For those with health insurance...

[jx3smom]

Horizon B/C B/S of NJ.

State plan:
$10. any type of dr visit
$25.00 emergency
100% of hospital stay covered (thank goodness with all my cancer related stays this past year)

Drugs
$10 name
$3 generic

 

[MarkBarbieri]

I'm in an HDHP so that I can contribute to an HSA. I pay 100% until I reach my deductible ($1,500/person, $3,000/family). After that, I pay 80%. I could have signed up for a plan with a $20 copay, but I prefer this one because of the HSA. My premiums are about $1,800 less per year, my company contributes $1,250 to my HSA, and I can shelter almost $6,000/year in income from taxes in the HSA. We average about 3 doctor visits a year as a family, so we have been coming out way ahead this way.

 

[BELLE1109]

$20 office visits, $100 ER
but I have no deductible

 

[LisaNJ25]

we pay $10 primary dr $15 specialist and $50 er

HBCBS

 

[jen0610]

It's called Signature Care which a insurance program from one of our local hospitals.

If you pick tier 3 (the best) it is.

Co-Pays - 0.00. That is for office visits and hospital.

But, we get to pay 100% of the 1st 1500.00 per person, with a $4500.00 cap for family.

After each person meets their 1500.00 or the family pays their cap, it then becomes 80/20, for the next 1500.00/4500.00.

But there is ZERO prescription coverage UNTIL you hit your deductable. After that it is 10.00 on generic, 25.00 on brand names and they have some mail order that you can do. It will only pay 50% on any drug that is considered a controlled substance.


We are NOT on this plan. The cost for this per week, is $75.65 for a family.

Tier 2 - same co-pay as tier 3.

You pay 100% of the 1st 2500.00/7500.00. After reaching cap, it then pays 70/30, of the next 2500.00/7500.00.

This one has prescripiton coverage. This one has the co-pays as the previous one. This is the plan we choose and it costs us $52.85 per week.

Tier 1 - same co-pay as 3 and 2.

You pay 100% of the 1st 5000.00/15000.00. After reaching cap, it then pays 60/40 of the next 5000.00/15000.00.

This one does not have a prescription coverage either, until deductable is met. Then the same coverage as the other two. The cost for this one, $37.35 per week for a family, but if your a single person it only costs you $5.50 per week.

You want dental or vision - those are other plans that you can purchase.

 

[daughtersrus]

How much are your copays?

We have BC/BS and to see a general practitioner, it's $20 and for any specialist it's $40. ER visits are $75, but the hospital gives a discount for paying cash then and there. Well, I assume they do -- I've been there for urgent care and they gave a discount for that.

We have a BC/BS PPO so it depends. For the most part, we pay 20% of the discounted bill. Some things are covered at 90% or 100%. If we got out of network, it's only covered at 70% and not discounted.

For example, DH had some blood work done. The total for 2 tests was billed at $212. BC/BS determined that the eligible expenses were only $63. Insurance paid $54.60 (they paid 100% of the venipunture) , we paid $8.40 and the medical group wrote off $149 as a contractual adjustment.

Edited to add....

We don't pay directly for insurance. DH's employer pays 100% of the premium but that is taken into consideration when it comes time to negotiate their contract.

 

[Handbag Lady]

Ours is $20 for doctor's visits each time. Doesn't matter for what, annual exam, something is wrong, strep throat, etc.

ER is $100 but that is waived if you are admitted. Don't ask me why I know that now.

Rx is $4 for generic, and non-generic (what is that term?) depends on the Rx.

Annual mammograms are free and our employer gives us free flu shots. All we have to do is pop in at the nurse's station and show our badge.

Another thing my employer does is offer us up to $300 for either our Flex-pay or benefit payroll deductions, your choice. You have to fill in a survey for the first $100, do a check-up for the next $100 and learn your stats such as your blood pressure, cholesterol, BMI, weight, etc., and then do something else for the last $100. I think it is lose a percentage of your BMI or something has to get improved? I've never gotten that far so I don't know.

 

[indimom]

We chose the Tier 2 option because it was half the price of Tier 1 and we are generally very healthy:
$25 GP
$35 Specialist
$75 ER
70/30 payout
$1,500 Deductible, $6,000 max out of pocket (family)

We also have a "free clinic" at DH's work (GPs and Pediatrician). We can receive treatment, get general lab tests done, and receive many antibiotics and allergy meds free. It can be difficult to get into at times, but we we haven't paid for a prescription med. in two years, only one lab test and two co-pays. It's been great to have.

