Northern California Babies

Help with healthcare enrollment

My DH employer is changing their coverage options and we will no longer be able to have Kaiser in the new year. I'm trying to figure out which plan to enroll in, and I could use your help.  All of our options are PPO type plans with varying copay and annual deductible amounts, so the determining factor of which one we choose will be expected costs... With Kaiser we never really see how much a doctors office visit really "costs". So, how much can I expect to pay for a typical sick doctors office visit in the San Jose are? (Well visits are no charge....) What about typical lab charges? Thanks for any help you can offer... Also, if anybody has any recommendations for pediatricians that accept Anthem Blue Cross PPO network I would really appreciate it :-)
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Re: Help with healthcare enrollment

  • We have an HSA plan, so we pay out of pocket for everything until we meet our deductible.  For us (we're with pamf/cmg) office visits are around $180-$210.  Lab charges vary depending on what's being done, but I've typically found those to be in the $30 range from what I remember...
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  • I'm so glad you asked this, and I hope you get some more responses. I'm trying to decide  which way to go when we have kids, Kaiser  or Anthem (or something else). I have kaiser & it's so easy, but it seems more expensive, too. It's hard when all you've known is Kaiser and you don't have to think about how much individual services cost.
  • imageStructenggal:
    We have an HSA plan, so we pay out of pocket for everything until we meet our deductible.  For us (we're with pamf/cmg) office visits are around $180-$210.  Lab charges vary depending on what's being done, but I've typically found those to be in the $30 range from what I remember...

    Thanks for the input - we'll be paying out of pocket too until our deductible is met... One of our choices has a lower deductible to meet but 20% copay once it is met, where another choice has a slightly higher deductible with a 10% copay once we meet it. I guess I'm trying to determine how probably it is that we'll actually meet our deductible amount to benefit from the lower copay.... Also, I'm wondering whether the max out of pocket is something to worry about. Have you ever reached the max?

    Dragonfly - We love Kaiser and if we had the choice we would stay with them in a heartbeat. They may be slightly more expensive on the front end, but the ease of service and no need to stress about copays/deductibles/specialists etc far outweigh the costs in my opinion :-)

     

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  • imageDragonfly_Bride:
    I'm so glad you asked this, and I hope you get some more responses. I'm trying to decide  which way to go when we have kids, Kaiser  or Anthem (or something else). I have kaiser & it's so easy, but it seems more expensive, too. It's hard when all you've known is Kaiser and you don't have to think about how much individual services cost.

    I'm dealing with this right now...  I remember when KP used to be the "less expensive" option, but it doesn't look like that anymore. It's not finalized, but it looks like we'll be saving 50+% by switching to a PPO.  That's seems huge to me.

  • In addition to the info you supplied about paying 20% or 10% after paying your deductible most plans have a co-pay for regular Dr. visits, I'd check to see if your plan has that or if you are simply stuck paying the % across the board.

    Meeting the out of pocket max or not will depend on a few things 1. If you have a co-pay amount ($10/$20/$30$40 being most standard option) for Dr.'s appointments or if it's 20% or 10% of the Dr. visits and all other tests/procedures 2. If your deductible counts towards your OOP (it should!) 3. What your OOP max is and 4. How much you guys go to the doc outside of well visits.

    Personally our insurance ( DH & I) has a $250 per person deductible, $40 co-pay for Dr. visits, 40% of procedures/tests and an OOP Max of $3,500 per person or $5,000 per family ( so one person has to pay up to $3,500, which I always do, but should DH have a lot of tests/procedures then in effect he'd only be paying a $1,500 OOP max).  

    I met my OOP max every year no matter what it is so when we combined out 2 individual plans the above option was significantly better for us than our previous plan where we had a $10 co-pay and 10% of procedures/tests.  With the $10/10% plan we had $2,500 per person but our monthly premium portion was over $800 where the $40 Co-pay plan is roughly $450 a month.  So yes we pay more for Dr. visits and RX's but since we know I'm going to hit my OOP max and we save over 4K a year in premiums it more than makes up for the increases along the way.

    *** It's not common for people to meet their OOP max unless you have a chronic illness, have a moderate or worse surgery or hospital stay or it's just low to begin with.  In my case I have cancer so I hit my OOP max around March of each year Party!!! ***

     

    Total Cost of vists

    Dr.- $75-$150 for standard office visits, range depends on quick/moderate problem/ annual exam type visit.

     

    If you want to know cost of any other types of visits I keep my explanation of benefits statements so I could probably come up with just about any kind of test.

  • imagejsugrin:

    Thanks so much for this info :-) We have the 10%/20% copay across the board, except for wellness visits which are no charge.  I'm trying to decide between 2 plans - one costs about $300 a month with a $1000 annual family deductible and 20% copays (separate deductible for prescriptions), and the other plan will run about $200 a month, has a $2400 annual family deductible and 10% copays but the employer contributes $600 annually to the HSA (prescriptions included in the medical deductible). I'm not really concerned about the OOP maximum now since you said it's uncommon to reach it, and after running some numbers it looks like unless we have an emergency we won't get there.... I guess now I just have to figure out how often we actually go to the doctor for things other than well checks...

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  • I don't know if you are still checking this thread or not, but our family deductible is $6000 and it's the same as our out of pocket max.  The last two years we've definitely met the OOP max, because we had a baby in 2010 and one in 2011.  If it weren't for the deliveries, we wouldn't meet the OOP max.  DS2 was born in July and up to that point we had only accrued about $1000 towards our deductible/OOP max (and that might have included things like ultrasounds that we don't normally have...I don't really remember when the billing for that was pushed through).  

    Also remember that if your plan is an HSA plan, you are eligible to put pre-tax money into an HSA account to cover your medical expenses.  I think the limits are $3150 for a single person or $6050 for a family.   

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