Heath plan CDHP vs. Traditional PPO (Long)
snicksnack
member
It is annual enrollment time at my company and I am trying to decide if I want to switch healthcare plans. First let me tell you a little about my family my husband and I are generally healthy, although I have Crohns disease that is in remission and heart disease runs in his family. I am in my early 30?s and he is 40. The two plans I am trying to decide between are the traditional PPO and the CDHP plan, both administered by Anthem, my delivery will be covered under my current traditional PPO plan.
Annual Cost
Traditional PPO $4,104.00
CDHP $1284.00
The Anthem CDHP uses the Blue Cross Blue Shield network and you are covered at 100% for nationally recommended preventive services, with no deductions from your HRA. The HRA is $2,000 (HRA is the amount of money the company gives you towards healthcare before your deductable kicks in. ) The CDHP Health Reimbursement Account(HRA) is initially used to pay for services that are not considered preventative such as hospital, emergency room, outpatient surgery, outpatient lab services, chiropractic services, sick doctor office visit, etc.The deductible for the CDHP (Amount that you pay out-of-pocket after you exhaust the 2,000, before the plan begins to pay benefits) is 1,600. The deductable for the PPO is 1,000. The PPO has copays $20.00 for primary and $40.00 for specialist. If you have any tests etc.. done you are charged extra until deductable is met. No copays with CDHP but you pay for services once your HRA has been exhausted until your deductible is met.
Both plans go into 80/20 mode once the deductable is met. The CDHP?s out of pocket maximum is 10,000 and the PPO is 6,000
The way I see it worse case scenario for CDHP if I used all of my medical benefits would be 1,284 + 1,600 + 10,000= 12,884
The worse case PPO, not counting copays, is $4,104..00 + 1,000 + 6,000= 11,104
Now the prescription coverage on both is dicey because the PPO uses the copay system and the most you would pay is 40 or 10 percent coinsurance, whichever is greater for one month or 80 for three months 10 percent coinsurance, whichever is greater with a $200.00 max copay per script.
CDHP you pay 20 percent of the total cost no copay max. Right now we are not on any meds so there is no way to project that cost.
The CDHP worse case comes up as more but that does not take into account the 2K you have to use before incurring costs or the amount I spend on copays each year with the PPO. I called our benefits line and they just keep giving me the generic language I helped write because I work in communications and we have so many plans that HR team won?t be specific about anything, they claim the reps on the number I called should be. I did put a call into HR about the issue I am having with getting a straight answer. Anyone have experience with this type of plan, and if so do you think it is too good to be true? The cost comparison just does not seem right to me. According to what I have read, CDHP rewards those who do not have a lot of health costs, which I can see but even for those with lots of medical costs I don?t see how it is really worth paying the extra premiums for the traditional PPO especially when both use the same doctor networks. I asked coworkers but everyone who uses the plan are young without kids and those with kids are nervous like me about switching. I guess I could get burned on the perscriptions.
TIA
Re: Heath plan CDHP vs. Traditional PPO (Long)
Hmmm. I am not so familiar with this CDHP type of plan. Am I understanding that the annual amt out of your paycheck is $1284, the company pays the first $2000 in expenses (no matter what they are other than the preventive services which have to be covered by law via the affordable care act) and then you have a $1600 deductible to meet, followed by 20% coinsurance?
How many kids do you have, how old are they & are you planning on getting pregnant or delivering in the next year? If you are, I think I'd go PPO to be safe. Without knowing how many kids you have and what age they are, it is hard to calculate how quickly you'd use up that $2K and go into your deductible. However, it seems to me that the CDHP is still a better deal, unless there is something you're leaving out or missing, since the provider list is the same.
ETA ooops just saw your tickers. will you be delivering on the new plan? Stick w/ the ppo. Ditto what pp said about daycare & whatnot too. Babies go to the dr so frequently, you'd eat through $2K in no time even if your delivery falls in your old plan, and god forbid you need any special services or anything for the new LO...
I work in healthcare on our CDHP plans, so am pretty familiar with them. I will say that it is nice your company covers much of your contributions towards a CDHP. Mine does not and I end up having to pay monthly premiums for me (around $200 per paycheck) and my family on top of having to meet the deductible ($1800 individual or $3200 family) before the plan kicks in to cover 80% of costs.
If your company is covering most of your monthly premiums and your deductible, then a CDHP isn't such an expensive option. However, maternity is not considered preventative care, so you will be subject to either paying for all of your services (if you need to meet the deductible) or 20% of all costs, depending. Of course you have your hospital bill as well. I just got mine and now that I finally met my deductible, I owe about $3k in hospital bills with the plan covering the rest. Of course I had to pay for her ultrasound, ranging anywhere from $300-$500 as well as all blood tests and everything else. For your child, all well baby visits will be covered at 100%, but anything more than an annual physical and annual ob visit on your end would be subject to to 20% cost. And if your child gets sick, then you also have to pay for all those bills and associated tests.
Since you also have a medical condition, you should weigh your options on how much you think you may spend on an annual basis, since you will have to pay for it. With a PPO, obviously you only have to pay your copay.