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We are on a small group family plan and our deductible resets every year Jan 1st. Our employer has open enrollment in March and the employees plans change April 1st. Our situation is that I have accrued $6,000 in medical bills by myself in the first quarter of the year. We currently are on a Bronze plan with a $5500 individual deductible and $6500 individual out of pocket max. The family deductible is $11000.
My question is, if we switch to a Silver plan, with a $2,000 individual detucible, $6,600 individual out of pocket max and a $4,000 family deductible, will all of what we have paid carry over to the new plan?
If it does, I will have hit my individual OOP max soon and could get a knee surgery in late fall for free basically. Plus my entire family will have met the family deductible.
We are on a small group family plan and our deductible resets every year Jan 1st. Our employer has open enrollment in March and the employees plans change April 1st. Our situation is that I have accrued $6,000 in medical bills by myself in the first quarter of the year. We currently are on a Bronze plan with a $5500 individual deductible and $6500 individual out of pocket max. The family deductible is $11000.
My question is, if we switch to a Silver plan, with a $2,000 individual detucible, $6,600 individual out of pocket max and a $4,000 family deductible, will all of what we have paid carry over to the new plan?
If it does, I will have hit my individual OOP max soon and could get a knee surgery in late fall for free basically. Plus my entire family will have met the family deductible.
Your employer is naming it's plans to correlate with the exchange plans from what it sounds like..just so others don't think you have an "exchange" plan. If your deductible resets in January but your plan year is April 1st. it's likely that your out of pocket costs from Jan 1st will translate to the new plan, however, you need to double check with your plan administrator or your HR people to verify how they handle that. Also know, just because YOU had $6000 out of pocket, it seems from the limited information you provided that you still have an individual out of pocket max so only $2000 will carry over to your out of pocket max..possibly. It's an unusual situation and I am sure there is a procedure for this type of situation. Double check your paperwork to see if they have anything in there about out of pocket cost incurred so far or talk to your plan rep or HR person to clarify.
Also, add up ALL costs to see if it really makes sense to move to the other plan. If the premiums for the other plan cost more than the out of pocket savings, doesn't make sense to switch.
Thank you Qwerty. Finally got a hold of our health insurance rep today. He said it will carry over. The deductible will get met and then it will be applied as co-insurance.
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