With the free clinic, the lower tier insurance was adequate and a real bargain. But, we are now looking at surgery for our DD (see the specialist next week), so we may get a taste of those deductibles and OOP costs very soon. (I feel like I gambled on our health and she lost. )
If she is a candidate for surgery, we will probably go back to Tier 1 next year. 75% of people who have this surgery, need a second procedure within a year, so we would benefit from the 80/20 payout, lower deductibles, and lower OOP max.

 

[mill4023]

$25 for primary
$50 for specialist (no referrals needed)
$100 for ER

Same here.

Most prescriptions are $5

 

[MrsJackSparrow4Life]

I work at a hospital and have a Preventative Care PPO through Aetna.

- Anything Preventative (Annual exam, etc) is 100% covered, no copays.
- Non-Preventative/Non-Emergency has a $10 copay
- Emergency room visit has a $70 copay
- If I am Hospitalized at a hospital we own the stay is 100% covered
- Eye exams (United Vision Healthcare) have a $10 copay and they cover up to $150 in glasses or contacts per year.
- Dental work (Delta Dental) has a $25 deductible and is 80/20.


I pay $100 per month in premiums to cover both my daughter and myself.

 

[SunnyP4Disney]

Tricare Prime Remote-AD military, no copays except for prescriptions, then it's $9 brand, $3 generic. We are very fortunate!

 

[mickeymedic]

How much are your copays?

We have BC/BS and to see a general practitioner, it's $20 and for any specialist it's $40. ER visits are $75, but the hospital gives a discount for paying cash then and there. Well, I assume they do -- I've been there for urgent care and they gave a discount for that.

Looks like we have the same insurance plan.

 

[scrapquitler]

Anthem BC/BS in CT. We have $20 copay, $30 for specialists (no referral needed). $75 for ER care, $1500 for hospitalizations and/or day surgery.

For Prescriptions: $10/$20/$30 depending on which list the medication is on, but they only pay up to $500 per year per patient, after that you pay the 'discounted' price yourself.

My husband is self employed, so we are 'direct pay'...we pay the WHOLE premium. And apparently the state of CT just approved a 47% rate increase for Anthem for next year. My health insurance policy is going to cost more than my mortgage payment.

 

[Polyluvr]

Excellus BC/BS 0 copay for kids; 25 adults pcp; 40 specialist


Rx's are 7,10,30

 

[shellybaxter]

I have Anthem Blue Cross - 100% coverage - no deductable, no co-pay. $10 for prescriptions. Its great insurance but my employer pays a pretty penny

 

[NikitaZee]

We have Empire BC/BS out of NY. $10 for regular doctor visits, $20 for specialist (no referrals needed). Prescriptions $6 brand name, generic is free. Hospital stays, outpatient, labs, etc. covered at 100% with no lifetime maximum. We don't have to pay anything towards it, it's covered by the union contract.

 

[Pembo]

$25 doctors visits, $17 prescrips

Not sure what Disneysix is referring to...our premiums have gone up every year for a l-o-n-g time.

 

[Mommee]

BCBS PPO high-deductible health plan with an HSA. We pay everything for the first $3100; they pay everything after that. Prescriptions go towards the deductible. There was a cheaper plan offered that was 80/20 coverage after the deductible was met, but because we expect to always hit the deductible this is cheaper for us.

We've already received next year's health insurance info; for the first time in years nothing is changing for us.

 

[marcyinPA]

How much are your copays?

We have BC/BS and to see a general practitioner, it's $20 and for any specialist it's $40. ER visits are $75, but the hospital gives a discount for paying cash then and there. Well, I assume they do -- I've been there for urgent care and they gave a discount for that.

Same here...but I don't know about the ER cash discount. Otherwise, our co-pays are the same as yours.

 

[nancycg56]

Retired military ~ Tricare Prime ~ $460/year.

$12 across the board ~ copays including any kind of surgery that is NOT done at a military treatment facility and any kind of tests. We pay nothing at a MTF.

$3 generic, $9 brand name.

We also have a supplement through a military org. that reimburses our co-pays including prescriptions.

So we pay $920/year for both and we consider ourselves very lucky!