Fixed or Scheduled benefits versus Comprehensive Plans: Which is best for me?
Firstly, let us define what fixed and comprehensive plans
are. They work quite differently from each other. A fixed plan also called scheduled benefits plan
is popularly known as fixed, because the insurance company has limits placed on what they will pay for each medical expense. A comprehensive plan
offers much more complete coverage. Let me explain using an example. Let's suppose that a person has incurred the following medical expenses: Doctor visit for $350, prescription medications for $160, minor surgery for $1350. The total expenses are $1,860. Let's give two examples of plans with a $100 deductible and a $50,000 maximum limit. The person with the comprehensive plan will pay the deductible of $100. After that, assume they have a 10% coinsurance charge, so they will still pay $176 (so a total of $276). With a fixed plan, the insurance company will pay only $55 for an office visit, only $100 for prescription medication and up to $3,300 for a surgery. That leaves $295 for the office visit, $60 for medication, and $0 for the surgery which totals $355. In this example, there is not much disparity between either policy. Now imagine that all costs are the same except the surgery costs $15,000. In that case, the person with a comprehensive plan will pay only $600 for all expenses ($100 deductible plus 10% of next $5000), whereas the person with the fixed plan will now have to pay an additional $11,700 (since the plan will only pay $3,300 for a surgery), which gives a total bill of $12,055.