of 80% / 20%
o Annual Copayment Maximum of $ 3,500 (individual) or $ 9,400 (family)
o No charge on preventative care or prenatal care visits
o $ 75 emergency room visit charge
o Prescription Plan: $ 10 Generic/ $ 25 Preferred/ $ 40 Non-Preferred
HIGH DEDUCTIBLE PLAN:
o Operates as an HMO Plan with a high deductible amount included
o Meet a deductible of $ 1,250 (individual) or $ 2,500 (family) and then you are covered at 100% with no copayments, prescription charges, lab fees, etc.
o Annual Out-of-Pocket Maximum of $ 2,500 (individual) or $ 5,000 (family)
o No charge on preventative care visits and Vision benefits are included
o Ambulance and Prescriptions are covered at 100% after deductible
Let me know which plan is best. I feel that since I am pregant, I will most likely spend the $ 1250 in lab work and the hospital when i have the baby, so I might as well go with the High Deductible. I may be looking at it wrong though. Also, what happens when the baby is born. Is the baby's bill paid for by my plan or out of pocket? Thanks!
33 minutes ago - 4 days left to answer.
Posted by plain ol' bill
We can't tell you what is best for your situation. That is something you need to do.
After the child is born, you have 30 days to add them to your coverage.
Posted by mbrcatz
Are you sure about that deductible? $ 1250 isn't particularly "high".
Plus, you need to see what the maternity benefit is with each plan. That HMO maternity deductible might be $ 250. Not $ 1250.
Baby is NOT automatically covered. You have 30 days from baby's date of birth, to add them to your policy - if you can. You then have to pay the extra premium, and baby's coverage is RETROACTIVE to baby's date of birth. If you don't add baby within that 30 days, you'll get a bill for all baby's services, from when they are born, from the hospital and doctors.
Some insurances, will pay for a regular NURSERY care (but not pediatrician or tests) under mom's coverage, for two days. You'll have to call YOUR insurance and ask. Call the insurance company, directly - and take notes, including who you talk to, and ask for something in writing from them, so it doesn't come back later to haunt you.
Posted by lucy
You save $ 25.48 per month in premium times 12 months equals $ 305.76.
1st off, take the baby and pregnancy out of the picture. Look back in your records to see how much you paid out of pocket for medical care, either for co-pays, and co-insurance and total up the costs. Do you take prescriptions, if so, how much did you spend out of pocket last year?
Have you used an ambulance in the past? Most people never do, unless in an auto accident. Do you go to the emergency room a lot or rarely?
Total up your prior costs and see how much you actually spent. Then I suggest with your calculations talk to your HR department and ask them for their advice on which policy might work best for you.
good luck and healthy baby.
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