Opioid Treatment Services $0 copay $0 copay Mental Health (outpatient) Group: $15 copay $0 copay per day for unlimited days after that $0 copay per day for unlimited days after that $500 copay per day: Days 1-20 Inpatient Hospital Care $395 copay per day: Days 1-5 Home Health Care $0 copay 50% of the cost $90 copay per visit ($0 copay when outside of the United States)Īmbulance Services $240 copay for ground or air $240 copay for ground or air ![]() $0 copay for at least 3-month supply of Tier 1 medications with Preferred Mail Home Delivery from OptumRx.Īmbulatory Surgical Center 2 $0 copay - $345 copay 40% of the costĭiabetes Monitoring Supplies 2 $0 copay for covered brands 50% of the costĭiagnostic Radiology Services (such as MRIs/CT scans, etc.)ĭiagnostic Radiology Services (such as MRIs/CT scans, etc.) $0 copay - $175 copay 40% of the costĭiagnostic Tests and Procedures, non-radiological (such as EKG/ECG tests, etc.)ĭiagnostic Tests and Procedures, non-radiological (such as EKG/ECG tests, etc.) $35 copay 40% of the costĮmergency Care $90 copay per visit ($0 copay when outside of the United States) $90 copay per visit ($0 copay when outside of the United States) Preferred Mail Home Delivery through OptumRx The money you spend using your card counts toward your out-of-pocket costs.Īfter your total out-of-pocket costs reach $7,400, you will pay the greater of $4.15 copay for generic (including brand drugs treated as generic), and $10.35 copay for all other drugs, or 5% coinsurance. ![]() Always use your Medicare Advantage member ID card during the coverage gap to get the plan's discounted drug rates. You may pay less if your plan has additional coverage in the gap. Different ways of presenting the data will be easier to understand and follow for different people.If your plan has an annual deductible, you (or others on your behalf) will pay your drug costs up to the amount of this deductible before moving into the Initial Coverage stage.ĭuring the Coverage Gap Stage, you (or others on your behalf) will pay no more than 25% of the price for generic drugs or 25% of the price (plus the dispensing fee) for brand name drugs, for any drug tier until the total amount you (or others on your behalf) have paid reaches $7,400 in year-to-date out-of-pocket costs. If there is a better way of showing the costs I am sure everyone would welcome the input. This isn't even getting into the benefits of a high-deductible health plan(HDHP) and the health savings account (HSA) which can put in pre-tax money into a medical savings account that can grow tax free. ![]() I recommend for anyone switching to punch some numbers in or use their prefilled example low, medium, and high cost years to see what the costs would be. If a couple of scenarios were used based off of previous year expenses, most plans will have a cost calculator where you can see what the costs would be under each plan. In my workplace, we change companies and providers every couple of years, more often than not, the PPO plan is easily 3-5k more per year in cost just because of the high premiums. People get discouraged by the sticker shock of having to pay a large sum of money out of pocket, and want to just go to the doctor and pay a small co-pay.īy putting the premiums in there it is, in my opinion, a way to show how big of an impact it is going to have on the costs. ![]() Probably not the best way of putting it out there, but it is a good way to show the actual costs involved. Here, please treat others with respect, stay on-topic, and avoid self-promotion.Īlways do your own research before acting on any information or advice that you read on Reddit. Get your financial house in order, learn how to better manage your money, and invest for your future. Banking Megathread: FDIC, NCUA, and your cash.Private communication is not safe on Reddit. Scam alert: Ignore any private messages or chat requests.
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