Quote:
Originally Posted by Chief Roundup
Wish I could post a pic of their breakdown.
The POS plan which I can choose for $130 a month has a $1500 deductible with a $5000 maximum out of pocket. $35 copay at Dr. $45 at specialists. Copay plus 20% up to the $5K max. Scripts are $20, $50, $70 for Generics, Preferred, Non-Preferred. Wellness covered 100%.
The HDHP which I can choose for $75 a month has a $3000 deductible which is also the max out of pocket. Wellness is covered 100% everything else is 0% covered until deductible is met.
I am on Simvastatin, Spiriva Respimat and Albuterol Sulfate HFA. I see the Dr twice a year for blood work and a wellness checkup.
Hope that helps. Any other info that might help?
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A little more info would still help, but overall health insurance and picking plans is a simple math equation. That said, it CAN be confusing when not familiar with the terms.
First question in your particular situation: Does your employer contribute anything to the HSA on your behalf for picking the HDHP? If they do, it's free money and may make that plan more enticing.
With the information provided, IMO, it still looks like I'd pick the HSA plan if I were you. There's a $55 monthly premium difference (or $660 annual premium difference) coming out of your paycheck. Add that $660 difference to the difference in deductible and you're looking at only $840 difference between plan 1 and plan 2 when simply comparing deductible amounts.
If you also take into account that the HDHP has 0% coinsurance, or in other words the deductible is the same as the max OOP (out of pocket), it becomes even more enticing. You could add whatever amount you want to the HSA out of your paycheck, tax-free mind you, as well to make up the potential difference in deductible levels.
Let's say you have a catastrophic event, or need a surgery, etc. In the $1500 deductible plan, you'll pay the first $1500 to satisfy the deductible and then also be responsible for 20% of the difference on everything above that number. Not many surgeries or health events are in that price range.
So....lets assume it's a $6000 hospital bill after network discounts. You pay the first $1500 and then you owe 20% of the remaining $4500, or another $900. So for that hospital visit, you owe a total of $2400 and insurance paid the other $3600. If you had the HDHP, you would pay the deductible, $3000, and then you're finished with any in network out of pocket expenses, so insurance is paying the other $3000.
Again that's a hypothetical number/cost for an event, but even in that situation, are you any better off with the lower deductible plan than the HDHP? At first glance, you might assume yes, because in one you're only paying $2400 and the other you're paying $3000. But remember you paid a higher premium for that plan, so in reality your out of pocket expense is slightly higher still when you include the extra $660 that lower deductible plan cost you already. Make sense??
Lot's of rambling there...I apologize if TLDR. I am a fan however of HDHP for those that can afford to fund an HSA, don't have a lot of health issues, etc. IMO, the vast majority of the public should be on HSA's. It makes you use the doctor smarter and honestly would reduce overall health care spending.
In regards to your prescription question, I would GUESS that the network on both plans are the exact same. Therefore, the allowed amount for all of your drugs and for any prescription should be identical. What will be different is whether you have different copay tiers between the two plans. Your simvistatin is cheap and generic, so you can probably get it at lower cost than even using your insurance. The Spiriva is likely the one you'll want to inquire about the most.