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Old 10-30-2013, 06:35 AM
 
Location: RTP area, NC
1,277 posts, read 3,019,001 times
Reputation: 946

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Has anyone figured out wake county / BCBS North Carolina policies on co-insurance and its interaction with out of pocket maximum?

so....I understand the concept of the deductible and out of pocket maximum for individuals and families.

But many of the 2014 plans include co-insurance. Per their examples, co-insurance seems to be in addition to the deductible. But how does it figure in with out of pocket maximum? anyone know or asked?

for example, is co-insurance in addition to the out of pocket maximum?

If it is, it adds considerable risk to the costs of the following plans.

I number crunched four advantage plans for a family of four (two adults, two teens) and the numbers are really baaaaadddddddd.

I have (in columns) our plan currently in the first column then three alternative plans that are similar in coverage to what we have now according to BCBSNC...<sigh> but they aren't really similar due to the co-insurance thing which I don't quite understand.

Advantage plans:
current plan: bronze 5500 bronze 2700 silver 3000
$600 $900 $973 $1,056 (premium/mo)
$7200 $10,800 $11,676 $12,673 (premium/yr)
$5400 $11,000 $5,400 $6,000 (deductible/family)
$5400 $11,000 $12,700 $12,700 (out of pocket max/family)
$12,624.00 $21,800 $24,376 $25,373 (total needed for premiums& rainy day fund)
no co-ins 0%/30%out 50% 30% in network (coinsurance)
yes yes yes no (Hsa eligible?)

Rx coverage is just too complicated to include but that comes into play too...

So bottom line....premiums are going up by at least 50% for less coverage -- deductible will be doubled, the HSA doesn't even come close to covering the deductible now (it used to match it) and I am unsure of the impact of co-insurance to my bottom line. Big OUCH.

However, this co-insurance addition is confusing -- I like to make sure I put away in a rainy day fund enough to cover a significant illness. If co-insurance is unlimited, then I just don't know how much to put in a rainy day fund to ever cover such a thing. any ideas?

I've been a proponent of the ACA making my premiums being nice & stable for the past 5 years, but next year kind of bites hard...
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Old 10-30-2013, 06:46 AM
 
Location: Oxxford Hunt, Cary NC
4,188 posts, read 9,811,768 times
Reputation: 3821
You pay 100% out of pocket until you meet your deductible. After that, if there is co-insurance you pay that until reaching the out of pocket maximum for the year.

https://www.healthcare.gov/glossary/co-insurance/
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Old 10-30-2013, 07:45 AM
 
Location: Carpenter Village, Cary
386 posts, read 671,564 times
Reputation: 269
I like the kind of insurance that has about a $5000 deductible and then they pay 100% after that. Otherwise, if you still have to pay 20% after the deductible is met, that's where the BIG money comes in. Say you have a $100,000 cancer bill. Well, now you owe the original $5000 plus $20,000!! I never understood why people chose small deductibles with an 80/20 after that.

I hope to look into the trick I've heard about of starting a new plan December 1st and then being allowed to keep that until next December 1st.
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Old 10-30-2013, 07:48 AM
 
1,225 posts, read 3,617,916 times
Reputation: 1029
We just received a letter that our BCBSNC HSA plan is being grandfathered. Our premium for a family of 4 increases by about $100 a month.
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Old 10-30-2013, 08:28 AM
 
7,695 posts, read 12,841,965 times
Reputation: 9599
Quote:
Originally Posted by CVAlicia View Post
Say you have a $100,000 cancer bill. Well, now you owe the original $5000 plus $20,000!!
A 3 month cancer battle can be more than a million...
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Old 10-30-2013, 08:37 AM
 
Location: Oxxford Hunt, Cary NC
4,188 posts, read 9,811,768 times
Reputation: 3821
Quote:
Originally Posted by CVAlicia View Post
I like the kind of insurance that has about a $5000 deductible and then they pay 100% after that. Otherwise, if you still have to pay 20% after the deductible is met, that's where the BIG money comes in. Say you have a $100,000 cancer bill. Well, now you owe the original $5000 plus $20,000!! I never understood why people chose small deductibles with an 80/20 after that.
Most (all?) plans with co-insurance have an out of pocket maximum so you'll know the max you can be liable for upfront. In one of the examples posted by WeLuvNC, $12,700 would be the max out of pocket for a family, including the $6K deductible.
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Old 10-30-2013, 12:22 PM
 
219 posts, read 411,232 times
Reputation: 424
This is all so confusing and heartbreaking to read.

