There are two types of plans that HMO’s offer in Massachusetts:
Co-payment plans are simple. You have a service done and you pay the corresponding payment; for example, hospitalization may be $1,000 while day surgeries are $250. The good thing about co-payments plans is that there is little confusion.
On the other hand, deductible plans have co-payments for certain items:
- office visits
- emergency room
All expenses outside a “normal” office visit, diagnostic lab testing, diagnostic non-lab (X-rays, MRI-CAT-PET scans), hospitalizations and day surgeries go towards an annual plan year deductible. We see $500, $1,000 and $2,000 deductible plans all the time with a limit of two times the deductible per family. Recently, Blue Cross came out with a $3,000 deductible (note last post).
Fallon, however, has a few deductible plans that they refer to as “Classic”. These plans will cover diagnostic lab testing as part of a “normal” office visit and not apply the deductible. If you had a non-Classic plan and incurred $300 in expenses for bloodwork, you would have to pay this out of pocket as part of your deductibe. On the other hand, if you had a “Classic” plan, you would have this covered as part of your office co-payment.