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Adjusting those Blue Cross Blue Shield rate changes

January 19, 2012

So, you probably already know that Blue Cross Blue Shield of RI is no longer asking for a 4.4% rate increase. The health insurance company reduced its request to 2.4% at a public hearing earlier this week.

But something else is different too. After reading my post about its changes to deductibles and out of pocket limits, Blue Cross said I’d left out an important detail. Here’s what the company told me about its Healthmate direct 500/1000 plan and its Healthmate direct 2000/4000 plan.

In 2011, the deductible did not apply to the out of pocket max.  However, in 2012 the deductible amount applies to the out of pocket maximum.

Essentially, when you look at the out of pocket maximum for the old plans, that’s actually NOT the maximum. The most you would pay out of pocket is that amount PLUS your deductible. But that’s only in the case of the 500/1000 and 2000/4000 plans.

This detail wasn’t mentioned anywhere on BCBSRI’s explanation of its current benefits. If this was your health plan, you’d only see it in writing in your subscriber agreement. Here’s the relevant text-

The deductible, infertility treatment copayment, flat dollar copayments, and prescription drug copayment do NOT apply to the maximum out-of-pocket expense; therefore, the level of coverage will not be increased to 100%.

My apologies for getting this wrong, but perhaps it’s an indication that this information needs to be more accessible. If I missed this detail after several hours of research, someone who doesn’t do this for their job might miss it too.

So how does this new information change the ACTUAL cost increase for people on these plans? Here are the new calculations, using myself as an example.

This is much lower than the cost increase calculated in my  earlier post, which put the extra cost at $1,346 or an increase of 9.64%. Here, the difference is minor. But the cost increase for the 2000/4000 plan is still significant.

Before, when I thought the deductible counted towards the out of pocket limit, I calculated the cost difference as $9,516 more than the old plan at a cost increase of 74.18%. Now it’s a cost difference of $5,516.60 or a 32.78% increase. Still, much more than a 2.4%.

2 Comments leave one →
  1. Kiersten Marek permalink
    July 19, 2012 3:27 pm

    Reblogged this on Therapy with Kiersten Marek, LICSW and commented:
    High deductibles such as those described in this article are a main reason why the middle class is effectively unable to access outpatient mental health care except by paying out of pocket.


  1. Unpacking BCBSRI’s rate request part 2 UPDATED « The Pulse: health care in RI

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