medical insurance advice neede

[Tink-aholic]

OP, we pay for our prescriptions until the deductible is met, but it goes toward the deductible and then is paid in full (we pay extra per month for that instead of the 80/20) once we hit that deductible. We went with the high-deductible plan after having our HMO co-pay us to death--from this year compared to the year before we're saving over $4000 between lower monthly premium and the cap on OOP. Our HMO had a cap, but almost everything outside of a hospitalization did not count toward it. Our high-deductible plan includes everything towards it.

We always set aside enough in our HSA to cover our deductible and uncovered costs. It's automatically deducted from DH's paycheck. I would rather pay myself (and have that money available to me if I don't use it) than pay the insurance company.

I just want to make sure that OP knows that an HSA acts like a savings account and any unused amount rolls over from year to year. But OP mentioned an FSA, which means that anything not spent during the year is forfeited. And, as mentioned by another pp, there will be much stricter rules on what FSA funds can purchase (mostly OTC items but some DME will be excluded).

 

[riley2008]

For us, we chose the high deductible plan with an HSA. I put away monthly the difference that I would have paid in the higher premium plus what I was putting in my FSA. The first two years we had saved nearly $4000.00.

Now certainly our HSA savings would have been less had one of us expereinced a major illness. I did meet my deductible the first year - I think it was $1050 at the time. Prescriptions and doctor visits all apply to the deductible. We don't pay for annual healthcare visits or vaccines. (Although this year, the insurance is encouraging people to go to pharmacies to get their flu shot and pay only the prescription coverage co-pay. For us that would be the $20 that the pharamcy charges. It is free to stop in at walk-in clinic when it's billed as just an injection or get at a well-visit.)

Really consider the cost difference. Consider the total annual premium cost and your known co-pay expenses (annual check-ups, meds, etc)of the higher priced insurance vs the total premium costs and known deductible(like meds) of the lower cost care. Also, consider both plans and total costs (make sure to include the premium in that calculation) of a major medical scenario.

Tough decision. For us, I'm hoping to really build our HSA now and then be able to stop contributing to it in a few years. (We're lucky to have our through a bank which is offering 1.75% )

 

[xanphylus]

You said the difference between the 2 plans was about $1968 for a year, right? Divide that by your 12 months, and you are almost at the price of your son's medications for each month. (If you had to pay out of pocket with the cheaper insurance)

I would go ahead and pay for the PPO and save myself the worry of saving that $30/month. We have a PPO with a deductible of $500/per person, or I think $1500/family and it works well for us..... beyond the bill I just got from the dr saying my insurance paid ten cents of my visit last month when I was sick.... but we won't get into that!

 

[j's m]

High deductible plans have an HSA, not an FSA. This is good because the money will carry over from year to year, unlike a FSA.

I would also need to know what the premiums on the two are. We have no choice other than a high deductible plan and I hate it. When something happens, you are stuck paying everything out of pocket. I have medication I need that I don't take because it is $180 a month and I'd have to pay it all. Last spring, I had a kidney stone and ended up in the ER. With a PPO, that would have cost me $50 - $100. With the high deductible plan, it cost me close to $4,000.

OMG, I was just at the ER yesterday for my first ever kidney stone. We have a $2500 deductible and 20 % copay after that. I'm really sick over that.

We've had a high deductible with prescription plan and free radiology/labs. It's always worked for us, haven't used anything towards the deductible in years. We were going to switch to really high deductible and HSA and changed our minds. After yesterday, we should have.

Thank goodness our Disney trip next week is already paid for.

OP, you just have to run the numbers for previous years and then add in the emergencies that you never think will happen.

 

[Nik's Mom]

Wow, you guys have really helped me think about the pros and cons of both options. One bad the I noticed about the HSA is that you can only spend what you have in the account from month to month. That is different than the FSA, that allows your entire contribution to be available from day one. So, lets say we go to the ER in January. Well, with the HSA, we really won't have much money in the account to use. That concerns me.

In the end, I think we will end up going with the ppo with the higher monthly costs rather than the ppo with a higher deductible and no prescription coverage until the deductible has been met. Like I said, ds takes 2 medications a day and one of them has no generic. So, a big chunk of our HSA would end up going to prescriptions rather than out of pocket medical expenses like visits to the doctor or urgent care for illness.

I would just feel better knowing what our budget will be from month to month, rather than not knowing what type of medical expense may pop up at any given time.

I appreciate all of the advice you all gave. It really helped me look at this at all angles.

 

[SunnyT]

OP, my DH works for county government so our insurance is really great (or was). I don't mean that as a brag, honestly, I know we are lucky. However, this past year the insurance changed and not for the better of course. I know you have sons with issues and your situation is different, but you mentioned that one prescription is $135 a month. How much is taken out of your DH's paycheck for insurance? My presentment is this...Have you ever thought of dropping the insurance (I know the rules are changing soon but there should be better options out there than what you are getting) and putting that money in savings for health bills. For example, we pay @ $600 month for insurance through county. That is $7200/yr. We are pretty healthy except for the occasional sniffle and what have you. There is me, DH and DS(5). A medical facility in our town has a health program for $450/yr which includes labs, xrays, dr visit. Everything except major medical. That would only be $1350/yr for the three of us. Why haven't I done this already?

