Insurance in NY or CA: Empire Blue vs Oxford/United

[+ FreshFluff]

You’re right @nycman . You can’t be cynical enough with the insurance carriers.

 

NY state basically forced each carrier to offer a plan that reimburses at the 80th percentile of actual charges from providers. But they intentionally make the plan unattractive (and very expensive) by offering a limited prescription formulary compared to the other plan, which pay 140% of the Medicare fee.

[RealAvalon]

Here are the 3 plans, from cheapest to most expensive. If you remove dental/vision, thmost expensive, the Oxford, is about $147 more than the cheapest. Oxford has the best coinsurance, but I keep hearing that they’re stingier.

 

FWIW, I’ll meet the $3000 OON deductible in a few months particularly if dental expenses count. I may use diagnostic imaging (likely OON) and labs and some minor outpatient procedures. I want to hedge against the possibility that I’ll need outpatient surgery and even have my first hospital admission.

 

Thanks again for all your help.

 

 

I just got back from my first COVID era dental appointment. With COVID new procedures. Temperature check and form to fill out on risk factors.

 

It's all manual scaling for the cleaning, no polishing because of the spray. The manual scaling takes extra time so instead of a 30 minute appointment, it was scheduled for an 1 1/2 appointment. Four X-rays, exam, scaling and fluoride cost me $77.00.

[+ FreshFluff]

PSA to anyone in the process of renewing BCBS PPO plans in NY state: They changed their plans and are switching people over to similarly priced plans with similar deductibles but have lower out of network reimbursement levels. They don’t disclose this anywhere in the booklets sent to consumers and employers; you have to look in the 100-page EOC contract to find it. 

BCBS still has a high allowed amount plan, but the OON deductible is now more than 2x higherand an in network deductible was added. Clearly, they’re trying to make this option unattractive. 
 

BTW, @blondeqgave excellent advice on the first page.  I recommend it if you’re buying health insurance. 

Edited July 18, 2021 by FreshFluff