Any experiences with CDHPs for health insurance?

[JenB1104]

So, I just realized my husband picked a CDHP with an HSA for health coverage for him and our daughter (mine is covered through my work). The deductible is 3500.00. This plan is 185.00 less per month than the other plan we had and he only elected to have 900.00 in the HSA part. Well visits are covered for our DD but otherwise I think we may be screwed (sorry for lack of better) word when it comes to out of pocket costs for any illnesses and pretty sure he can't make any changes at this point. I am sure he thought he was saving money by doing this.

Has anyone had experience with this type of plan? Did you find it to be more cost effective or a financial nightmare?

Thanks!

 

[CoP Luv]

Is this the same thing as a High Deductible Health Plan? If so, I have had one since 2005 and have had a good experience with it. There were a few times where I met my deductible, but I had the funds to cover it. I generally was never at the doctor or had any major illness, so this was the best for me. My HSA was funded by my employer, and I added a little bit to it as those contributions decreased. I kept good records of what a "normal" year was for me as far as health costs and made sure that amount was in the HSA each year. For my plan, it rolled over each year if it wasn't used.

By it being less of a premium, I also put the difference in premium of a standard PPO in an ear-marked savings account labeled "Medical Expenses" each month and wouldn't touch it. This way, I was still "paying" the same amount each month as a PPO, but that money was staying with me instead of going to the insurance companies. If I needed to pay out of pocket for something, generally the money was available from my Medical account to cover it. As time went on, since I wasn't using the money in the medical account, I capped at one year of a deductible, and stopped contributing to it, knowing what my general medical expenses were. If an unforeseen medical expense came up, I had the full amount of the deductible to pay for it available to me.

Now that I am in a place where funding the medical account isn't necessary anymore, I can use the premium savings in other areas, which has worked really well for me.

 

[Jeff_G]

I am seeing more and more employers dropping their PPO and HMO plans in lieu of these high deductible plans. I have been on one for 5 or 6 years now, in the beginning my employer provided us a set dollar amount in an HRA (like and HSA but different rules) each year, however over time they decreased the dollar amount they would contribute and this year stopped it all together. But basically you need to budget / plan that you will pay for all your medical expenses upto the $3,500, then it probably switches to an 80/20 plan or something like that. Your charges will of course still have the insurance negotiated rate. The trade off here is the lower monthly premium you are paying.


Is it more cost effective then a traditional PPO / HMO plan, no not for you, however it is a better deal for the employer and the insurance company. The theory is that you now will shop around for the best deal on your medical care, hence the Consumer driven part. Here is what I have found, these insurance plans basically setup health care rationing based on the expense of the dr bill. I find I will now only goto the DR if its really needed, I wait longer to see treatment to see if an issue will clean up on its own.

 

[candy0730]

Your husband should be able to contribute to the HSA using payroll deductions. Ask him to check with his employer if he is unsure on how to do it. My husband is able to change his contribution amount at any time. This is our third year with a HSA/high deductible health plan. It is a good choice for people who are able to save money to cover the deductible if needed. My husband's employer gives us $1200 per year and we contribute an additional $100 per paycheck. The first two years we were pretty healthy so we didn't use much of the HSA money we saved. This year is a different story. We have had a few surgeries and lots of medical tests so we have already met our $3750 deductible but we have more than that in our HSA fund so we will pull the money out of there to cover the bills.
We did have the choice of a PPO plan but the premiums were more than double and we would end up paying the same out of pocket either way. For us it makes sense to hope we are healthy and pocket the extra money we put in the HSA fund since that is our money no matter what. Even if my husband leaves his company that money is ours to keep. With the PPO plan it would be money wasted on premiums. So while you may end up paying the same per paycheck if you put some extra in the HSA account, at least that extra is your money if you don't use it instead of being thrown away paying higher premiums with a PPO plan.

Hope that helps and good luck!

 

[lanejudy]

We had a high deductible plan with an HSA for several years. It was an adjustment to get used to it, and the bills can seem enormous at first, but I have closely tracked our expenses and all told at year-end we spent less on the high deductible (premiums plus OOP) compared to the more traditional PPO (premiums + copays). What helps is having a good idea of expected costs, so this first year could be a "learning" year. Then next year you'll have a better idea of how much to fund the HSA.

Good luck!

 

[Luna81]

This is what we have had through work for almost a decade now. You get use to it. I contribute about $100 a month to the hsa and work does $600 a year.

But yeah... It can get costly. My daughter broke her arm. $2200 all said and done. Then I was training for a half marathon and fell on a run. Broke my nose and got a concussion and three months later still dealing with post concussion syndrome. So far $3000-4000ish. But we hit the family deductible so now everything is 30%.

Medical stuff is so hard.

 

[Steelers0854]

CHDP is very different than a high deductible plan in my experience. They are great if you are healthy and only need to see the doctor on an irregular basis. What will happen is you receive an account that is funded with a certain amount for the year, this is an upfront amount at the beginning of your plan year. This account is not an HSA, it is separate. Say that's $1,000 for ease of use. If you get sick and go to the doctor they will charge the full amount of a prenegotiated price to your account. So let's say you doctors visit cost $120, they debit your account account and your balance is now $880, you pay nothing out of pocket. This would apply for all of your medical needs, doctors visits, urgent care, blood work, X-rays etc. I believe you still get your annual physical and associated routine blood tests for free and they won't impact your account. Once your account is depleted your deductible kicks in, you pay out of pocket 100% of the costs until you met your deductible, then the coinsurance part kicks in where they pay a majority of the cost and you pay a smaller amount until you reach your out of pocket maximum.

So in a sense if you are generally healthy you likely won't pay anything for healthcare costs in the year. Some plans roll over the unused balance in your account to the next year, not sure if all plans are like this. The issue you can run into is many people are used to paying $20-$30 for an office visit, the real cost is usually over a $100 and thus a couple of visits to the doctor can quickly deplete your account.

Again, this was my experience many years ago when I had a CDHP. Things may have changed and YMMV.

 

[JenB1104]

Thanks for the replies everyone. I think the challenge for us is going to be figuring out prescription coverage for my husband. He has several medications he takes on a regular basis and the individual deductible is 3500.00 for him. One of them got denied yesterday and it is 200.00 - guessing they don't see it as a preventive medication like his blood pressure one that went through just fine. We may have to increase the amount for the HSA, but unfortunately his cost deducted from his paycheck is only 140.00 less than his previous plan which was not a CDHP which does not give a lot to cover out of pocket expenses if we put that all in an HSA.

 

[Tink-aholic]

There are services and even apps now that can help you source the cheapest prescription cost in your area. Also, check with your husband's doctor and see if there is a comparable Rx available that is either on the insurance's formulary or on the Walmart $4 plan. Make those dollars stretch!