Murphy's Law. Once I drop the insurance, something bad will happen. Well, hospitals cannot turn you away (at least ours can't). And you can't bleed a turnip. They will get $20 a month till paid off.

This is just something to think about. I have always believed in insurance but I've been thinking differently lately. Not to mention ask a dr's office the price of a visit without insurance and one with insurance. Your answers will be very different.

Good luck with whatever you choose, because ultimately the choice is yours.

 

[Shelly F - Ohio]

One big thing to remember! If you have an HSA account, the monthly premiums you are paying, are being deposited to a checking acct in your name. You then take that money and pay for your medical expenses. Once you have paid $3000. out of you acct then you are responsible for only 20% of the medical bill.
What makes a HSA acct great is. All that money you are paying is going into a checking acct. If your family doesn't get sick all that often that money is yours. It will stay in that acct for you to use for medical expenses at a later date.

For example we elected to put into our HSA acct $200 a month. Over 12 months we have $2400 in the acct. If over the 12 month period we don't go to the doctor but 4 times a year and say my doc bills us $100 each visit. Then we have to pay out of that acct $400 Then then remaining $2000 in our HSA account remains in our account to be use for 2011. Since we will have a balance of $2000 to start off with in 2011 we are going to drop our premium amount to $100 a month. You get to chose what set amt a month that you want deposited to your HSA and you must deposit that same amt all year long.

Why would we want to pay a monthly health insurance premium for a PPO plan which for our company is $280 a month. Only to have that money go into someone elses pocket. With an HSA they money we pay into it is ours to keep and use the following year for medical expenses. Our HSA plan is through Cigna and I get the same benefits as a Cigna PPO plan.

If we chose the PPO plan over 12 months at $280 a month for the PPO plan we would have paid $3360 yet our yearly medical cost were only $400 so the other $2960 I would never see again. Wasted money.

My Niece who works in a doctors office is the one who talked me into going with this plan. She has expierence with useing an HSA acct for herself and 2 kids and said its great. She was hospitalized and needed a pace maker. She said she priced what her bills would have cost had she had her companies PPO verse the HSA and she would have had to pay $18000.00 with the PPO. Her company PPO plan has a deductible of $750 and the 80/20 after the decutible.
But because she had the HSA all she had to pay was the $3000 deductible because her plan paid 100% after the deductible.

I'm reading the brochure and it says we can have up to $6150 per family in the account. But I'm reading the fine print and it says it's an HSA account. I think this year we have an FSA account. I better make sure on this before we decide. While we have a personal savings account, I don't want it to be wiped out by medical expenses in one year.

I also just checked on the prescriptions and it looks like the amounts we pay will go toward the deductible.

Thanks for everyone giving me some in-put on this. You have helped shed light on this for me.

 

[Shelly F - Ohio]

Good point about the ER example.
Here is what happens. If at the beginning you do not have enough money in your HSA acct to pay that ER bill you will simply pay it out of your pocket. For example say your bill is $300 but the acct only has $200 so you must pay out of your pocket $100. Later on down the line when you do have enough in your HSA acct, you can pay yourself back the $100 you paid out of your pocket for the ER by withdrawing the money from the HSA.

Wow, you guys have really helped me think about the pros and cons of both options. One bad the I noticed about the HSA is that you can only spend what you have in the account from month to month. That is different than the FSA, that allows your entire contribution to be available from day one. So, lets say we go to the ER in January. Well, with the HSA, we really won't have much money in the account to use. That concerns me.

In the end, I think we will end up going with the ppo with the higher monthly costs rather than the ppo with a higher deductible and no prescription coverage until the deductible has been met. Like I said, ds takes 2 medications a day and one of them has no generic. So, a big chunk of our HSA would end up going to prescriptions rather than out of pocket medical expenses like visits to the doctor or urgent care for illness.

I would just feel better knowing what our budget will be from month to month, rather than not knowing what type of medical expense may pop up at any given time.

I appreciate all of the advice you all gave. It really helped me look at this at all angles.

 

[Nik's Mom]

Good point about the ER example.
Here is what happens. If at the beginning you do not have enough money in your HSA acct to pay that ER bill you will simply pay it out of your pocket. For example say your bill is $300 but the acct only has $200 so you must pay out of your pocket $100. Later on down the line when you do have enough in your HSA acct, you can pay yourself back the $100 you paid out of your pocket for the ER by withdrawing the money from the HSA.

Thank you for sharing that. I did not know you could do that. I guess I will have to look more closely at the other plan then. It doesn't sound as bad when you put it that way.

Dh has his benefits meeting today and we plan on going over everything this weekend. I'm glad I have the added information that you all shared in this thread. Thanks!