A West Palm Beach family 42 M, 46 F, 17 F, 14 F (about) deciding if they are better off with Blue Cross Blue Shield of Florida or the South Florida HMO Plan from Vista Health Plan
For families I believe a PPO would be the better option, especially the BCBSF option since it does offer some of the advantages found in a HMO plan such as copays for much of the medical services rendered throughout the course of the year. Attached you’ll find the BCBSF proposal along with the respective benefit details for the three plans I felt came in comparable to the plan with Vista but for substantially less in premium.
The major advantages for families especially that I find are available through the BCBSF options are the following:
- Three deductibles maximum per family, whereas each individual has their own deductible and maximum out of pocket with Vista Healthplan.
- The maximum out of pocket for Vista’s OA20-2500 is $2500 per individual; $10,000 for the entire family
- The maximum out of pocket for BCBSF Plan 596 is $1500 per individual; $4500 for the entire family
- Mental Health benefits are covered with BCBSF
- National In-network Benefits with BCBSF
- Out of network benefits available with BCBSF
- No maximum benefit for pharmacy drugs although generics are only covered with Plan 596 and 597; Plan 503 does offer Name Brand coverage.
- Vista has a $1200 per calendar year maximum benefit limit for pharmacy drugs per individual
In the end as Vista charges per member with no family discount on the monthly premium the decision was an easy one as a family can buy more health insurance in West Palm Beach with Blue Cross Blue Shield than they could with Vista. However in Broward County the situation would be entirely different and it is plausible that Vista would be the better choice as Blue Cross has substantially higher rates in Broward County for some reason.
The only drawback to the decision in West Palm Beach was that the family will not have the Vista HMO copays which are lower for some diagnostic testing then the Blue Cross 590 series. Additionally the 590 series from Blue Cross does not offer brand name drug coverage.
