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Ulcerative Colitis
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dsmk
New Member
Joined : May 2019
Posts : 13
Posted 7/25/2019 3:04 AM (GMT 0)
I want to know which is the best insurance plan among cigna OAP and cigna POS in California. Right now i am taking mesalamine and xeljanj for uc
deltaforce
Veteran Member
Joined : Jun 2010
Posts : 2373
Posted 7/25/2019 9:11 AM (GMT 0)
Nobody can tell you that. Every plan under the same name is underwritten in a different fashion. I would ask the HR to provide as many details possible and then decide.
iPoop
Forum Moderator
Joined : Aug 2012
Posts : 16483
Posted 7/25/2019 1:33 PM (GMT 0)
Ditto, nobody can tell you (plan details vary wildly employer-to-employer, and state-to-state). Often we choose the plan with the highest monthly premium as it has the best coverage (always verify that point though). Save the cheapest, high-deductible plan for the healthy who will never use it! We need low copays, low deductibles, and the best possible coverage and that often means more in the premium but we save in the out-of-pockets as we use the insurance A LOT.
Make sure both plans include your doctor as in-network, and make sure your current medications a covered.
I always do a quick cost analysis in a simple spreadsheet when trying to decide among plans. For both plans I'd do this. Take the premium and multiply it by your number of paychecks in a year. Figure the monthly out of pocket cost of your medication at the pharmacy and multiply it by your number of anticipated refills within a year. Figure the number of doctor's visits that are typical and multiply it out. If you anticipate any procedures (colonoscopies, etc) then estimate their cost in those plans. See how the numbers add up and choose the best one!
dsmk
New Member
Joined : May 2019
Posts : 13
Posted 7/26/2019 4:18 AM (GMT 0)
In POS plan - must select a PCP when enroll. PCP will direct all care. PCP refers you to specialist. I want to know if insurance company deny my medication coverage, my specialist will appeal against insurance company to cover it. In AOS you can choose your specialist in-network.
dsmk
New Member
Joined : May 2019
Posts : 13
Posted 7/26/2019 5:06 AM (GMT 0)
In OAP - per pay period contribution 79$.
In POS it is 46$ .
In OAP annual deductible 1000$
In POS it is 300$
In OAP - cost of coverage is highest
In POS - Less
In POS - you must select PCP when enroll. your PCP will direct all care. PCP refers to specialist.
In OAP - you can choose your specialist in network.
In POS - annual out of pocket max ( includes deductible and copays , where applicable) is - 2500$.
In OAP it is - 4000$
Prescript
ion drugs supply coverage is same in OAP and POS.
Inpatient surgery fees in network 10% after deductible and 30 % out of network in POS.
Inpatient surgery fees in network 20% after deductible and 40% out of network in OAP.
In POS - doctors office visit out of network is 30 % after deductible.
In OAP it is 40% after deductible.
In network it is same in both.
Preventive care in-network are same but out of network it is 30% after deductible in POS and in AOP it is 40 %.
It would be great help if anyone can tell that which is the best plan.
NOTE - i am taking mesalamine 2 tablets of 1.2 mg in the morning and it is shire brand and xeljanj 10 mg in morning and 10 mg in evening
dsmk
New Member
Joined : May 2019
Posts : 13
Posted 7/26/2019 5:11 AM (GMT 0)
Both medicine are covered in both plan .
iPoop
Forum Moderator
Joined : Aug 2012
Posts : 16483
Posted 7/26/2019 10:50 AM (GMT 0)
POS sounds better at a quick glance, but do the math
I'm sure your primary care doctor defers to specialist 99% of the time for anything UC.
imagardener2
Veteran Member
Joined : Jan 2010
Posts : 5896
Posted 7/26/2019 2:12 PM (GMT 0)
Besides what RX is covered I always make sure my GI is "in-network" in the plan under consideration and the hospital I prefer if things go wrong. It sucks to have to be an expert on insurance but this disease is "for life" so becoming educated is necessary.
This year I change over to Medicare and more education will be needed. Plus we're changing state we live in, new doctors, etc. Ugh.
dsmk
New Member
Joined : May 2019
Posts : 13
Posted 7/26/2019 6:35 PM (GMT 0)
Thank you so much everyone.
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