Stressed- Insurance decisions

[puffkin]

I am getting pretty stressed out this year about what to do with our insurance. We currently have a PPO Family plan that costs us about $6000/year in premiums. We have a $750 deductible ($2250 family). Copays are in the $35-$45 range. I put $2000 in a Flex spend account so basically my medical expenses are in the $8000 range/year. Plans for next year are basically the same.

We are a pretty healthy family. My kids hardly ever go to the doctor except for well visits. I did have Strep this year twice (unusual for me), but other than that no visits except my yearly visit. My husband does have Type 1 Diabetes so he will hit his deductible each year no matter what plan he is on with all the supplies/blood work/visits he has. Beyond that though, he is pretty healthy.

Is it crazy for us to consider his companies HSA plan? It would cut our premiums in half to $3000. If I fund the savings account with $5000 (within the limit so would be ok), this year I would be spending the same as I did last year on insurance. The deductibles are $1500/$3000 (family) and then 100% coverage plus copays ($15-$35 range). Prescription coverage is the same on both plans.

What am I missing I am figuring if we had a bad year and needed to visit the doctors a lot we would be out $6000 ($3000 premiums and $3000 family deductible). But on a good year we would come below that and be able to carry any extra funds forward in the HSA. Considering I am paying $8000 a year now....won't I come out ahead since the remaining money in the HSA would be mine to keep?

I did check and it looks like all our current doctors/medical suppliers are considered in-network. I just feel like I must be missing something because its so different than the insurance we have always had. Any advice?

ETA: I do see this blurb....If you are enrolled in a Family Health SAvings Account, you and/or any members of your family must meet the Family Calendar Year deductible before any benefits are payable.

So does that mean that with my husbands expense, we basically would have to hit the $3000 every year first with all his expenses (he would) before anything would be payable and not the $1500?

 

[Gracie09]

First - its not crazy to consider a high deductible plan. The year we had one was great! Well not great because we happen to have a lot of health issues but we hit our deductible by February then we were covered 100% for everything and since we had the deductible in our HSA we got it paid back over the course of the year. I think we pay more oop with our ppo than with the HDP.

That said, I would ask HR about family vs individual deductible. In ours both sort of apply. We have $1000 deductible per person $2500 per family. So if my husband is sick he has to hit $1000 before coverage. But then if my daughters get sick, they don't each have to hit $1000, but our family combined has to hit $2500. (Ours only applies to out of network doctors though so also check that).

 

[MillauFr]

For me switching to the HSA plan was no brainer. As you say if you don't end up using the funds in your HSA account you get to keep them. I believe these plans are getting people to question the costs doctors are charging which is exactly what I did.

 

[CoP Luv]

I have used a high deductible plan since 2005 and besides one year, haven't paid anything besides premiums (thankfully, no health problems). I left my job almost two years ago that I had that plan and still have money in my HSA, though it will be used this year. Our family puts also puts the premium difference between a high deductible plan and a regular PPO in a separate savings account so besides the HSA and FSA we have money put aside for a "bad" year.

 

[supersnoop]

On thing you may be missing is, at least for my plan, the deductible is not separated by the individual, but is total. So, if your husband always hits his deductible, then he'll have to hit the full $3,000 deductible, not the $1,500 individual deductible. But, for my plan, prescriptions are included in the HDHP, so that helps you hit the deductible, and then they'd be covered at 100% afterwards. But, you would be responsible for the full price, not just a copay for those prescriptions.

All in all, I think you'd still be better off with the HDHP.

 

[Marionnette]

I am getting pretty stressed out this year about what to do with our insurance. We currently have a PPO Family plan that costs us about $6000/year in premiums. We have a $750 deductible ($2250 family). Copays are in the $35-$45 range. I put $2000 in a Flex spend account so basically my medical expenses are in the $8000 range/year. Plans for next year are basically the same.

We are a pretty healthy family. My kids hardly ever go to the doctor except for well visits. I did have Strep this year twice (unusual for me), but other than that no visits except my yearly visit. My husband does have Type 1 Diabetes so he will hit his deductible each year no matter what plan he is on with all the supplies/blood work/visits he has. Beyond that though, he is pretty healthy.

Is it crazy for us to consider his companies HSA plan? It would cut our premiums in half to $3000. If I fund the savings account with $5000 (within the limit so would be ok), this year I would be spending the same as I did last year on insurance. The deductibles are $1500/$3000 (family) and then 100% coverage plus copays ($15-$35 range). Prescription coverage is the same on both plans.

