explanade
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- Joined
- May 10, 2008
- Messages
- 7,457
I enrolled in an Anthem Blue Cross plan which had the lowest premiums.
But now I'm having misgivings. Their in network is limited. So while $4500 deducible and $6500 out of pocket max sound good, these are for in-network providers only.
The out of network amounts are double.
So for instance, for urgent care, I have to go to a clinic 7 miles away through cross-town traffic and they have limited hours, 7 AM to 5 PM, M-F. Only one MD on staff.
I'm not sure what happens in an emergency. I call 911 (or someone does) and I get taken probably to one of the big hospitals and they're not in network as far as I can tell.
Then I had problems sorting through their in-network doctors, trying to get an idea of whom to choose. Of course back in the day, I just went to whichever doctor they appointed me at one of the large clinics around here. I was for instance handed over after doctor retirements. Now I've Googled some of the doctors and not sure that's a useful exercise, though I'm wary of that a lot of doctors went to medical school overseas, at some institution most people here never heard of. I thought the AMA limited credentialing doctors trained overseas.
The Kaiser Bronze HMO plans are about $50 more a month, one an HSA plan. When you go through the CoveredCA search and line up plans side by side, the terminology is perplexing.
For instance the Anthem plan has an Individual deductible while Kaiser HMO (non HSA) is "Not Applicable." But then further below there is a Medical Deducible and Brand Drug deductible of $6000 and $500 respectively. The Anthem is Not Applicable for these categories.
Interestingly, the Out of Pocket Max for these two categories are Not Applicable for Kaiser.
Primary Care, Specialist visits are 40% Coinsurance after deductible for Anthem and "$70 Copay before deductible." OK what happens after the deductible is met for Kaiser, would it be free?
The drug benefit might be good if you have a lot of prescriptions, 100% after deductible which would presumably be $500 for the drug deductible. For Anthem, it's 40% but there is no separate drug deductible so it would be part of the $4500 or $9000 deductible bucket.
Emergency Care is 40% vs. 100% and Urgent Care is 40% vs. $70 Copay before deductible.
The other thing is there's a relatively new Kaiser facility just 2-3 miles from me. But I had Kaiser coverage growing up and remember ridiculously long waiting times. I usually went in for urgent or emergency care reasons so I suspect that would still be the case, because their clinics are probably packed all the time.
My folks chose Kaiser for Medicare Advantage and they report good experiences with getting appointments and so forth.
But I guess one's experience with Kaiser may depend on the facility and the doctors at a particular facility.
Price-wise, for $600 more a year in premiums, the potential for lower out of pocket costs seems to be there.
But now I'm having misgivings. Their in network is limited. So while $4500 deducible and $6500 out of pocket max sound good, these are for in-network providers only.
The out of network amounts are double.
So for instance, for urgent care, I have to go to a clinic 7 miles away through cross-town traffic and they have limited hours, 7 AM to 5 PM, M-F. Only one MD on staff.
I'm not sure what happens in an emergency. I call 911 (or someone does) and I get taken probably to one of the big hospitals and they're not in network as far as I can tell.
Then I had problems sorting through their in-network doctors, trying to get an idea of whom to choose. Of course back in the day, I just went to whichever doctor they appointed me at one of the large clinics around here. I was for instance handed over after doctor retirements. Now I've Googled some of the doctors and not sure that's a useful exercise, though I'm wary of that a lot of doctors went to medical school overseas, at some institution most people here never heard of. I thought the AMA limited credentialing doctors trained overseas.
The Kaiser Bronze HMO plans are about $50 more a month, one an HSA plan. When you go through the CoveredCA search and line up plans side by side, the terminology is perplexing.
For instance the Anthem plan has an Individual deductible while Kaiser HMO (non HSA) is "Not Applicable." But then further below there is a Medical Deducible and Brand Drug deductible of $6000 and $500 respectively. The Anthem is Not Applicable for these categories.
Interestingly, the Out of Pocket Max for these two categories are Not Applicable for Kaiser.
Primary Care, Specialist visits are 40% Coinsurance after deductible for Anthem and "$70 Copay before deductible." OK what happens after the deductible is met for Kaiser, would it be free?
The drug benefit might be good if you have a lot of prescriptions, 100% after deductible which would presumably be $500 for the drug deductible. For Anthem, it's 40% but there is no separate drug deductible so it would be part of the $4500 or $9000 deductible bucket.
Emergency Care is 40% vs. 100% and Urgent Care is 40% vs. $70 Copay before deductible.
The other thing is there's a relatively new Kaiser facility just 2-3 miles from me. But I had Kaiser coverage growing up and remember ridiculously long waiting times. I usually went in for urgent or emergency care reasons so I suspect that would still be the case, because their clinics are probably packed all the time.
My folks chose Kaiser for Medicare Advantage and they report good experiences with getting appointments and so forth.
But I guess one's experience with Kaiser may depend on the facility and the doctors at a particular facility.
Price-wise, for $600 more a year in premiums, the potential for lower out of pocket costs seems to be there.