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Just sarted my insurance shopping...A few questions please?
Old 11-03-2015, 02:55 PM   #1
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Just sarted my insurance shopping...A few questions please?

I'm Single, 56 yo, thinking about retiring Jan 1, 2016.
From BCBS of Georgia-Gold, Multi State Plan.
With out the discount $831 + $4900 OOP (Includes deductible)
With discount $681 + $4900 OOP )Includes deductible)

1. When it describes the drug tiers it give the cost in $ and/or % - not subject to deductible.
What exactly does "not subject to deductible mean"?
Do I still pay for perscriptions after the OOP is paid or are they paid in full after the OOP is paid?

2. Also, what does " Multi State Plan" mean.

This is the plan the representative at BCBS sent me after a brief discussion. I'm not sure why this plan and not another one.

Anyway, this seems extremely high for a single person but I guess this is the new normal.


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Old 11-03-2015, 03:13 PM   #2
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A multi state plan means the same plan has been registered and approved for sale in many states, so an employer could offer this one plan to employees in all those states. It probably means there is one single network of health care providers that is large and covers all those states, but you should confirm that with the plan literature.

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Old 11-03-2015, 04:00 PM   #3
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Congratulations on your potential retirement. This BCBSGA Gold HMO plan has a $1150 deductible and $4900 OOP max. The tier 1 and tier 2 drugs have a copay. You do not have to meet the deductible first. You just pay the copay. That amount is applied to your maximum out-of-pocket limit but is not applied toward meeting the deductible. The tier 3 and tier 4 drugs have a 10% coinsurance after deductible in the document I'm viewing. You must meet the $1150 deductible first. Then the 10% you are responsible for is applied to the out-of-pocket limit but not the deductible.

The plan covers the full prescription cost after the OOP max has been met.

FYI...In Cherokee County, GA there is also a BCBSGA Silver 3500 HMO plan with $3500 deductible and $5200 OOP max for about $410 after subsidy discount. With this plan, the tier 2,3 &4 drugs are after deductible.
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