High Deductible Health Insurance?

[ilovepete]

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.

 

[bumbershoot]

We had such a plan, twice. DH had just switched over to the plan, then about 4 months later he changed jobs and we signed up for it again.

Problem was, both times DS got to visit the ER, which meant that we got hit with that cost. Just got the first one paid off, switched companies and plans, got hit again with the second ER visit.

Ouch.

We decided that we weren't strong enough (financially or emotionally, LOL) to deal with paying that much out of pocket up front. Half of our deductible was covered by DH's employer (they don't do a traditional HRA , but something they call an HSA instead) but still, ouch. Twice in a row.

So we decided that since we had an active, seemingly accident-prone little dude, we'd switch back to the PPO. And soon after that DH was diagnosed with a pituitary tumor which means LONG-term weekly drugs that are expensive, and yearly MRIs along with specialist visits. So that meant we would be using all of the HSA (with DH's company that money rolls over, so if you have no expenses one year you have more the next, etc), and the out of pocket costs to us were just about the same with the HD plan vs the PPO. We also got to cover the drugs up front until the deductible was done with.

IT was all just too painful for us. So we went back to the PPO.


Of course, now DS has calmed down, so financial fear of ER visits isn't in our hearts anymore (knock wood), but DH still would be using all of the employer's contribution every year, so the PPO still works well for us.

 

[pantherlj]

I have had one for about 4 years and am very happy with it. It's a bit unnerving at first until you get a feel of how much a visit is for things like a sore throat.

My company contributes a certain amount into an HSA which is a big chunk of the deductible. When I first got the plan, I put in the difference of the premium of the PPO and high deductible plan that I would have paid into the HSA as well. I put more into it now since it's pre tax and can be used for things like braces for the girls and carries over if I don't use it all in a year.

The other good thing is if you do have a bad year and hit your maximum amount, you are done with out of pocket expenses for the year. With a PPO, once you hit your coinsurance and deductible maximums, you still have to keep paying copays for the rest of the year.

 

[Psychodisney]

We had it this year and it worked out very well. My DH had shoulder surgery the first week of January. We knew at that point we would have to cover his deductible out of our savings. Otherwise, everthing else the rest of the year has been 100%. Once we had enough in our HSA(from employer contributions and our pretax contributions), we paid ourselves back. Well care for the kids was covered without having to meet the deductible. I used the HSA for other sick visits and prescriptions. My true out of pocket costs were very reasonable.

 

[ilovepete]

It looks like our OOP costs will either be lower (if we don't meet the high deductible), or just above even (if we do meet the deductible) from what I can tell taking the lower premiums and the contribution from the employer into account.

 

[packofjedis]

We have had one for 4 yrs. We figured up cost-wise and if we made it through the first year not meeting the deductible, but contributing the maximum, we would be fine from there on out. It has worked and this year is the first year we're going to meet the deductible (and the out of pocket too). But prior to this year, there was enough money in the HSA that we were comfortable enough to use it for my kids' braces.

 

[mom2boys77]

We changed to a high deductible plan last January and as luck would have it in February I had to have emergency gallbladder surgery and then in March found out that I was pregnant. We've paid a small fortune this year. Now with our baby due in 2 weeks, we decided to go back to the plan we had before.

 

[MrsPete]

We did this for a while, and it was fine. We are generally healthy people, and it was MUCH cheaper for us to pay out of pocket when we caught brochitus or had a sinus infection. It did make us stop and think about whether we were sick enough to need to go to the doctor. We decided we'd do this 'til it wasn't feasible anymore.

Most years we saved big time. One year -- one child broke an arm on a growth plate, and we had more than our normal number of doctor visits -- we just broke even. I kept good records to be sure we were staying "in the black".

After 7-8 years of doing this, my husband became very ill and one night in the hospital (plus lots of tests, etc.) ran 8K. Yes, it was expensive to pay that bill, but given that we'd been saving about $450/month for all those years, we still came out ahead. However, during that hospital stay we learned that he was also diabetic; thus, we knew it was time to go back to a traditional health care plan.

I am not a bit sorry that we had essentially an "emergencies only" plan for all those years. We saved TONS by doing that.

Important things to note:

- If you're going to emergency-only type health care, be honest with yourself about whether you're the type of person who keeps enough cash in a checking/savings account to cover doctor visits. If you're typical, you won't have a doctor's visit for a while . . . then all three of your kids will get sick at once AND need prescription meds. Some months we paid quite a bit. At some point you'll run into a big-ticket problem, and then you may end up paying your whole deductible; for us, that deductible was 5K. Right now.

- Since you won't have a handy little prescription meds card, always ask your doctor whether the medicine he or she is prescribing is an affordable choice. Often they throw out the "latest and greatest" option, when an older item like penicillin or a Z-pack will do -- for a fraction of the cost. We go to a practice with three doctors, and the doctor whom I see most often is very cost-conscious. He'll often ask before he writes a prescription, "Do you have a prescription drug card?"

- I was LIVID to realize that people who pay cash at the doctor's office pay a smaller amount than those who use insurance. I don't mean $10-20 off. It's more like 1/3 off the total price. Wonder why health care is so expensive? Insurance is not part of the solution; it's part of the problem! Doctor's offices know they'll have to wait months to get paid by the insurance company, and they know they'll have to pay people to manage those costs; thus, they charge more to insurance patients. In contrast, when I was standing there with a checkbook in my hand and they knew they could cash that check that very day, I paid so much less.

