How much are office visits if it says " " 0% Coinsurance after deductible" for PPO plans?

Submitted by ctcx t3_z5n3ai in personalfinance

Comparing these two plans, the $512 is the HSA plan from Blue Cross https://imgur.com/a/XjwyRyE

The $512 Bronze 60, HDHP PPO, HSA, 7k deductible is the one that I am considering.

For doctor visit costs for primary care and specialist visits it says " 0% Coinsurance after deductible". I know that means that oncei pay 7k, then insurance will cover it..

But how much will I actually pay for office visits and specialist visits? Can someone give me an estimate?

Is the HSA plan worth it despite the higher monthly office visits?

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Ciderwood t1_ixwzh2n wrote

It can literally be anything until you reach $7000 in expenses. Its like any other service; the healthcare provider sets a price and you pay it. Usually it’s the uninsured price, but it may range a little bit because you still bill it to insurance for proof paying towards the deductible. That range is due to the “contracted” amount agreed to between the healthcare provider and the insurance company.

Ask your provider what they charge for their service before getting it, you can usually get the pricing online or by giving a call. Again, it’ll be an estimate based off the uninsured price, but it’ll likely be close to the number you’ll end up paying.

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ctcx OP t1_ixx1nc3 wrote

Ah I see. Makes sense. Most likely it will be higher than the copays of the non-deductible plan right I suppose, or again it could vary I guess.

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Ciderwood t1_ixx6m0g wrote

Unless you think you’re gonna spend more than $6300 on healthcare this year, it doesn’t really matter. The only thing that looks more beneficial possibly is that $65 copay that you get for 3 visits before it requires paying the deductible, but if you need to go to the doctor more than that then that also doesn’t matter.

Honestly both these plans are really bad, I’m sorry that these are your options.

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ctcx OP t1_ixx81iy wrote

I have other options but that was the only HSA option with Blue Shield. I was interested in HSA mainly for investing purposes in addition to my SEP plan. There is a Health Net bronze plan for $418 with a 7k deductible but I think Blue shield has the best network.

Another option is Silver PPO $647, $4750 deductible (not HSA)

Plan Highlights

Total Expense Estimate $8560.11

Plan Name Silver 70 PPO

Primary Care Visits You pay $45

Generic Drugs You pay $16

Yearly Deductible $4750 / $85

Health Savings Account (HSA) No

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NickyNackyPattyWacky t1_ixx2gov wrote

It depends on the doctor. For a primary visit, it usually is around $150ish for me. I just went to an ENT and it was $315 just for the visit alone. I went to a derm and it was between $210- $250ish just for the visit alone. If you have anything else done at the office, it'll cost more. So at the ENT they used a scope and it cost another $230.

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ctcx OP t1_ixx3yet wrote

Damn, what kind of insurance plan do you have? PPO and what company?

I guess I am used to the cheaper prices at Kaiser....

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NickyNackyPattyWacky t1_ixx51j5 wrote

A CDH/HDHP plan. When you have a HDHP plan you're paying the full (discounted) cost for the service until you hit the deductible. All insurance has similar negotiated discounts on costs. It's practically like your insurance doesn't start doing anything until you hit that. If you have a true PPO plan, you just pay copays, not the full cost but your premiums are bigger. I don't know your area of the country and such but doctors office visits arent cheap. If you go HDHP, this is what it'll probably be like. You pay less premiums to have the insurance cover less...that is until you hit the deductible. I'm younger and rarely go to the doctor ever so I have always gone for a CDH plan because it's the lowest cost overall. Also my companies have given me HSA money too so I can always use that to cover cost of need be. I'll start paying larger premiums and go PPO once doctors visits become more regular. You can roughly estimate how much in total costs you'll have in a year between premiums+out of pocket cost and roughly determine which plan makes more sense for you. My deductibles have always been low anyway, but I've never even come close to hitting it. So I'm sticking with what I'm doing for now. Again, younger and no chronic medical issues yet. Your situation determines which makes more sense for you.

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ctcx OP t1_ixx5vpw wrote

For me the true PPO plan is just a few bucks more. You can see it here https://imgur.com/a/XjwyRyE

Is it worth it having a HSA when the co payments are higher? For the true PPO Bronze Plan the first 3 visits are $65 before deductible and $95 for a specialist after deductibe...

Ok, I see why people like using their credit cards to get points/cash back now instead of paying directly with the HSA card.... It can get pretty expensive

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NickyNackyPattyWacky t1_ixx7l1h wrote

That looks different than what I'm used to. Your PPO doesn't have standard copays, it's still after deductible. Only your first 3 visits are $65. I'm used to seeing a PPO where you always have copays. This basically looks like the HDHP plans with slightly different rules. It's practically the same. How often you go to the doctor will determine which is better so you'll have to do a guestimate of how often you'll go to the doctor in a year and what kinds of doctors and what that'll cost under each plan. Then take the difference in premiums and add that too.

HSA money is tax free. So if you know you have a certain amount of medical expenses for sure, you can contribute that tax free money to your HSA and use it when you have medical expenses. You can also invest that money and use your HSA as sort of a retirement account so it's usually recommended to max out your contribution and do that.

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ctcx OP t1_ixx88sw wrote

Silver and up are the only plans with standard copays on the Covered CA website. I am self employed so these are the plans that I'm stuck with it. Yea, looks like only Silver and Gold have standard copays.

Silver 70 PPO

SILVER PPO

$647.67

$45 copay

Specialist $85 copay

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Only the bronze plans have HSA for me. I could afford the silver plan but I kind of wanted a HSA plan to invest but with more standard co-pays

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