Continuing our in-depth look at some of the new health insurance plans that were created this year as a result of the Affordable Care Act, we're going to take a look at one of my favorite plans today, the MedMutual Market HSA 2000 Gold.
NOTE: Medical Mutual will no longer offer the Market HSA 2000 Gold in 2016. Click here to review the best plans available this year.
If you missed it, last week dove deep on Medical Mutual's Market Classic 1000 Gold plan, the "top-of-the-line" traditional plan offered in the Marketplace.
Click here to view the summary of benefits and follow along.
In-Network vs. Non-Network
The first thing you will notice is that there are two columns, one for in-network services and another for non-network.
You are ALWAYS going to want to do everything you can to "stay in-network." If you don't, you're setting yourself up for a much more expensive and unpleasant adventure.
Deductible
The Market HSA 2000 Gold has a, you guessed it, $2,000 single deductible and $4,000 family deductible. Watch the video below for more detailed explanation on embedded vs. aggregate deductibles.
That is the amount of money you will have to pay, upfront essentially, before your plan kicks into the co-insurance.
Non-network it's $6,000 single and $12,000 for a family.
Maximum Out-of-Pocket (MOOP)
The nice thing about HSA's is that their deductible is their MOOP. That means, this plan has $2,000 single or $4,000 family MOOP and that you will never pay more than $2,000 for yourself or $4,000 for your family in covered medical services for the year.
Or, to put it simply that's the bottom line number you need to be concerned with.
It's important to notice that your Non-Network MOOP is unlimited. That means the bills will just keep coming and there's no cap on what you could potentially spend. Now you believe me when I say stay in-network.
Co-Insurance
The HSA Gold has zero percent co-insurance, which means after you pay the deductible Medical Mutual will take care of the rest of covered, in-network, treatment for the year.
Except for non-network treatment with will have 50 percent coinsurance.
Accumulation Method
Watch the video breakdown for a more detailed explanation on embedded vs. aggregate deductibles.
Overall Benefit Period Max
Like what data used to be like on your cell phone plan, it's unlimited, or in other words your health insurance never runs out.
Medical Mutual will pay for as much, covered, medical treatment that you need for the year and lifetime of the policy.
Dependent Age Limit
You can keep you children on your health insurance in Ohio until they are 28 years old. Of course you are welcome to kick them off well before that, but they CAN be there until the end of the month in which they turn 28.
Benefit Period
January 1st, through December 31st.
It doesn't matter when your policy starts, your deductible and MOOP will always reset at the end of the year.
Physicians/Office Services
The HSA 2000 Gold will require you to pay for the full "discounted rate" for all doctors visits up to your deductible.
Again, watch the video for a more detailed explanation of the discounted rate.
From this point on you will notice that everything is pretty much split 50/50 between you and Medical Mutual for non-network treatment. With the exception of prescription medication and emergency room visits.
Preventative Services
There are a host of preventative services outlined by the Affordable Care Act that have to be covered at 100 percent, before the deductible. In other words, free.
The preventive services that didn't make the ACA list will go towards your deductible and then into co-insurance.
Outpatient Services
Everything except non emergency use of the emergency room will apply to your deductible and coinsurance.
Non-emergency use of the emergency room is NOT covered. So, think twice before you run to the emergency room after your doctors office closes for a sinus infection.
Inpatient Services
This is going to include things like hospital stays, maternity care and surgery. Everything under this category is going to be subject to your deductible and then covered in full after.
Additional Services
Here you will find coverage for ambulance rides, hospice and organ transplants. Again, all of these services will go towards the deductible and then into co-insurance, which is zero percent.
Prescription Drugs
It's important to note that only prescription medication filled through in-network pharmacies will be covered at 100 percent after your deductible. Again, a fancy way of saying "free after the deductible."
You will also pay for the full discounted rate, like doctors visits, for all of your prescription medications.
The Bottom Line
Health savings accounts really cut to the chase and simplify most of the process. Hopefully this breakdown gives you a decent understanding of what's covered and how the plan works.
If you want to know more about the actual bank account portion of HSA's you can read about that here.
Of course, working with someone who knows what their doing and can simplify the process for you makes it even easier.
You Tell Me
I've got two questions for you.
One, what questions do you have left about Med Mutual's Market HSA 2000 Gold plan?
Two, what other health insurance plans would you like to see a detailed breakdown of?