What am I missing I am figuring if we had a bad year and needed to visit the doctors a lot we would be out $6000 ($3000 premiums and $3000 family deductible). But on a good year we would come below that and be able to carry any extra funds forward in the HSA. Considering I am paying $8000 a year now....won't I come out ahead since the remaining money in the HSA would be mine to keep?

I did check and it looks like all our current doctors/medical suppliers are considered in-network. I just feel like I must be missing something because its so different than the insurance we have always had. Any advice?

ETA: I do see this blurb....If you are enrolled in a Family Health SAvings Account, you and/or any members of your family must meet the Family Calendar Year deductible before any benefits are payable.

So does that mean that with my husbands expense, we basically would have to hit the $3000 every year first with all his expenses (he would) before anything would be payable and not the $1500?

It's my understanding that with HSA Family Plans, the deductible for "family" must be met (either by combining all family expenses or by a single individual) before the coinsurance kicks in. The individual deductible only applies when it is an individual HSA plan. You might want to check with your husband's benefits manager for clarification on this. It has been a long time since we considered an HSA and the rules may have changed since then.

In general, a high-deductible plan is a good idea for people who are healthy. People with chronic health conditions do better with a lower deductible and somewhat higher premiums. We decided on higher premiums with $0 deductible, $3K indiv. OOP max for this past year and for 2015 because of my husband's heart condition. In evaluating the plans we could purchase, it appears that it didn't make a difference on what we would pay for the premiums because it would cost us the same amount when we added up premiums for the family + indiv. deductible/OOP max. for him + copays for just him. So, going with the "gold" plan made more sense for us because it lowered the OOP costs for myself and our son, who is still under 26 and living at home. Had we gone with a "bronze" plan, the premiums would have been lower but the indiv. OOP max. would have offset the savings, plus copays and coinsurance on the "bronze" plans would have been outrageous for my son and me.

Good luck muddling through all of this. The insurance companies do not make it easy to decide. I feel as if they are purposefully confusing with their language and the way they define their plans.

 

[puffkin]

On thing you may be missing is, at least for my plan, the deductible is not separated by the individual, but is total. So, if your husband always hits his deductible, then he'll have to hit the full $3,000 deductible, not the $1,500 individual deductible. But, for my plan, prescriptions are included in the HDHP, so that helps you hit the deductible, and then they'd be covered at 100% afterwards. But, you would be responsible for the full price, not just a copay for those prescriptions.

All in all, I think you'd still be better off with the HDHP.

That is what I am thinking too. He will easily hit the $3000 family deductible every year and the way I am reading it then it wouldn't really matter for the rest of us because the 100% coverage would always kick in. With the cheaper copays and premiums, I think we would still come out ahead plus get to roll our unused HSA funds forward. He is verifying with his benefits person the $1500/$3000 thing.

 

[puffkin]

For those that have a HSA plan...

If I choose to "save" $4,000/year in the plan, is that money available up front like an FSA is? So in our case, since my husbands expenses until the deductible is met would be front-loaded in the year, can I pay them through that and then have the account funded through the year from the payroll deductions?

 

[lanejudy]

We also use a HDHP, and we are big users of our health insurance. I run a spreadsheet every year comparing this plan to the standard PPO plan, and we always come out ahead. For us it is a "family deductible" meaning the full family amount must be reached before the "benefits" kick-in -- that can be one individual in the family or any combination of all family members. Our prescriptions count towards that deductible, but Diabetes management is waived from the deductible requirement (meaning even on Jan. 1st we only pay coinsurance for diabetes needs).

For those that have a HSA plan...

If I choose to "save" $4,000/year in the plan, is that money available up front like an FSA is? So in our case, since my husbands expenses until the deductible is met would be front-loaded in the year, can I pay them through that and then have the account funded through the year from the payroll deductions?

Unlike a Flexible Spending Account, a Healthcare Savings Account must have the funds deposited before you can withdraw them. You may need to set-up a payment plan with the providers your family uses early in the year, explaining that only $x goes into the account each month, therefore you can pay $y towards the bill.

This may not pertain, but you should also be eligible for a Limited Flexible Spending Account that can be used for vision or dental (if not covered under your medical HSA plan) and any OOP after you reach the deductible on your HDHP. Such as co-insurance or copays after the deductible.

Good luck with your insurance shopping!

