Over the past few years, more and more of my practice has involved individual medical plans. There are myriad reasons for this, but for now I�d like to focus more on the �what� than the �why.�
For example, yesterday a young lady called about medical coverage for her family (mom, dad, son). She had called a number of places before getting to me (hard to believe!), and every one of those places gave her a quote for a generic co-pay plan. I know that it�s easy to do that, and to fall in the rut of cookie-cutter offerings, but I�ve found that this isn�t always (or even usually) the best way to go.
So I recommended a plan with a $2500 (per person) deductible, with a drug card but without office visit co-pays, and � best of all � no co-insurance.
As an aside: I�ve been in this business for over 20 years, and the single most difficult item to explain is co-insurance. �It�s 80/20 coverage!� Oh yeah, 80/20 of WHAT? Oh, today it�s 60/40 but only if you go to Doctor Kildare. Sheesh!
Anyway, as I explained to this potential new client, her family would save well over $100 a month with this plan; it seemed pretty far-fetched that they�d accrue anything close to $1,200 in doctor�s office visits over the year. And on a large claim, she�d actually SAVE money.
How�s that?! Well, today�s generic plans include a $1,000 deductible, then 80/20 (ahah, there�s that co-insurance again!) of the next $10,000, and then 100% coverage after that. So that means on a big-ticket claim (say $50,000), her out of pocket exposure would be $3,000 ($1,000 deductible + $2,000 co-insurance). But the plan I proposed limited her out of pocket maximum to only $2,500. And she saved $1,200 along the way!
Okay, that�s my soap-box for today�.
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