High Deductible Health Insurance?

[bethy]

We've had one for quite a few years and have enough ongoing health issues in our family that we plan on pretty much having to pay most of the deductible every year. It's still worth it for us financially - we just have plan around it.

The biggest perk I like is that we can go to any doctor or specialist or hospital we darn well please. No referrals necessary, etc.

Also we've had the same issue come up once or twice where an office has tried to charge us more than the "cash" price since we were technically still running things through a insurance plan first. I fought back and insisted on paying straight cash instead - like with a credit card or check right there at the front desk. The downside of that though is that ti doesn't count toward your deductible. Luckily in my case they were small charges.

The most profound thing about this type of plan though is that it educates you that healthcare actually does cost money - and that we all DO have some choices involved that can raise or lower our out of pocket expenses. Those people who work in the doctor's office actually have to get paid so they can feed their families - whether i can afford to pay for their services or not. Also, I recognize that if i want the best healthcare in the world then I'm natually going to have to pay for it.

So I am a mother of three kids who pretty much never takes my kid in for a fever or a sore throat or any other minor ache or pain. My kids go to the doc once or twice a year max. Also, I think about things like - gee, do i really want them jumping on that trampoline and possibly getting hurt and incurring a huge ER bill. Or for example I cut myself the other day on a piece of sharp plastic and I believe there is a small piece of it still lodged in my thumb. I am watching for infection and otherwise waiting to see if it works it's way out on it's own. Yes, it hurts a bit but i dont' want to pay $500 to have it dug out when it might work it's way out naturally . . .

If there is an issue i need to call in about I am VERY careful to get it addressed at the doc's office on a Friday and thus reducing the risk of a weekend urgent care visit. And finally, i batch things - I try and get several issues addressed when we do go in - to get my money's worth out of the visit.

 

[SuzanneSLO]

I had one two years ago, loved it, switched companies, they didn't have it, and will have it again next year.

Ours has a reasonable deductibe (around $1200 per person) and a reasonable max out of pocket per family. ($6k). Since these are doable numbers for us to pay out of pocket in a year, its a good deal for us.

The best part is the Health Savings Account. I still have $5k from my previous employer - which has made money in the year since I left. Which means that year I had about $1k out of pocket. So going into next year I already have $5k of my $6k maximum out of pocket set aside. I'll put $6k more in this year, and - with a little luck - have a tidy sum set aside for medical expenses in retirement pre-tax and tax free. Its a little more for us to do this than having our old PPO plan - but the savings account is ours.

Like you, we have a substantial sum in our HSA. Because we earn about 3% on this money, we try to pay our medical bills out of current income.

The downside to this strategy is that we need to keep all the medical receipts until we deplete the account. The paperwork is about an inch per year. So 20" after 20 years! I think I need to spend a weekend with our scanner. -- Suzanne

 

[HLAuburn]

My husband just started with a new company and we also opted for a plan like this for the remainder of this year. We also crunched the numbers and decided to sign on for next year too. We had a similar plan years ago, but we ran into issues with doctors not knowing how it all worked and how to bill, so we were a little turned off.

Here are my questions: when you go to the doctor, do you find yourself explaining that basically you are paying out of pocket and you just want what's necessary done? Working in healthcare for years, I know that the idea is to charge for every little thing, so if I take the kids is for a sprained ankle, I don't want a $50 pulse ox check.

Also, how do you as a consumer know what these "negotiated rates" are? I assume they aren't the same as someone with no insurance, but you feel somewhat at their mercy for what they are going to bill you, and that's after the procedures are done.

I think it's all about taking control of your healthcare, and I'm OK with that as long as I have all the rules of the game.

We were hoping to make it til the end of the year with no DR visits, but yesterday I went to a CVS clinic for a sore throat that ended up being strep. The visit plus rapid strep test was about $120 and meds were about $24...not terrible I guess. The company "gave" us $400, so I guess we are still ahead...for now....

