Medical Insurance Enrollment questions

[Chief Roundup]

Alright it is that time of year again. The college I work at it changing insurance companies from Blue Cross Health Advantage to UMR that is using United Healthcare.
The new company is pushing the High Deductible Health Plan. I am now trying to figure out if it is worth it for me to switch from my PPO/FSA to the HDHP/HSA.
I am not sure how to figure out the costs that would be different. They cannot provide me information ahead of time as to the "discounts we will get at our PCP" over what paying full price would actually cost. They cannot provide me information as to what prescriptions that I take will actually cost with the southern scripts, mail order company, that we will be required to use.

Any advice would be greatly appreciated.
Hoping that there is a medical insurance agent/consultant on here!!!

[Hog's Gone Fishin]

Don't get sick and don't get hurt. Cancel insurance.

[Chief Roundup]

Originally Posted by Hog's Gone Fishin

Don't get sick and don't get hurt. Cancel insurance.

Can't live in dream world.

[2112]

If you plan on having a lot of procedures this year pay the higher premium payment with a lower deductible. If you don’t plan on procedures go for the lower premium hospital advantage with a higher deductible and a reasonable out of pocket expense for the year.

You gotta crunch the numbers to see what works best for you this year

[Chief Roundup]

Originally Posted by D2112

If you plan on having a lot of procedures this year pay the higher premium payment with a lower deductible. If you don’t plan on procedures go for the lower premium hospital advantage with a higher deductible and a reasonable out of pocket expense for the year.

You gotta crunch the numbers to see what works best for you this year

I don't plan on procedures but I do have 3 scripts a month. That I have no idea about what the cost will actually be with no real or standard script deductible.

[2112]

Originally Posted by Chief Roundup

I don't plan on procedures but I do have 3 scripts a month. That I have no idea about what the cost will actually be with no real or standard script deductible.

If you go to your insurance website you can compare plans. RX/Doctors et al

Just have to research it nowadays

[Chief Roundup]

Originally Posted by D2112

If you go to your insurance website you can compare plans. RX/Doctors et al

Just have to research it nowadays

Now we had an hour long meeting. They didn't know and could not tell us any of that type of information.
I am thinking about calling my Dr which is in network with this new company and finding out their side of the $$$ info. I also thought about calling this new script company as well as my current Pharmacist and getting any and all info from them that I can.

[Third Eye]

Originally Posted by Chief Roundup

Alright it is that time of year again. The college I work at it changing insurance companies from Blue Cross Health Advantage to UMR that is using United Healthcare.
The new company is pushing the High Deductible Health Plan. I am now trying to figure out if it is worth it for me to switch from my PPO/FSA to the HDHP/HSA.
I am not sure how to figure out the costs that would be different. They cannot provide me information ahead of time as to the "discounts we will get at our PCP" over what paying full price would actually cost. They cannot provide me information as to what prescriptions that I take will actually cost with the southern scripts, mail order company, that we will be required to use.

Any advice would be greatly appreciated.
Hoping that there is a medical insurance agent/consultant on here!!!

An HDHP is not a specific type of plan. If you were a PPO before, you’ll probably still be a PPO. As for your question, it’s kind of odd that they would ask you to sign up for a plan that you don’t know the details. I’m not even sure if that’s legal. They should have your pharmacy benefits information. I’d consider calling Southern Scripts.

[Chief Roundup]

Originally Posted by Third Eye

An HDHP is not a specific type of plan. If you were a PPO before, you’ll probably still be a PPO. As for your question, it’s kind of odd that they would ask you to sign up for a plan that you don’t know the details. I’m not even sure if that’s legal. They should have your pharmacy benefits information. I’d consider calling Southern Scripts.

HDHP and POS are both PPO but you can only have an HSA with a HDHP.
Their responses were they didn't know each and ever Dr. charges and what the discount would be actually. Nor did they know the prices of every medicine and southern scripts discounts on each of those. Even though I could and was ready to give them a list.

[kccrow]

Originally Posted by Chief Roundup

HDHP and POS are both PPO but you can only have an HSA with a HDHP.
Their responses were they didn't know each and ever Dr. charges and what the discount would be actually. Nor did they know the prices of every medicine and southern scripts discounts on each of those. Even though I could and was ready to give them a list.

You are providing way too little information about the plans for anyone to help you whatsoever.

You should know the premiums, deductibles, and coinsurances/copays under the plans at the very least. Hard to compare the situations without that.

Normally every insurance company has a list of the prescription drugs and what tiers of the plan they fall under. Your HR lady isn't going to provide you that.

For all we know at this point is you could be comparing a 1200/2400 PPO 70% plan to a 1500/3000 HDHP 100% plan and so the benefits of the HDHP, especially if you contribute the deductible to the HSA, could far outweigh the PPO plan. We also have no idea how much you use the doctor and prescriptions you're on, which will factor into your choice. And, I doubt you'd want to divulge that information. You need to get more facts in order.

[Chief Roundup]

Originally Posted by kccrow

You are providing way too little information about the plans for anyone to help you whatsoever.

You should know the premiums, deductibles, and coinsurances/copays under the plans at the very least. Hard to compare the situations without that.

Normally every insurance company has a list of the prescription drugs and what tiers of the plan they fall under. Your HR lady isn't going to provide you that.

For all we know at this point is you could be comparing a 1200/2400 PPO 70% plan to a 1500/3000 HDHP 100% plan and so the benefits of the HDHP, especially if you contribute the deductible to the HSA, could far outweigh the PPO plan. We also have no idea how much you use the doctor and prescriptions you're on, which will factor into your choice. And, I doubt you'd want to divulge that information. You need to get more facts in order.

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?

[oldman]

Originally Posted by Chief Roundup

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.

Those seem like pretty expensive generics. Before you let the company do your meds, check GoodRx and places like Walmart, Costco, and the like. I've never paid over $10 for any generic.

[blake5676]

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?

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.

[kccrow]

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?

I'd research the cost of your meds under the HDHP and cost you'd pay for your normal visits. If you're paying 100% up until the deductible is met, you'll need to know this to make a good decision. You should do the math on both plans. What would be your normal cost under each plan for your meds, visits, and premiums on a monthly and annual basis? GoodRx is fairly cheap for Simvastatin, but I'm not sure on the asthma meds. If you're taking a cholesterol pill, that certainly means you may be at a higher risk for a catestrophic event so factor that in. Blake did a really good job of breaking down some of the math for you.

What you do know is that if you contributed $250 a month to your HSA, you'd pay the deductible over a year. The question is, would you exceed $250 a month in costs under that plan up until the deductible is met. If you don't, going with an HDHP/HSA plan makes sense because you can bank for the future. One thing to factor here too is your bank account. You know for a fact that 3900 is the max you'll pay during a year under this plan. Can you cover that now? You could pay $6560 under the other plan. If you have the funds for a catastrophic year, then the HDHP makes far more sense regardless.

[Third Eye]

Originally Posted by Chief Roundup

HDHP and POS are both PPO but you can only have an HSA with a HDHP.
Their responses were they didn't know each and ever Dr. charges and what the discount would be actually. Nor did they know the prices of every medicine and southern scripts discounts on each of those. Even though I could and was ready to give them a list.

A POS and a PPO are similar, but not the same. A PPO, POS, EPO, HMO can all be HDHP. All HDHP indicates is that it’s high deductible and can have an HSA. It doesn’t indicate anything about the network.