 

[powellrj]

For those that have a HSA plan...

If I choose to "save" $4,000/year in the plan, is that money available up front like an FSA is? So in our case, since my husbands expenses until the deductible is met would be front-loaded in the year, can I pay them through that and then have the account funded through the year from the payroll deductions?

No, its pay as you go. If you don't have the money in your account, they don't pay. I found out the hard way in Aug when I paid off my DDs hospital bill. I thought I had enough money in the account and was .08 off. They didn't pay one of the bills because of the 8 cents and because I didn't log onto the account until the next month to pay some bills, I didn't find out until then my bill wasn't paid. No big deal because I just called and explained what happened and then paid, but it was still a pain.

We have been using a HSA for 5 or 6 years and haven't had any problems. I have health issues, plus we are getting close to being seniors and we have a couple kids in college and it seems to work well for us. It usually takes until May to pay the deductible. We pay into the HSA what our premiums would be for regular insurance and it is almost the max of what we can contribute, so we consider that to be a win for us because the money will always belong to us even when we retire.

 

[supersnoop]

For those that have a HSA plan...

If I choose to "save" $4,000/year in the plan, is that money available up front like an FSA is? So in our case, since my husbands expenses until the deductible is met would be front-loaded in the year, can I pay them through that and then have the account funded through the year from the payroll deductions?

As others have already stated, no, and HSA is funded by your own money and is not front loaded. However, you can be reimbursed from the HSA account at any time. Some people are even planning to save medical receipts for years and claim reimbursement in retirement. An HSA account is essentially an IRA with the added benefit that medical expenses can be withdrawn tax-free.

 

[MillauFr]

In general, a high-deductible plan is a good idea for people who are healthy. People with chronic health conditions do better with a lower deductible and somewhat higher premiums.

Yes I agree 100%.

 

[ktate82]

It seems to me that even if your husband has to hit the $3000 deductible, you will still come out ahead since the max you will pay out of pocket is $6000 (premiums and deductible). With the other plan, you will pay just that in premiums. I would go with the HSA and save some money. You won't have to worry about copays and such after that max is hit. As others said, you have to have the money in the HSA to use it, but if you could put extra in it, next year, you would be ahead.

 

[lanejudy]

In general, a high-deductible plan is a good idea for people who are healthy. People with chronic health conditions do better with a lower deductible and somewhat higher premiums.

Yes I agree 100%.

I respectfully disagree. That WAS my opinion until I actually ran the numbers. Now, of course, each health plan is different and it will depend on the plans available to you. But my family is a high user of our health care plan. At one time we had an HMO, then a PPO, and I was very hesitant to switch to the HDHP a few years ago. Every year I run a spreadsheet tallying our expenses on the HDHP and comparing to what it would cost on the PPO. Every year we have come out ahead -- anywhere from $500 to $3000 better with the HDHP.

I suggest anyone considering an HDHP take time to work out calculations and compare which plan is better for you. It takes time and can seem daunting, but worth the effort to compare and make informed decisions, not decisions based on assumptions.

 

[wendow]

We have a HDHP for the first time this year. We are 100% OOP until we hit 10k. The individual deductible is 5k but as a family, we must meet 10k before they pay.

We are very healthy and only one person (out of 6) has been to the doctor this year and that was just a scoliosis check. So far, we've only paid $127 towards our deductible. Our monthly premium is still $420 though which seems high to me for this type of plan But we used to pay over $800 for a low deductible plan that we never used. So, I'm much happier with this plan.

 

[Shelly F - Ohio]

Absolutely not crazy!

For off you mentioned you are paying $6000 a yr in premiums anyway. That is just money you are putting in someone elses pocket! If you had an HSA and your family did not get sick this yr. that $6000 would be in a savings acct in your name that you get to keep year after year until you need to pay a medical bill.

We have had a HSA for 6 years and love it. We too barely get sick except for a strep throat episode for which I went to the Walgreens medi clinic cost $53 were the dr. office would have been much more.

You can write it off on your taxes I do the EZ form and with Turbo tax I noticed that when I enter the amt I put into my HSA I get $300 more back in my taxes last year.
Oh and because we have done this for a number of years and have very little medical bills that means I only put in $55 a month into my acct. this year and plan to do so for next year. Since the acct balance is close to $9000. for the HSA. Plus if you leave your company you get to keep the HSA acct. you won't be able to contribute to the acct once you leave but that money belongs to you and you can still use it to cover medical, dental and vision expenses. With a traditional medical insurance you are just putting money into someone elses pocket. Never to see it ever again.

