Federal health insurance plans

[Anonymous]

This is OP, thanks so much for all of this info. I have been reading about plans, and there is so much info out there.
DC receives therapies on a weekly basis, and all, All, ALL providers are out of network. This also goes for a Social group that he attends, in addition to ST, PT, OT and Counseling.

I have narrowed down to GEHA and BCBS, but the question is still there, if all your providers are out of network, what makes most sense?

[Anonymous]

Anonymous wrote:What is the Katie Beckett waiver?

https://en.m.wikipedia.org/wiki/Katie_Beckett_Medicaid_waiver

[Anonymous]

I was ready to try GEHA, but decided to check that our doctors take it. Ouch! Pediatrician that we would not change, does not take it...
I guess can do out of network, but that would make all doctors that kids see out of network...
Makes me feel nervous. I think we should stick with Cigna (NALC) even if it costs a bit more. Just piece of mind for us.

[Anonymous]

Anonymous wrote:This is OP, thanks so much for all of this info. I have been reading about plans, and there is so much info out there.
DC receives therapies on a weekly basis, and all, All, ALL providers are out of network. This also goes for a Social group that he attends, in addition to ST, PT, OT and Counseling.

I have narrowed down to GEHA and BCBS, but the question is still there, if all your providers are out of network, what makes most sense?

We do BCBS basic, because the premiums are so much lower. We decided that the amount we get for the out of network reimbursement is less than the difference in premiums. We'd rather just pay out of pocket for the docs, then pay the premiums AND pay an out of network deductible AND pay 60% for the docs. The Rx coverage is about the same with BCBS basic and BCBS standard.

We also know would never hit the out of pocket limit because there are all these exceptions -- out of network copays don't count towards the out of pocket limit, and Rx copays don't count towards it, etc. We made a spreadsheet and looked at what we spend and for us the basic plan plus all our out of pocket spending ends up being the cheapest. We max out the FSA set aside for both of us and always kick it.

[Anonymous]

Anonymous wrote:

Anonymous wrote:This is OP, thanks so much for all of this info. I have been reading about plans, and there is so much info out there.
DC receives therapies on a weekly basis, and all, All, ALL providers are out of network. This also goes for a Social group that he attends, in addition to ST, PT, OT and Counseling.

I have narrowed down to GEHA and BCBS, but the question is still there, if all your providers are out of network, what makes most sense?

We do BCBS basic, because the premiums are so much lower. We decided that the amount we get for the out of network reimbursement is less than the difference in premiums. We'd rather just pay out of pocket for the docs, then pay the premiums AND pay an out of network deductible AND pay 60% for the docs. The Rx coverage is about the same with BCBS basic and BCBS standard.

We also know would never hit the out of pocket limit because there are all these exceptions -- out of network copays don't count towards the out of pocket limit, and Rx copays don't count towards it, etc. We made a spreadsheet and looked at what we spend and for us the basic plan plus all our out of pocket spending ends up being the cheapest. We max out the FSA set aside for both of us and always kick it.

I remember the other thing that doesn't count towards the out of pocket maximum--the difference between what the provider charges and what they consider allowable, even in network. So if you see an in-network provider who charges $185 a visit, and they consider $145 allowable, and there is a $35 copay, the $35 counts toward your deductible. The $40 the provider will balance bill you between what the insurer pays them and what they charge does NOT count towards your "out of pocket" limit. So, basically everything we actually pay out of pocket except the deductible and copays doesn't actually count towards the out of pocket limit. If you are evaluating insurance plans, don't even factor that in.