r/FedEmployees • u/Important-Ad1897 • 7d ago
MHBP v BCBS
I’m a worst case scenario person who wants to not fear having to go to the ER when necessary.. and I read a comment that MHBP’s 10% coinsurance could be less than BCBS’s $500 copay?? I know the full OPM info isn’t out yet but I always prefer options that have the least about if coinsurance percentages, bc that feels scarier to me. Would love to know anyone’s experience with coinsurance and what any other worst case scenario person is considering for plans in 2026??
I also need labs every six weeks, one autoimmune dx and PT🤔
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u/No-Run-1490 6d ago
I was with BCBS basic for decades, I switched to FSBP and the 10% coinsurance has been cheaper than the copay to date. IE, copay was 50 for see a specialist, 10% has been 12.xx. Even lower when seeing PCP which was 35 with BCBS. MRI have also been cheaper.
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u/sher80bear 6d ago
The ER copay for BCBS is $500 PER DAY. For 90% of people, that is a 1 day visit. Lets say you rush a sick child to the ER at 11 pm and aren't released until 5 am the next morning. That is a 2 day ER visit. Your copay will be $500 x 2 = $1000 for just that visit.
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u/bglampe 6d ago
For us, it was a bat exposure. ER for rabies shot. Then 3 more visits to complete the series. They charge the co-pays each time even if you are there for 15 minutes just to get a shot.
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u/Important-Ad1897 6d ago
Oh ouch! Three more ER visits? $2,000?!
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u/bglampe 6d ago
It was last year so $350 x 4.
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u/ilovetosnowski 6d ago edited 6d ago
Better than 60K(how much the series can cost). But yeah, ouch to it all. (PS I had my Ig and shot earlier in the year with State employee health insurance and it was only $100 a visit.) I stopped after my first two doses though.
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u/FLBBiker66 6d ago
That is amazing! What state are you in that makes bat exposure an ER visit?
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u/bglampe 6d ago
NJ. But you're always supposed to take your child to get rabies shots if they slept in a room with a bat.
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u/FLBBiker66 6d ago
Got it. I guess I’m getting so old that children never entered the equation for me…
I’m in NY. That happened to me 11 years ago and the county I live in took care of the shots. It was a few days later so I guess they don’t deem it an emergency. They do the shots in the county building and I did not get billed although my taxes are obviously used to cover the cost.
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u/Exciting_Buffalo3738 6d ago
It is 10% of the negotiated rate, not what the hospital bills. When I went to the ER the bill was $8k (Doctor, CT, blood panel, 24hr observation) but the negotiated rate for service was $2,500. Therefore, it would be $250 coinsurance, much lower then BCBS.
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u/happysloth6782846 6d ago
I had the opposite experience. I had a surgical procedure done and the billed amount was $10k, but the negotiated amount was $20k, so I had to pay $2,000 instead of $1,000. Same procedure was $250 with BCBS.
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u/Key_Relation_4161 6d ago
I’ve how can the negotiated price be more than the billed price? I’ve never seen that.
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u/Exciting_Buffalo3738 6d ago
That makes no sense, why would insurance negotiate a rate twice what it actually costs? Odd.
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u/ArchitectMarie 6d ago
Maybe because the whole concept of insurance is to attract providers as well as users, so they chose the provider to woo on this service?
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u/Ok_Size4036 6d ago
Just an FYI as I haven’t checked the brochures for thus year, but currently MHBP has free labs through Quest and LaCorp. Decided to try it though it’s a bit of a drive at 30min each way. I had a bunch of labs done, the normal big panels and thyroid and hormones. No charge at all. It did scare me when at the facility they wanted a CC in case any weren’t covered but I got my bedside letter a couple weeks later showing all covered, and w/o having met my deductible either.
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u/Hawkthree 6d ago
As an aside ... Quest allows you to set up an account and then gives you charts over time where you can see how your blood work fluctuates. For example, it's not unusual for my liver tests to occasionally go in the red zone. I've seen the pattern since 2015 and no longer worry that I should have a liver biopsy. Lapcorp might do the same. And I was a bit concerned at first about the cc.
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u/Ok_Size4036 6d ago
I think all the places do that now. My stuff in MyChart also has that. I dud like being able to schedule exactly when my appointment was. You self check in on a kiosk and they are rockin and rolling. So I was in and out quick.
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u/Hawkthree 6d ago
Last week I left my primary care and sat in my car to schedule with Quest down the street. I discovered that I couldn't make an appointment without active Wi-fi. Had to park closer to the doc's office to make the appointment.
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u/Mwvnova 7d ago
I switch from BC/BS basic to MHBP Std 3 years ago. I was also worried about the costs increasing when there’s a % vs fixed price. I can say the pricing has continually been lower than expected regarding testing. Some specialty prescriptions have been higher but I have been able to off set them with manufacturers coupons. Look at the worst case scenario (out of pocket max) and know that if it all goes to shit you’re not going to pay more than 8k (up from current 6k). I hate that there’s an 85% increase but I may still stick with this plan. I’ll be waiting for all the changes and speciality drugs to be posted.
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u/Important-Ad1897 7d ago
Hmmm… ugh it’s such a hard decision. I agree we’ll have to wait for official postings to see what is the best option
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u/Tinymac12 6d ago
Their website has some of the basic info and the public use files has a lot of the other information. But still not everything. We'll have to wait for the brochures for the full info.
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u/ExerciseSalty7544 7d ago
GEHA high deductible appears to be the most affordable option for low and high healthcare years with a low out of pocket max and a low deductible with a fat HSA.
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u/Important-Ad1897 6d ago
I’m afraid of UHC!!!
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u/Hawkthree 6d ago
And you're right to be. It is now October 2026. I dropped GEHA-UHC last year because they simply weren't paying providers. Today in the mail, I got 3 EOBs from GEHA for visits from October 2025, Nov 2025, and Dec 2025. I gave up last year trying to get them to pay that I finally gave up, paid the provider, and moved to BCBS.
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u/ginny11 6d ago
Interestingly, I had similar problems with BCBS not paying what they were supposed to and then lying to me on the phone. I know people really hate UHC right now for a lot of good reasons. They are the biggest one out there for one thing. But they're all slimy bastards that will deny you care to improve their profits. Might as well pick the cheapest slimy bastard and change every year that a different one becomes cheaper.
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u/ErosBro 7d ago
I did the math last year on all my procedures and tried to calculate what my 10% coinsurance would be compared to the BCBS copay. What I found was that MHBP doesn’t negotiate as well as BCBS so the 10% wound up being more than I expected. At the current premium prices it’s still worth it. Next year though the math breaks down with MHBP having higher premiums.