I would do it in a heart beat if I were you.

 

[Lisa loves Pooh]

I am getting pretty stressed out this year about what to do with our insurance. We currently have a PPO Family plan that costs us about $6000/year in premiums. We have a $750 deductible ($2250 family). Copays are in the $35-$45 range. I put $2000 in a Flex spend account so basically my medical expenses are in the $8000 range/year. Plans for next year are basically the same.

We are a pretty healthy family. My kids hardly ever go to the doctor except for well visits. I did have Strep this year twice (unusual for me), but other than that no visits except my yearly visit. My husband does have Type 1 Diabetes so he will hit his deductible each year no matter what plan he is on with all the supplies/blood work/visits he has. Beyond that though, he is pretty healthy.

Is it crazy for us to consider his companies HSA plan? It would cut our premiums in half to $3000. If I fund the savings account with $5000 (within the limit so would be ok), this year I would be spending the same as I did last year on insurance. The deductibles are $1500/$3000 (family) and then 100% coverage plus copays ($15-$35 range). Prescription coverage is the same on both plans.

What am I missing I am figuring if we had a bad year and needed to visit the doctors a lot we would be out $6000 ($3000 premiums and $3000 family deductible). But on a good year we would come below that and be able to carry any extra funds forward in the HSA. Considering I am paying $8000 a year now....won't I come out ahead since the remaining money in the HSA would be mine to keep?

I did check and it looks like all our current doctors/medical suppliers are considered in-network. I just feel like I must be missing something because its so different than the insurance we have always had. Any advice?

ETA: I do see this blurb....If you are enrolled in a Family Health SAvings Account, you and/or any members of your family must meet the Family Calendar Year deductible before any benefits are payable.

So does that mean that with my husbands expense, we basically would have to hit the $3000 every year first with all his expenses (he would) before anything would be payable and not the $1500?

We had a similar plan for the past few years. Anything except visits like a well visit were all OOP until deductible was met and then it was 100% insured for the rest of the year. We hit May of this year. (But now in a new job and decided to take a break from such an insurance plan.)

We met family deductible due to allergy shots and a few other things. (I broke my ankle this year, so we hit about 1-2 months earlier than usual.) So any regularly planned and scheduled health expenses make if a good deal so to speak. The problem is coming up with that out of pocket cash up front. If you have an HSA to draw from, then this is not an issue. But knowing you are covering 100% yourself can be a bit of sticker shock.

For us, the co-pay way of things just helps to spread things out more.
So unless required, we are unlikely to go back to it.

For now, our current plan is a little confusing. Mundaughter's surgery had a negotiated rate, but otherwise it seems we are paying all the costs.
Maybe it is because if is out of network or something. Awaiting the EOB in that.

 

[puffkin]

I think over the course of the year, it makes sense for us and will save us money to switch. Still waiting to hear back and make sure my husbands insulin pump and CGM supplies would be covered. I am really struggling though with where we will be able to come up with the $3000 up front until the plan kicks in. Since we would be starting the HSA from scratch this year, we wouldn't have that to pull from to "spread thing out" so to speak. We would probably hit the $3,000 by March.

So a related question. The HSA would be through DH's work (who currently carries our PPO plan). At my work I have a Flex Spend account which is funded on Jan 1. I put about $150/month in it from my paycheck. So would I be able to do this?

1. Switch to husbands HSA plan which would save us about $200/month in premiums.
2. Up my contributions to the max for my flex spend (approx $200 mo) which would give us $2500 for the year.
3. Take the remainder of what we are paying now and fund the HSA plan to use in future years.

Am I allowed to do that? I am thinking it would basically keep our costs about the same for this year and give me access to most of the $3000 that I would need basically "up front" for the deductible for this year and build a little savings in the HSA to use in future years. Does this make sense?

 

[staceyeileen]

You cannot have both an FSA and an HSA at the same time. Since your FSA is with your own employer, they will definitely let you continue contributing to it because they don't know about the HSA with your husband's plan. BUT you will pay for it at tax time since the IRS does not allow it.

 

[staceyeileen]

Still waiting to hear back and make sure my husbands insulin pump and CGM supplies would be covered.

Just know that none of those expenses will be covered until you have paid your $3000 deductible. Whereas right now you might be paying a co-pay for these things as an Rx, you'll pay the full price.