Thanks!

 

[amylevan]

We have one in conjuction with an HSA. Our deductible (family) is $6K, after which we pay 10% while the plan pays 90% up to a max out of pocket of $9K.

We have been on this plan for 5 years, including the year that my son was born prematurely with 3 weeks of NICU bills. Even considering that we made our max out of pocket that year, the plan has saved us money overall. The monthly premium for our PPO option is about $300/month more than the HDP, and you still have copays and other such fees - so overall it just makes sense for us. Especially considering in a typical year, we have few costs.

Our plan also covers all well child visits, yearly physical, and woman yearly exams, so those do not come out of our pocket.

 

[mom2daisy]

We have a HDP & HSA for our family. I literally spent MONTHS crunching numbers and trying to make a decision. Our situation is actually the opposite of who "should" have this type of plan because I have MS and the cost of my monthly injections is $4,000

Our deductible is $3,800 w/ a $2,000 company contribution and then $750 OOP max ($2,550). Because prescriptions apply toward the deductible, we meet that in February and then the plan kicks in 100% for the rest of the year! Like I said, we're definitely the exception to this rule.

Be careful with the FSA in connection with the HRA. I use a limited FSA with our HSA to help with dental, vision, and yoga membership.

 

[amylevan]

Also, how do you as a consumer know what these "negotiated rates" are? I assume they aren't the same as someone with no insurance, but you feel somewhat at their mercy for what they are going to bill you, and that's after the procedures are done.

We've had our plans with 2 different insurance companies (Blue Cross and Aetna) and both companies had us present our insurance cards at time of service. We were told not to pay anything then - no copays, no anything - and the doctors were to bill the insurance company. The insurance company would then be responsible for the negotating the "negotiated rates" with the doctors office, and then we would get a bill from the doctors office for the correct amount afterwards.

 

[AmericangirlinFrance]

Can I ask what some of you with high deductible health plans have as your maximum out-of-pocket expense limit before the plan takes over paying 100%?

We do not have a HDHP - we have a traditional PPO (Blue Cross). Our family deductible is only $500 (it's just me and my husband), but our out of pocket max is $5,000.

We're both generally healthy people so normally it's a non issue, but of course this year I got very sick, spent 5 nights in the hospital, tests, had surgery, etc. so we are going to probably hit our OOP max.

I'm not sure if that is about normal or a little high - seems like I read on this thread that some of you with HDHP actually have a LOWER OOP max??

 

[sookie]

If I could get away high deductible plan under these circumstances, I would - but with more than 1 asthmatic in the house - I could get dinged big time.

It all depends on your family OP. Since health maintenence should be covered now - if your all very healthy and since the employer may contribute up to a point, you could be ok.

 

[HLAuburn]

Also, how do you as a consumer know what these "negotiated rates" are? I assume they aren't the same as someone with no insurance, but you feel somewhat at their mercy for what they are going to bill you, and that's after the procedures are done.
[\QUOTE]

We've had our plans with 2 different insurance companies (Blue Cross and Aetna) and both companies had us present our insurance cards at time of service. We were told not to pay anything then - no copays, no anything - and the doctors were to bill the insurance company. The insurance company would then be responsible for the negotating the "negotiated rates" with the doctors office, and then we would get a bill from the doctors office for the correct amount afterwards.

OK thanks, that sounds reasonable. We have United Healthcare, so hopefully it works the same way. At the CVS clinic yesterday, they normally just bill you for the copay, so I didn't pay anything. It did have the costs on there though, so it will be interesting to see how much the bill is when it comes.

Thanks for the reply!

 

[Fjobe]

We have always (for 12 years) had a high deductible plan with an HRA. For us it has been great - even with paying for the pregnancy and birth of 3 kids. With DH's insurance, if we paid for the lower deductible, it would be more than meeting the high deductible. Luckily, our only ER visit (when DS busted his head open falling down the stairs in the middle of the night) was the same year our last child was born, so we had already met our family deductible.

