Old Oop

What insurance provider has a good plan for a 26 year old, healthy, married couple.?

I’ve been looking at Blue Cross Anthem’s, Smart Sense 2500 insurance plan: $196 month premium with $2500ind/$5000family deductible, annual OOP is same. It says 30% co-insurance (i don’t know if that’s member responsibility or theirs). $30 office visit PPO. I live near San Francisco.

Is this good? Have you heard of better?

I always recommend to go with a reputable local HMO unless you travel frequently outside San Francisco and want to be treated in other cities, but remember emergencies will always be covered by HMO in other states.

Why HMO, because they have co payments and there are no surprises or charges you did not expect. For instance, in a PPO with a $2,500 annual deductible, if you need to have a $800 MRI in any given year,you need to pay the $800, that will go towards your deductible. In that same year you need to have a Cat Scan- $500,you will still need to pay this in full since you have not met your $2,500 deductible for that year yet and so on until you have paid out of pocket the full $2,500. Assume you have met the yearly deductible and had to be hospitalized, you still need to pay 30% of the bill up to whatever the stop loss figure is according to the policy.

Now, in an HMO (more regulated than PPO which is an advantage) the co-insurance in the hospital could be a total of $2,500- usually $500 a day for the first 5 days= $2,500. But this applies only to hospitalization. Good HMOs have a co-pay for an MRI for only $50 and also for the Cat Scan and any other nuclear medicine testing as they are called.

Another advantage of the HMO over the PPO is the very important benefit of emergency room. PPO you need to pay the $2,500 deductible even if you are not admitted, but with the HMO is a low flat co pay which could be from $100 to $500.

Hope this has helped. I am sure you can get an even better rate if you go with an HMO. I wish I was in your city, for that same premium they are offering you with B/C I would have given you 100% hospitalization, no deductible, $10 copay for doctors, critical illness (money in your pocket in the event of a critical illness) and life insurance.

Shop around, I hope I have been of help

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