 

[ilovepete]

Thank you for the responses. Our deductible would be $5000 total for the family. Is that what you guys had, too? Or was it even higher?

 

[disneymom2003]

We are doing that now but don't really have a choice. We are self employed. Our plan will be $5000 deductible each and the premium will be over $800 a month.

 

[JoiseyMom]

We have had it for a few years. We have a 2800 family deductible before anything kicks in. We also use the HSA so we pay all oop out of there, once we have it in there. For us we met it last year around May.

If we would take the other plan, it would cost us in premiums more then the 2800, so it is a no brainer for us.

 

[Disneefun]

We have what it sounds like you're looking at. Our deductible is $5000, but the employer puts up $2000. The first 2 years we had the plan, we didn't get close to using up "their" money. This year, we've gone over the employer contribution by about $300.

It's been a great option for us. We don't pay a copay when we visit the dr. and all preventative stuff (physicals, mammograms, etc.) are not applied against the deductible, so in essence, are free. Even if the worst were to happen it's nice knowing that we'd only have to come up with $3,000 in a given year before everything would be covered 100%.

 

[Psychodisney]

Ours has an individual deductible of $2500 or 5K for the family. In our case, my DH met his deductible quickly. We haven't met the family deductible yet.

 

[fab5friend99]

I have the HD plan and my employer does not charge any monthly premium with this plan so it makes a lot of sense to use it. Plus, the only way to get an HSA is go with the HD plan. My employer also contributes $500 to the HSA so that makes it even more attractive. I already max out my 401k so being able to contribute to an HSA allows me to sock away even more savings pretax. I love the HSA because you don't have to use it all in one year or loose it - it carries over year to year. I just wish the investment options were a little better. For a single person it's a win-win-win situation. But I can see for a family the deductible might be too steep.

 

[JKMJ441724]

We have a $2500 total deductible, not split into a per-person amount. Hubby's insurance gives us "free" money, too. My daughter broke her arm early this year, but we hardly had any OOP because the free money took care of most of that.

When we changed from traditional to high deductible, we took that $30 per week savings in premium and put it into a savings account (the regular kind, so we could liquidate the money) if a non-medical emergency came up.

For us, so far, it has saved us quite a bit of money doing it this way.

Good luck.

 

[SuzanneSLO]

When looking at a proposed policy, you need to know both the deductible and the maximum out of pocket. Our first year on an HD plan, the deductible and the maximum OOP were $6K. This year, the deductible is the same but te maximum OOP is $9K. After we spend $6k, we then pay 20% of additional bills until we have paid $9K. -- Suzanne

 

[crisi]

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.

 

[wdwnomad]

Everyone has given great advice. As most people are saying you really need to sit down and run the numbers. I have a HDHP with a HSA attached it it. The monthly premiums are the lowest from my employer and they contribute $500 to the HSA. My deducible if $1500 (for single) with a maximum OPP of $3000. Between $1501 and $3000 employer picks up 90% of the costs and employee pays 10%.

The way I looked at it is I added my monthly premium for the HDHP plus a monthly contribution to the HSA to get me up to contributing $2500/year to it. I look at that and compare the monthly cost to other health plans offered. If the that cost is less than your other plans then it might be a good idea to go with the HDHP.

However, the first year could always be a gamble. If your plan year starts in January and you go to the hospital in January then you most likely will get hit with a huge bill. Your HSA might not have enough cash to pay for the bill. Hopefully, you have some savings that could cover the balance. That is something you need to think about as well.

Now if you are someone that never goes to the doctor you could potentially make out very good. You can keep your contributions to the HSA lower and save some cash. If you never use it it stays there and the balance keeps growing. This is risky too but I know many people that do it.

In the end, you do what you are most comfortable. Just keep in mind the cash flow issues.

 

[Neesy228]

I'm also currently wrestling with this option OOP, so thanks for asking this question! I am really at loss on which option is best for my family.

The premium for the HDHP is about $60/month less than the PPO we currently have and my employer will put $600 into the HSA. Our in-network deductible is $3,000 with an OOP maximum of $5,000. (Out of network is a $10k max!) I'm also a little concerned because, even though it says that once you've reached your OOP max things are covered at 100%, there is a little asterisk that states "services that are charged over and above URC are still the responsibility of the individual." That makes it sound like you'll always be responsible for a bill...

This is the first year we've had this option. I find it intriguing, but also a little scary! It's a lot of information to digest.

 

[indimom]

We had a tier two plan for a few years because we were a healthy family with no medical issues. We loved it and it saved us some money. BUT, we didn't have an employer donation and we didn't plan ahead for the emergencies that can, and do, eventually arise. We should have been putting something back toward that.

We got nailed with some huge medical bills at then end of one year and start of the next, meaning two deductibles ($10,000 total). We didn't realize how bad it was going to get or we would have changed our plan. Duh! The two deductibles were bad enough. But, the 30/70 split after that, and the large OOP max made it even more painful.

Because this health issue is chronic and can flare up at any time, we've opted to stay on the tier one plan now. If we ever went back to the other plan, I would make sure we were saving extra income toward medical emergencies. If we had been doing that all those years we were "saving" money on medical, we wouldn't have been so by those bills.