DH's employer contributes a different amount each year to his HRA. One year was $1500, once was $250, once $1000, but most years it is $500. We also put $2500 in my Flex spending account at work (we have 4 people in our family wearing glasses or contacts).

Something I've noticed is that some people are talking about HSA with a high deductible, and and some people are talking about HRA. There is a difference. HSA funds left at the end of the year can be carried over to the following year. Also, with most HSA accounts, prescriptions are not covered until the deductible is met. DH takes 2 medications, so the HSA offered at his job would not be worth it for us. The HD insurance we have with the HRA covers prescriptions from the beginning, so that is what we go with.

 

[FLmomof2]

OK thanks, that sounds reasonable. We have United Healthcare, so hopefully it works the same way. At the CVS clinic yesterday, they normally just bill you for the copay, so I didn't pay anything. It did have the costs on there though, so it will be interesting to see how much the bill is when it comes.

Thanks for the reply!

We opted for this plan with United Healthcare for next year. So nervous about the whole thing but hoping it all works out!

 

[ntink]

This is a very timely discussion as we are exploring the very same options.

The one thing I can't figure out is the difference between the deductible and the out-of-pocket maximum? It looks like once we meet the deductible, the plan kicks in but I can't figure out how the out-of-pocket maximum factors into that. For the options we are looking at, each line says "$0 cost after deductible" and then for prescriptions, there is a co-pay required after the deductible is met.

Any information on this would be greatly appreciated. I sent an email in to our insurance rep as well

 

[SuzanneSLO]

We have always (for 12 years) had a high deductible plan with an HRA. For us it has been great - even with paying for the pregnancy and birth of 3 kids. With DH's insurance, if we paid for the lower deductible, it would be more than meeting the high deductible. Luckily, our only ER visit (when DS busted his head open falling down the stairs in the middle of the night) was the same year our last child was born, so we had already met our family deductible.

DH's employer contributes a different amount each year to his HRA. One year was $1500, once was $250, once $1000, but most years it is $500. We also put $2500 in my Flex spending account at work (we have 4 people in our family wearing glasses or contacts).

Something I've noticed is that some people are talking about HSA with a high deductible, and and some people are talking about HRA. There is a difference. HSA funds left at the end of the year can be carried over to the following year. Also, with most HSA accounts, prescriptions are not covered until the deductible is met. DH takes 2 medications, so the HSA offered at his job would not be worth it for us. The HD insurance we have with the HRA covers prescriptions from the beginning, so that is what we go with.

Ubpner current IRS rules, prescription drugs are always allowable costs which can be paid out of an HSA. They may not however apply to the deductible of
your HDHI. On my plan, most prescriptions apply to the deductible but some, like smoking cessation products, do not. -- Suzanne

 

[fab5friend99]

.....Something I've noticed is that some people are talking about HSA with a high deductible, and and some people are talking about HRA. There is a difference. HSA funds left at the end of the year can be carried over to the following year. Also, with most HSA accounts, prescriptions are not covered until the deductible is met. DH takes 2 medications, so the HSA offered at his job would not be worth it for us. The HD insurance we have with the HRA covers prescriptions from the beginning, so that is what we go with.

You bring up a very good point about prescriptions. The HDHP at my previous employer had a separate deductible for prescriptions. At my current employer's HDHP the deductibles are not separate so it makes a big difference in the breakeven point.

 

[bored]

My company pushed a high deductible plan out this year as an "affordable opportunity" aka this is what your all gonna have next year. It was only $1000 cheaper than my current PPO for family coverage per year with a $5000 deductible and a max out of pocket of $13k. The company was going to contribute $500 to the HSA to help cover the $5000 deductible.


mmm no thanks!

