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Old 10-30-2013, 02:21 PM   #103
Mr. Plow Mr. Plow is offline
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Join Date: Dec 2005
Location: Mmmmmm....Forbidden Donut
Casino cash: $9021
Actually, cosmo & Direckshun......while I don't agree with a lot of your views, I'd like to get your opinions on my situation if you don't mind. I posted it a couple weeks ago & never really got much response as to why.

Here is my original post #1:

Quote:
Originally Posted by Mr. Plow View Post
I've got a question I would like someone to explain to me. Preferably without all of the whole "OMG, Obamacare suckz bawlz" or "OMG, Obamacare is going to save us" BS.

I don't care which side of the aisle you are on, I really am just looking for a legitimate answer.

I get notice that my insurance plan is essentially not good enough and is going to be discontinued Dec. 31st with this message:

Quote:
Your current healthcare plan does not meet the benefit standards specified in the new health care reform law and will be discontinued after December 31
No indication what portion doesn't meet the new standards, but whatever. So, I go to the link the paper gives me for BCBS of KS so that I can view all these other plans. Probably 13-15 plans listed ranging from $650 - $1200 (these are family plans FYI).

So, I immediately skip over the Bronze plans because the Family deductibles on them are anywhere from $12,000 - $15,000/year. As I'm going through the next level of plans (silver I think) and comparing them, I come across the exact plan I'm currently on....for the exact same price that I'm paying now.

I'm sure there some minor difference, but seriously. Deductibles are the same, copays are the same, prescriptions are the same, hell even the price is the same. So why the **** do I need to get off of the plan I'm on to get onto the plan I'm on?

And post #2 with plan details:

Quote:
Originally Posted by Mr. Plow View Post
Here are the two plans I am looking at. The one on the left is my current plan, the one on the right ($40 more per month) is the comparison I was looking at.



