Quick ???? (I hope) about insurance coverage

[momster]

DH began a new job about 6 weeks ago and we had to choose between 2 insurance plans. We sorted through them and made a choice - and not his company has added a third choice and is opening enrollement until Friday. What I have learned in the few weeks that we have been on this plan, which is a PPO, is that the scripts are very expensive. Concerta is a $60 copay. So is My nasal steroid and my antihistamine - all third tier!!!

The new plan is an HMO, and our meds are all first or second tier meds, which means they're cheaper. But here is my question: both plans have an out of pocket maximum. In making our decision it would really help to know if scripts count towards the out of pocket max. Does anyone know (unfortunately there is no HR office on site to answer......)

Thanks for helping!!!

- momster

[mpalmer118]

We are on an PPO and scripts do not count towards deductible for us. I think (not positive) the biggest benefit of PPO vs. HMO is more freedom to choose doctors and not needing referals.

[momster]

Thanks for the info - I thought that must be the case, b/c a $2000 out of pocket doesn't go too far if you are paying $70 a script!!!!!

I've been on PPOs for the past 5 years,and you're right - it's better to choose your own doctor and be able to go out of network. That's especially true in Boston, where we have a big selection of hospitals, each of which has its own speciality, it seems. But if I am analyzing it right, the ppo would save $1000+ a year!!!!! Choice may be overrated.:rolleyes:

- momster

[lmb3]

Be careful though. We are on a PPO and love it. However, the out-of-pocket maximum does not include dr office co-pays either. $2000 is a low max too. Sounds good. Our is $2500 per person and $4000 per family. My son eats his up after 6 months so he is 'free' for the remainder of the year outside of dr. co-pays, but we never get to the family max.

[Denae]

The out of pocket max does NOT include co-pays for dr.visits and meds...

Your out of pocket is met by the percent that you pay for hospital admissions, equipment, testing, and other stuff that is usually paid by the insurance at a specific percent (usually 80%, you pay 20%)

I just started a new job not long ago and had to chose a plan, we went with a more expensive plan that covers everything at 100% after the deductible which is only $250 per member and $500 for the family....

The math for the others just added up more than I was willing to pay at each visit/ med/ admission....

[momster]

We've never had an out of pocket max that was so "low" - it's amazing what a misleading term that is - you'd think that "out of pocket" would mean, well, out of pocket!!!!!

Thanks for the advice.

- momster