Originally Posted by usc90grad
Not sure about out of pocket max
Coinsurance max is $3000 (not sure what that means...maybe you can tell me)
$20 copay for primary care, $40 for specialist. RX copays are 10/25/40
Out of pocket max is deductible + Coinsurance max.
What you have is a fairly decent plan and the rates you are seeing may be in line with what you should be paying. However, you may be over-insured.
One idea is to increase the deductible to 2,000 and the Out of pocker (OOP) to 6,350. Those are the maximums allowed under ACA to meet minimum value coverage.
Another idea is to go with a HDHP/CDHP plan with an HSA. You will not have copays but you may not be using your copays thatoften right now anyway. On avg, people only see their PCP 2 times a year and a specialist 1 time a year. With the HDHP you pay the contracted rate that the carrier has with the doctor which is 80-100 for PCP and 120-200 for Specialist. You will also no longer have coapys for Rx so you need to take that into account. If you rarely go to the Dr and don't take drugs that often then the difference in premium and what you pay for not having copays will be pretty dramatic. Additionally you can use an HSA to put aside money pre tax to use for medical expenses.
Using my company's "traditional" plan would cost me 7000 to insure my family but I use the HDHP option and it only cost 2000 plus I put away an additional 2000 each year into my HSA.
Alao- Lots of things are covered now as preventative care and are free. Physicals, colonoscopy, etc.
Hopefully this gives you something to think about when selecting a new plan.