PreventiveIn Network$0. Preventive is without cost share.$0. Preventive is without cost share.
Out of NetworkDeductible then 50% coinsuranceDeductible then 50% coinsurance
DeductibleIn Network$2,500 person/$5,000 family$3,000 person / $6,000 family
Out of Network$5,000 person/$10,000 family$6,000 person/$12,000 family
CoinsuranceIn Network20%20%
Out of Network50%50%
Coinsurance maximumIn NetworkN/AN/A
Out of Network$7,000 person/$14,000 family$12,000 person/$24,000 family
Annual out-of-pocket maximumIn Network$5,200 person/$10,400 family$6,000 person/$12,000 family
Out of NetworkN/AN/A
Doctor's Office Visit
Office visit - primaryIn Network$35 copay/visit, 5 visits per person at copay then subject to deductible and 20% coinsurance$35 copay/visit
Out of NetworkDeductible then 50% coinsuranceDeductible then 50% coinsurance
Office visit - specialistIn Network$70 copay/visit$70 copay/visit
Out of NetworkDeductible then 50% coinsuranceDeductible then 50% coinsurance
Prescription Drug Coverage
GenericIn Network$100 person/$200 family deductible then subject 50% coinsurance$15 copay
Out of Network
BrandIn Network$100 person/$200 family deductible then subject to 50% coinsurance$50 copay
Out of Network
Non-formularyIn Network$100 person/$200 family deductible then subject to 50% coinsurance$75 copay
Out of Network
SpecialtyIn Network$100 person/$200 family deductible then subject to 50% coinsurance$150 copay
Out of Network
Mail orderIn Network$100 person/$200 family deductible then subject to 50% coinsurance$37.50 generic/$125.00 preferred/$187.50 non-preferred/$375.00 specialty 3 month supply
Out of Network$15 generic/$50 preferred/$75 non-preferred/$150 specialty 30 day supply
Medical Services
Emergency room servicesIn Network$300 copay then subject to deductible and 20% coinsuranceDeductible then 20% coinsurance
Out of Network
Emergency medical transportationIn NetworkDeductible then 20% coinsuranceDeductible then 20% coinsurance
Out of NetworkDeductible then 50% coinsuranceDeductible then 50% coinsurance
Inpatient surgery physician/surgical servicesIn NetworkDeductible then 20% coinsuranceDeductible then 20% coinsurance
Out of NetworkDeductible then 50% coinsuranceDeductible then 50% coinsurance
Inpatient facility feeIn NetworkDeductible then 20% coinsuranceDeductible then 20% coinsurance
Out of NetworkDeductible then 50% coinsuranceDeductible then 50% coinsurance
Outpatient facility fee/ASCIn NetworkDeductible then 20% coinsuranceDeductible then 20% coinsurance
Out of NetworkDeductible then 50% coinsuranceDeductible then 50% coinsurance
Outpatient surgery physician/surgical servicesIn NetworkDeductible then 20% coinsuranceDeductible then 20% coinsurance
Out of NetworkDeductible then 50% coinsuranceDeductible then 50% coinsurance
Outpatient lab and radiologyIn NetworkDeductible then 20% coinsuranceDeductible then 20% coinsurance
Out of NetworkDeductible then 50% coinsuranceDeductible then 50% coinsurance
Advanced imagingIn Network$250 copay then 100%Deductible then 20% coinsurance
Out of NetworkDeductible then 50% coinsuranceDeductible then 50% coinsurance
InjectionsIn NetworkDeductible then 20% coinsuranceDeductible then 20% coinsurance
Out of NetworkDeductible then 50% coinsuranceDeductible then 50% coinsurance
Recovery & Special Needs
Outpatient rehabilitationIn Network$70 copay then 100%Deductible then 20% coinsurance
Out of NetworkDeductible then 50% coinsuranceDeductible then 50% coinsurance
Outpatient habilitationIn Network$70 copay then 100%Deductible then 20% coinsurance
Out of NetworkDeductible then 50% coinsuranceDeductible then 50% coinsurance
HospiceIn NetworkDeductible then 20% coinsuranceDeductible then 20% coinsurance
Out of NetworkDeductible then 50% coinsuranceDeductible then 50% coinsurance
Home health careIn NetworkDeductible then 20% coinsuranceDeductible then 20% coinsurance
Out of NetworkDeductible then 50% coinsuranceDeductible then 50% coinsurance
Mental Illness and Substance Use Disorders
Mental illness/substance use disorders inpatient servicesIn NetworkDeductible then 20% coinsuranceDeductible then 20% coinsurance
Out of NetworkDeductible then 50% coinsuranceDeductible then 50% coinsurance
Mental illness/substance use disorders outpatient servicesIn Network$35 copay/visit$35 copay/visit
Out of NetworkDeductible then 50% coinsuranceDeductible then 50% coinsurance
Maternity Coverage
Pre and postnatal office visitIn NetworkDeductible then 20% coinsuranceDeductible then 20% coinsurance
Out of NetworkDeductible then 50% coinsuranceDeductible then 50% coinsurance
Labor and delivery hospital stayIn NetworkDeductible then 20% coinsuranceDeductible then 20% coinsurance
Out of NetworkDeductible then 50% coinsuranceDeductible then 50% coinsurance
Dental & Vision
Pediatric dental (age 0-19)In NetworkDeductible then 20% coinsuranceDeductible then 20% coinsurance
Out of NetworkDeductible then 50% coinsuranceDeductible then 50% coinsurance
Pediatric vision (age 0-19)In NetworkDeductible then 20% coinsuranceDeductible then 20% coinsurance
Out of NetworkDeductible then 50% coinsuranceDeductible then 50% coinsurance
Adult dental (age 20+)In NetworkNot CoveredNot Covered
Out of Network
Adult vision (age 20+)In NetworkNot CoveredNot Covered
Out of Network
Other
Lifetime maximumUnlimited for each covered personUnlimited for each covered person.
Eligible dependentsCovered to age 26Covered to age 26
Diabetic education$35 copay/visit$35 copay/visit then 100%
HSA compliantN/AN/A
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