Maximus Implementing Drastic Health Cost Increases for 2021
Employee Out-of-Pocket Expenses for Individual Health Coverage at In-Network Providers:
Comparison of 2020 vs. 2021 Health Plans
| 2020 | 2021 | ||
|---|---|---|---|
| Core Plan | "Buy-Up" Plan | ||
| Annual Employee Premium Contribution | $0 | $0 | $1,950 |
| Annual Deductible (Individual) | $2,500 | $4,500 | $1,500 |
| Annual Out-of-Pocket Maximum | $5,000 | $6,000 | $6,000 |
| Coinsurance (after deductible) | 20% | 30% | 0% |
| Office Visits (Non-Preventive Care) | $25 (Primary Care)$35 (Specialist) | 100% up to deductible, then 30% | 100% up to deductible, then 0% |
| Telehealth Visits | Free | 100% up to deductible, then 30% | 100% up to deductible, then 0% |
| Prescription Drug Deductible* | $150 | $4,500† | $1,500† |
| Urgent Care | $50 | 100% up to deductible, then 30% | 100% up to deductible, then 0% |
| Inpatient Hospital | 100% up to deductible, then 20% | 100% up to deductible, then 30% | 100% up to deductible, then 0% |
| Emergency Room | $500 (waived if admitted) | 100% up to deductible, then 30%‡ | 100% up to deductible, then 0%‡ |
* Some preventive generic medications are fully covered and require no copay. See the list of preventive generic medications for 2021, located at www.express-scripts.com.
† Starting in 2021, the prescription drug deductible will be lumped together with your medical plan deductible.
‡ Maximus' 2021 Benefits Guide does not indicate that these out-of-pocket expenses are waived in the case patient is admitted to hospital, as they were in 2020.