News, schools, and views from a uniquely Lowell perspective
3rd June 2010

A tale of two health insurance plans

posted in Education, Healthy Living, Money Matters |

With the enrollment period ending tomorrow, there has been much talk regarding savings in health insurance costs and how those funds could be used to keep more people employed, especially on the school side where we have eliminated 60+ positions and still have a deficit.  Aside from government savings, what do these health plans offer our employees in terms of care and cost?

For the purposes of simplicity, I will compare some differences between the most-expensive Master Medical (MM) health insurance plan with the least-expensive Blue Cross Blue Shield Network (HMO) currently offered to Lowell employees. The city also offers Blue Cross Blue Shield Preferred (PPO). For a detailed comparison of all three in terms of costs and covered benefits, check here.

The HMO costs an employee about $1200 less annually than the MM for family coverage. The HMO requires a primary care physician and referrals for specialized care while MM does not require referrals but also does not cover any routine visits, such as annual checkups and tests. Any doctor’s visit with the HMO costs the employee a  $5 co-pay while with MM, employees pay 20% of the cost for the visit. With MM, an employee easily could be required to pay $350 for an annual checkup as well as all costs for preventative tests, such as a colonoscopy and gynecological exams, while an HMO employee pays $5 for everything.  For prescription drugs, HMO-covered employees pay $5 per prescription while MM-covered employees pay 20% of the drug’s cost, which also can get very expensive.

Aside from costs and preventative care, which clearly lands in favor of the HMO, some may have concerns regarding the HMO referral process. As a long-time subscriber, thankfully through decades of wellness and routine visits, I can tell you I have never had a problem getting a timely referral for any complaint. Nothing tested this coverage more than last year’s cancer diagnosis for my son, where the HMO coverage was exceptional. Another difference is that MM has no cap on stays in a skilled nursing facility or rehabilitation center, while the HMO provides 100 and 60 days respectively for each calendar year. This, however, does not include hospital stays where both offer complete coverage as needed.

Clearly, changing health insurance is a complicated and personal decision. For my family, the HMO has provided excellent coverage through years of good health and our recent life-threatening diagnosis. The savings to employees and the city are significant, so please examine your options closely. It’s worth a second look.

There are currently 2 responses to “A tale of two health insurance plans”

Why not let us know what you think by adding your own comment! Your opinion is as valid as anyone elses, so come on... let us know what you think.

  1. 1 On June 6th, 2010, kpemscott said:

    This seems like an absolute no brainer. Gone are the days that your local doctor tried to only give you referrals to local doctors. I have Blue Cross HMO and my co-pays have gone crazy in recent years. I pay $40 per doctors visit, $200 emergency visit, $500 per hospitilization or day surgery, and $15 for generic drugs and $30 for non-generics. I also pay $6 more per week for coverage. I now have zero sympathy for looking for cuts in the city health plan or for the city providing more school funding unless the union works with the school committee.

  2. 2 On June 8th, 2010, Jackie said:

    The good news is that we are seeing tremendous movement as more employees are choosing the less expensive (and I would argue better) health insurance options.

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