- A regional, narrow network, low-cost option
- A national, broad network, health savings account (HSA) qualified high-deductible health plan (HDHP)
- A national, broad network, normative EPO
- When individuals rarely do meet the deductible, the plan does not actually pay 60% of the resulting charges. Because this plan’s “allowance” of 150% of the Medicare reimbursement rate is generally far less than providers’ retail charges, this 60% will generally feel more like 30 to 40%.
- The out-of-pocket maximums, while much higher than most of us could afford to pay in cash, are not even close to representing the true out-of-pocket risk to the enrolled individual. For example, we know that if the individual enrolled in single coverage incurs a $75,000 inpatient out-of-network retail bill, the individual could easily end up owing the hospital and providers an amount vastly exceeding $10,000 (even after the insurer or administrator attempts retrospective negotiation).
