I’ll lay out the relevant info in what follows. The coverages I’m listing aren’t all the coverages, just the ones I want to ask further information about:
Plan A: $93/mo
Plan B: $109/mo
Plan A covers brand-name prescription drugs with a 35% coinsurance rate. Plan B covers them with a $40 co-pay. Which is better? Are brand-name prescription drugs, when discounted down to 35%, likely to cost more or less than $40?
Similarly, Plan A covers “non-formulary brand-name prescription drugs” with 50% coinsurance while B covers them with a $75 copay. Which is better? (And while I’m here, what is a “nonformulary” drug?
The plans also list values for “mail order prescription drugs.” Plan A covers with 35% coinsurance while B covers with a $120 copay. Which of these is better? (And when would one have to use this benefit? When the drug is not available widely at pharmacies?)
For the mail order drugs, both plans list “90 day supply.” Does this mean per 90 day supply, or does this mean after the 90 day supply the drug is no longer covered? (Or does this differ from company to company meaning there’s no wya to to tell from the information I’ve given here?)
Under hospital services, plan A covers with a $250 deductible, while plan B covers with a $250 deductible “plus 20% coinsurance after deductible.” Does this probably mean plan A covers 100% after deductible, or 0%?
One further question. There’s an insurance company which as far as I can tell is always less expensive–by $10 to $50 or so per month–than equivalent plans from other companies. (This holds up even after I read the detailed coverage documents.) Should I be wary of this company, or is it plausible that a reputable company could undersell its competition across the board this way?
They have an A- rating from some some company called “A.M. Best” which I know nothing about. Are there any other places I can go to get ratings for insurance companies?
Formulary - Every insurance company has a drug formulary which is basically a list of drugs that they cover. Non-formulary is everything else. For an example, look at the list of anti-depressants. Perhaps they’ve chosen to cover Paxil and Zoloft but not Prozac and Lexapro.
Mail order - This is used as a convenience. You would use mail order for something that you take on a regular basis, say Zoloft from my prior example. The main benefit is that you can order 90 days worth at a time and it comes right to your home.
Co-pay vs Co-insurance. This one can be tricky, but if you regularly take an prescriptions I would suggest you find out how much they cost. Some can be outrageous. One of our customers is taking something right now that costs nearly $1000 for 6 doses. This is somethign you need to research to see what is best for you. In general though, I would say co-pay is nearly always the best choice.
Hospital services - Is the plan A a per day cost or a per admission cost? Even at per day it isn’t that bad. 20% can add up really fast, especially if there is surgery involved.
She (I’m shopping for insurance for someone else) currently takes no prescription drugs, and who knows what prescriptions she could end up taking some day or other. So I guess the best bet in such a low-information situation is copay?
I personally prefer the co-pay route if only for the fact that you have a fixed cost. You know if you are going to take a brand-name drug that you’re going to pay $40. 35% may have worked out to $20 on that drug but what if next time it would have been $300?
Somewhere in the neighborhood of 65% of prescriptions are for generics. (just a fun fact for you)
When confronted with this choice (which is a common one for employers to present to you), always, always, ALWAYS take the co-pay prescription drug option. The percentage is all well and good for the average person with the occasional sniffle or sprained ankle, until you actually get seriously ill or injured. There are plenty of drugs out there, with no available generics or alternatives, that cost thousands of dollars per refill. I’m not kidding.
That’s here. You pick a deductible, and then your coinsurance is 80/20 “after… deductible of the next $10,000.”
Does that mean the deductible per year is your deductible amount per $10,000 in expenses? As in, with a $2500 deductible, if I have 12,500 in medical expenses in a year I’ll be paying $5000, not just $2500?
Is this usually how deductibles work?
(Sorry for my ignorance–my insurance has always been via an automatic enrollment through the various schools I’ve gone to so I’ve never had to deal with this before.)
