(This question may be better suited in GQ depending on the factuality of the answers)
A few weeks ago my neck cracked after a coughing fit and I couldn’t turn it a certain way without pain. I checked my insurance and went to a nearby in-network urgent care facility. There they determined it was neck spasms and also tested me for strep (as a precaution as my girlfriend had it).
Anyway, skip forward to today where I get the bill of roughly $170 (slightly down from the original bill of $235). I’m new to the world of health insurance (well, paying for my own, at least) and I guess I mistakenly believed my insurance would have covered 80%, but alas, I hadn’t met my deductible yet, so it appears I won’t be getting help from them.
Now I thought my insurance was good, but it seems like in this kind of situation having an insurance plan with a copayment would be much better. Am I wrong in my thinking here? What benefit does my insurance plan offer if I have to pay $700 each year before they start paying for 80% while I could just be paying $20-25 per visit with copayments? In what situations is my plan better than a plan with copays? Also, is there any reason I should care about in-network vs out-of-network until I hit my $700 deductible since the insurance company isn’t going to be paying anything anyway?
And finally, my health plan says I *do *get copays of $75 for ER visits (that are also subject to the deductible and have 20% coinsurance) so does that mean it would have just been cheaper to go to the ER for this particular visit?
WAG because I don’t have your plan in front of me - the health plan with copays instead of deductibles probably costs you more per year. It also may pay less for “out of network” doctors/clinics/hospitals/ERs.
If you have low to no copayments and no deductible, your monthly premiums will probably be much higher, and if you don’t go to the doctor that frequently, it’s really a waste of money to have no copayments if you’re paying so much in premiums that the cost won’t balance out.
So, IMHO it makes the most sense to have a zero copayment plan if you want to be overinsured and/or see the doctor often or have high prescription costs. If none of those things applies to you, you’ll probably save money in the long run with a deductible and/or copayments.
I’m not seeing a plan with a deductible instead of copays (like mine) can be better. My deductible is $700 per year, so I’ll have to pay $700 a year before the insurance company pays any of my coinsurance. Let’s say I had a plan that used a $25 copay for office visits. I’d have to visit the doctor 28 times before paying the same I would have paid out-of-pocket had I visited the doctor the four times with my no-copay, deductible-only plan (using my recent bill as the benchmarking cost). I know it’s a lot more complicated than that, but it just seems unless you visit the doctor an extraordinary amount of times, the plan that uses copays is always going to be cheaper since its a set cost each visit versus paying the bill-in-full until I hit my deductible.
We have two options here at work, both free to us. The PPO has no copayment (except for regular annual office visits) but you have a lot more choice in your providers. I believe but am not sure that it works out better for you if you end up needing a lot of care in a particular year. The HMO has copays ($15 for an office visit, $35 for a specialist or emergency) and better prescription benefits. Just depends on what’s best for you. I used to have the PPO but just switched and it’s great except that you have to get a stupid referral to do just about anything, and that can take a long time when your ankle hurts.
You have to consider ALL your expenses: premiums, copays, deductibles, out of pocket maxima, etc.
At our company we had a choice of several plans. One had low copays and low deductibles, but high premiums. Another had no copays and low premiums, but a very high deductible. After crunching all the numbers, I decided on the second plan.
You didn’t mention the premiums. I had a similar choice at work, but the premiums were so much cheaper for the higher-deductible plan that it was worth it. Specifically, over the course of a year I saved in premiums way over the cost of the deductible.
If you are paying less for that plan per month it could be advantageous if you don’t use it or if the premium discount ends up making the plan cheaper in the long run. If you are paying for coverage with the intent that you just need it for emergencies and to keep you from going bankrupt if you are hospitalized and you never really go to the doctor (I assume your plan probably gives you one free well care visit with your GP and that wouldn’t cost you anything) being able to save several hundred dollars a year might be beneficial. There are lots of people who don’t ever really have to go to the doctor and are happy to take a chance with a higher deductible in exchange for a lower premium.
We have the same deal. In fact, I put the difference in cost between the two into an HSA and have just been using that to pay for the deductibles.
There’s this weird twist in my plans where if you hit the out-of-pocket maximum (which is the same in both plans) you are much better off with the higher deductible/no co-pay plan. On our low-deductible plan, after you hit your out of pocket max, you keep paying copays–they just take care of the 20% you’d usually also pay. And the hospital co-pay is $100/day. But on the high deductible, once you hit the out of pocket max, they pick up everything.