 

[EMAW_KSU]

My previous company offered a high deductible plan. I created a spreadsheet and graph of the total cost to determine which plan was the best for us. This is the graph I did then. Is shows the total cost (premium + out of pocket) for different levels of medical cost.

 

[riley2008]

If I could get away high deductible plan under these circumstances, I would - but with more than 1 asthmatic in the house - I could get dinged big time.

It all depends on your family OP. Since health maintenence should be covered now - if your all very healthy and since the employer may contribute up to a point, you could be ok.

I have asthma and take very expensive monthly meds. For us the HDP saves us about $3000 per year. Once I pay for my meds the first two months, EVERYTHING for the family is covered for the rest of the year. If I had to jump to the next tier - the Co-Pays for prescriptions monthly and doctor visits plus the increase in premium would cost us about $3000. Surprisingly the upper tier insurance would cost even more, although the examples the insurance provides does not take into account the increased premium amounts.

...Something I've noticed is that some people are talking about HSA with a high deductible, and and some people are talking about HRA. There is a difference. HSA funds left at the end of the year can be carried over to the following year. Also, with most HSA accounts, prescriptions are not covered until the deductible is met. DH takes 2 medications, so the HSA offered at his job would not be worth it for us. The HD insurance we have with the HRA covers prescriptions from the beginning, so that is what we go with.

HSA pay for prescriptions - deductibles do not have to be met. That is what it there for. Not sure what you meant to say.

My previous company offered a high deductible plan. I created a spreadsheet and graph of the total cost to determine which plan was the best for us. This is the graph I did then. Is shows the total cost (premium + out of pocket) for different levels of medical cost.

Nice!

 

[Jack&Ryan'smom]

WE are just finishing out 2nd year with this type of plan. It is very overwhelming at first. Not sure if we/re sold on it yet.
We definatley don't run to the doctors office anymore. Not going to pay the pediatrican $95 to tell me my kid has a virus.
I do love the preventive cars is 100% covered!!!
I do love that we don't need referals!!!
Basisically once you meet your deductable then you pay the % set till you meet that out of poacket maxium then they pay 100%.
For us once we hit the $2400 deductable then we only pay 10% of all bills. Hence why this month I am having a few things done at the dermatologist.
Most offices see this type of plan a lot now. Some are surprised I have no co pay. They will just send you a bill a few weeks after the visit.
I am disappointed a bit cause this year my prescriptions go towards the deductable but next year they will not...that stinks cause now I wonder if I'll hit my deductable during a "healthier" year.

 

[ccgirl]

Does anyone use a high deductible insurance plan? We are thinking of switching to that vs the traditional plan we have now. The employer will also contribute money to an HRA for us, so potentially we'd have lower premiums and "free" money from the employer to use up on health expenses first before we have any other out of pocket expense. We could also have an FSA that only we would contribute to. I am not really seeing a downside here. Yes there is a higher deductible but we may never get to that amount (we usually don't, but if we had a major event, we might). And I'm assuming the first part of our expenses will be covered by the employer's contribution. Does anyone else have a high deductible insurance plan with an HRA? Or just high deductible? How do you like it? I'm a bit nervous to take the plunge, but I'm just thinking it may actually save us a lot of money.

You have to know the stop loss of the plan. Meaning the most you would be required to pay OOP. The stop loss on my HSA plan was $2500. Therefore, I would never be required to pay more than that. We are a healthy family and never ended up paying anything OOP nevermind reaching our stop loss. It was unnerving when we first had the plan but once I realized how it worked I liked it. Now we have fairly high copayments as we had to switch to a "traditional" plan per the employer. I would have rather the HSA.

 

[robinb]

I skimmed the thread, so I don't know if this has been mentioned ... the Flexible Savings Accounts (FSA) will now have a limit of just $2500 in pretax dollars. So, if you are relying on a high FSA to help cover expenses you should be aware that the maximum contribution will be lower in 2013. We adjusted our dental insurance because of the changes in the FSA.