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DW is on Bronze HSA PPO plan thru ACA. Very high deductible. She does not see doctors often. She switched PCP earlier this year and had the first visit with the PCP to get the base line, I guess. She also scheduled the annual physical later this year with the same PCP.
The bill now came in showing as office visit for $270. Insurance paid $2. She called and was told that the negotiated rate from that PCP office is simply high, and she hasn't satisfied her deductible yet. Her annual physical later this year would be no cost to her.
DW is on Bronze HSA PPO plan thru ACA. Very high deductible. She does not see doctors often. She switched PCP earlier this year and had the first visit with the PCP to get the base line, I guess. She also scheduled the annual physical later this year with the same PCP.
The bill now came in showing as office visit for $270. Insurance paid $2. She called and was told that the negotiated rate from that PCP office is simply high, and she hasn't satisfied her deductible yet. Her annual physical later this year would be no cost to her.
I guess this is normal?
Maybe C-D should split those with regular insurance from those with Medicare.
You will have to check with your insurance how this operates. Very possible with your deductible you still owe $268. Price does seem high for an "office visit" unless it also includes some tests, bloodwork, etc.
I am not familiar with "Bronze HSA PPO plan thru ACA" So I googled it.
What I go back was:
Quote:
Bronze health plan
One of 4 plan categories (also known as “metal levels”) in the Health Insurance Marketplace®.
Bronze plans usually have the lowest monthly premiums but the highest costs when you get care. They can be a good choice if you usually use few medical services and mostly want protection from very high costs if you get seriously sick or injured.
Note: Bronze plan deductibles can be very high. This means you could have to pay thousands of dollars of health care costs yourself before your plan starts to pay its share.
All health plans in all categories provide free preventive services, and some plans offer other services at low or no cost before you meet your deductible.
I do not use ACA, as my employer [US Navy] provides for my healthcare.
I assume OP doesn't understand what a high-deductible plan means - YOU (the insured) have to meet the deductible before they start paying their percentage.
An annual deductible isn't new or unusual. FWIW, I've had the same employer-sourced health insurance for something like 30 years. It wasn't a high deductible plan either. Every January a new out-of-pocket deductible was applied.
Hmm, I have a silver plan and have never paid more than a small copay for an annual physical. It’s supposed to be covered as preventative care, if you’re within network.
I recently changed PCP’s too and was wowed at the $400+ charge from the doctor. Everything, including bloodwork, was taken care of by my insurance.
DW is on Bronze HSA PPO plan thru ACA. Very high deductible. She does not see doctors often. She switched PCP earlier this year and had the first visit with the PCP to get the base line, I guess. She also scheduled the annual physical later this year with the same PCP.
The bill now came in showing as office visit for $270. Insurance paid $2. She called and was told that the negotiated rate from that PCP office is simply high, and she hasn't satisfied her deductible yet. Her annual physical later this year would be no cost to her.
I guess this is normal?
Her Bronze plan should give her three visits each year with her primary care doctor for $65/visit, without having to meet the deductible. After the three visits, then the deductible applies and its full pop. There is also a $0 "annual wellness" visit which is not a physical. My recollection is that full physicals aren't covered. Blood work is only $40 which is great. Here is a chart that outlines what's covered for each metal level, if you haven't already seen this. This insurance agent's blog has a lot of helpful info that helped me navigate ACA insurance, and later, Medicare.
Her Bronze plan should give her three visits each year with her primary care doctor for $65/visit, without having to meet the deductible. After the three visits, then the deductible applies and its full pop. There is also a $0 "annual wellness" visit which is not a physical. My recollection is that full physicals aren't covered. Blood work is only $40 which is great. Here is a chart that outlines what's covered for each metal level, if you haven't already seen this. This insurance agent's blog has a lot of helpful info that helped me navigate ACA insurance, and later, Medicare.
The OP's plan is an HSA-eligible HDHP. The $65 maximum copay you reference only applies to plans that do NOT qualify as HSA-eligible HDHP. The plan in your link has an $8200/$16,400 MOOP which exceeds the $7500/$15000 MOOP to qualify as HSA/HDHP.
Quote:
High deductible health plan. For calendar year 2023, a “high deductible health plan” is defined under § 223(c)(2)(A) as a health plan with an annual deductible that is not less than $1,500 for self-only coverage or $3,000 for family coverage, and for which the annual out-of-pocket expenses (deductibles, co-payments, and other amounts, but not premiums) do not exceed $7,500 for self-only coverage or $15,000 for family coverage.
Here is the Benefits Summary for one Covered CA HSA-eligible HDHP. With this plan, once the $7000 deductible/MOOP is met, non-preventive office visits have $0 copay in-network.
The OP's plan is an HSA-eligible HDHP. The $65 maximum copay you reference only applies to plans that do NOT qualify as HSA-eligible HDHP. The plan in your link has an $8200/$16,400 MOOP which exceeds the $7500/$15000 MOOP to qualify as HSA/HDHP.
Here is the Benefits Summary for one Covered CA HSA-eligible HDHP. With this plan, once the $7000 deductible/MOOP is met, non-preventive office visits have $0 copay in-network.
You are right. I forgot there are two Bronze plans, one regular and one HSA eligible. I knew someone who didn't have an HSA, thought both plans were the same, and signed up for the HSA eligible one. The non-HSA Bronze plan has bloodwork for $40; the HSA one was different, I think the deductible applied. Most healthy people never reach their deductible so the expenses can add up. It pays to study the plans closely, model your anticipated medical care needs, and choose accordingly.
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