I'm fortunate that my employer-sponsored plan isn't getting much more expensive, and that our service level remains the same. I don't know how much longer that will be the case, though. If I had to endure what so many of you are, with all this researching and not coming up with many good or feasible options, monthly costs doubling and coverage staying the same or lessening, I seriously don't know what I would do. This is the most incredible debacle I have seen in the last 30 years. The cost is just crippling to the average family.

All I can say is I hope the turnout at the next national election is astounding. Will it become "the" event for which people start camping out in line the night before? I hope so.
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Old 10-30-2013, 01:11 PM
 
Location: Containment Area for Relocated Yankees
1,040 posts, read 1,634,341 times
Reputation: 1082
Quote:
I have (in columns) our plan currently in the first column then three alternative plans that are similar in coverage to what we have now according to BCBSNC...<sigh> but they aren't really similar due to the co-insurance thing which I don't quite understand.

Advantage plans:
current plan: bronze 5500 bronze 2700 silver 3000
$600 $900 $973 $1,056 (premium/mo)
$7200 $10,800 $11,676 $12,673 (premium/yr)
$5400 $11,000 $5,400 $6,000 (deductible/family)
$5400 $11,000 $12,700 $12,700 (out of pocket max/family)
$12,624.00 $21,800 $24,376 $25,373 (total needed for premiums& rainy day fund)
no co-ins 0%/30%out 50% 30% in network (coinsurance)
yes yes yes no (Hsa eligible?)

Rx coverage is just too complicated to include but that comes into play too...

So bottom line....premiums are going up by at least 50% for less coverage -- deductible will be doubled, the HSA doesn't even come close to covering the deductible now (it used to match it) and I am unsure of the impact of co-insurance to my bottom line. Big OUCH.

However, this co-insurance addition is confusing -- I like to make sure I put away in a rainy day fund enough to cover a significant illness. If co-insurance is unlimited, then I just don't know how much to put in a rainy day fund to ever cover such a thing. any ideas?
As a previous poster mentioned, co-insurance is the portion of the out of pocket payment (OPP) that the insurer pays. For a High Deductible Health Plan (HSA eligible), there cannot be co-pays. Therefore, until you meet your deductible, the insurer pays (co-insures) 0% of your OOP costs. After you meet your deductible, the insurer pays 80% (example) of your OOP costs until you reach your OOP maximum. Then the insurer pays 100%. Generally, preventive doctors' visits are covered at 100%, whether you've met your deductible or not.

Have you tried calling BCBSNC to ask them to explain it? It may be easier than trying to figure it out on your own.
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Old 10-30-2013, 03:07 PM
 
Location: RTP area, NC
1,277 posts, read 3,019,001 times
Reputation: 946
Quote:
Originally Posted by WorkingMomof2 View Post
As a previous poster mentioned, co-insurance is the portion of the out of pocket payment (OPP) that the insurer pays. For a High Deductible Health Plan (HSA eligible), there cannot be co-pays. Therefore, until you meet your deductible, the insurer pays (co-insures) 0% of your OOP costs. After you meet your deductible, the insurer pays 80% (example) of your OOP costs until you reach your OOP maximum. Then the insurer pays 100%. Generally, preventive doctors' visits are covered at 100%, whether you've met your deductible or not.
Thanks -- that was exactly my question. I was really really hoping that co-insurance was not on top of the premium & out of pocket max.

Quote:
Originally Posted by WorkingMomof2 View Post
Have you tried calling BCBSNC to ask them to explain it? It may be easier than trying to figure it out on your own.
That is my next step. Actually, I might drop by one of their in-person office -- they have one down here at Park West -- I have so many plan details that I am juggling, that it might be worthwhile to go in and ask if they are set up to respond that way. Otherwise, it is the phone for me.

I am glad that BCBSNC allows you to choose/read directly from their website. That has proven very useful and fast to get info, It is just hard to sift through various plans as you can only 'compare' three at a time.

thanks for the insight!
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Old 10-30-2013, 03:51 PM
 
Location: Containment Area for Relocated Yankees
1,040 posts, read 1,634,341 times
Reputation: 1082
Quote:
Originally Posted by WeLuvNC View Post
Thanks -- that was exactly my question. I was really really hoping that co-insurance was not on top of the premium & out of pocket max.



That is my next step. Actually, I might drop by one of their in-person office -- they have one down here at Park West -- I have so many plan details that I am juggling, that it might be worthwhile to go in and ask if they are set up to respond that way. Otherwise, it is the phone for me.

I am glad that BCBSNC allows you to choose/read directly from their website. That has proven very useful and fast to get info, It is just hard to sift through various plans as you can only 'compare' three at a time.

thanks for the insight!
You're welcome! I know it's confusing. Going to the store would probably be a great solution for you. The stores are staffed with licensed agents who should be able to walk you through all your options and help you figure out what's best for your family. Good luck!
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