Carefirst PPO, POS, and HMO -- best choice for healthy?

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MnyGrl
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Carefirst PPO, POS, and HMO -- best choice for healthy?

Post by MnyGrl » Tue Oct 16, 2018 9:28 am

Hi,

I have been signing up for the BCBS Carefirst PPO plan through my company for the past few years. My portion is about $525/mo., pre-tax, for individual coverage.

I am very healthy (so far) - I rarely go to the doctor. I do get a yearly physical, but probably only go about once or twice a year other than that.

I am thinking of trying the HMO option since I so rarely use medical care and would really only be relying on insurance for a catastrophic event. The cost savings would be substantial.

Any experience with any of these plans? Or perspectives? Thanks!

DarkHelmetII
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Re: Carefirst PPO, POS, and HMO -- best choice for healthy?

Post by DarkHelmetII » Tue Oct 16, 2018 12:19 pm

I can offer a guiding principle, which is to consider two types of characteristics to any health plan: 1) network, and 2) the financials (e.g. premiums, deductibles etc...).

For someone healthy, on point #2 very well might make sense to go bare-bones e.g. high deductible. But you don't necessarily want to scrimp on #1 network strength even if healthy. In the rare event you need something big (e.g. rebuild a mangled hand, cancer treatment) you want the flexibility to choose your own doctor (still subject to constraints of the network). An HMO for example will typically be more constrained as you have to coordinate through the primary doctor.

This is a long way of saying I'd recommend a plan that 1) has a strong network / flexibility such as a PPO, and 2) high deductible that is HSA compliant. If you are paying $525 for individual coverage through work, and your work does not offer this combination, might be that on the exchanges you can find something meeting this criteria at a similar price.

On DC health exchange found BluePreferred PPO HSA Standard Bronze $6,200.
age 60: $656.38 / month
age 35: $273 / month

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MnyGrl
Posts: 240
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Location: DC

Re: Carefirst PPO, POS, and HMO -- best choice for healthy?

Post by MnyGrl » Tue Oct 16, 2018 1:23 pm

DarkHelmetII wrote:
Tue Oct 16, 2018 12:19 pm
I can offer a guiding principle, which is to consider two types of characteristics to any health plan: 1) network, and 2) the financials (e.g. premiums, deductibles etc...).

For someone healthy, on point #2 very well might make sense to go bare-bones e.g. high deductible. But you don't necessarily want to scrimp on #1 network strength even if healthy. In the rare event you need something big (e.g. rebuild a mangled hand, cancer treatment) you want the flexibility to choose your own doctor (still subject to constraints of the network). An HMO for example will typically be more constrained as you have to coordinate through the primary doctor.

This is a long way of saying I'd recommend a plan that 1) has a strong network / flexibility such as a PPO, and 2) high deductible that is HSA compliant. If you are paying $525 for individual coverage through work, and your work does not offer this combination, might be that on the exchanges you can find something meeting this criteria at a similar price.

On DC health exchange found BluePreferred PPO HSA Standard Bronze $6,200.
age 60: $656.38 / month
age 35: $273 / month
Hi, thanks for your perspective. I hadn't thought about looking on the exchanges, but that is a great idea.

The only plans my company offers are fairly low-deductible - like $500. Mostly I never hit the deductible since if you get a physical it is free, and doctor visits are $15. It would be great if I went to the doctor often, but for the last 20 years it has been maybe once or twice a year so it is probably time to look into a less cushy plan.

DarkHelmetII
Posts: 166
Joined: Mon Jul 24, 2017 12:25 pm

Re: Carefirst PPO, POS, and HMO -- best choice for healthy?

Post by DarkHelmetII » Tue Oct 16, 2018 1:52 pm

You can calculate it out. You may save $100+ a month on premiums (even with exchange plan). Plus a tax break on HSA contributions - federal + state (looks like you live in DC). Note however premiums are paid pre-tax so that's a slight favor toward low deductible plan. But still if you have say $500 - $1,000 a year in expenses I bet you'd still come out ahead. Now something catastrophic...you pierce that $6,200 deductible ... but what is the chance of that happening?

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