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!!!

[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.

[prhom]

Originally Posted by Chief Roundup

Yes and no. You are correct that the HSA allows you to keep or roll over the money that you don't spend year after year.
You can only get the HSA if you get the High Deductible Health Plan which is that they don't pay a dime until I spend $3000 out of pocket which is also the maximum out of pocket expense. But I can put $3550 in it a year and anything I don't spend I get to keep tax free.
If I ever get over $2K in the account that I don't feel I will need I can roll it into a money market and let it make me even more money.

I guess all I was trying to say is that the high deductible plan can be beneficial if you aren’t going to need to spend a lot on medical costs and don’t get unlucky. The more typical lower deductible plan is better if you are a high consumer of medical services.

I doubt I’ve had more than $5k of medical services in the last 15 years. My wife and kids on the other hand...

If I was single I’d do the HDHP and take the risk. No way I would do that now.

[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?

[BryanBusby]

I would probably consult with your financial person instead of the ins company on which option would be better for you. But shot in the dark here from someone that has worked in the insurance field, you'll probably want to stick with the PPO.

Originally Posted by Chief Roundup

The HDHP which I can choose for $75 a month has a $3000 deductible which is also the max out of pocket.

I would double check those numbers.

[Chief Roundup]

Originally Posted by BryanBusby

I would probably consult with your financial person instead of the ins company on which option would be better for you. But shot in the dark here from someone that has worked in the insurance field, you'll probably want to stick with the PPO.


I would double check those numbers.

It is in print on their color brochure that they gave over 400 of us today.

[MahiMike]

If you are generally healthy, go high deductible. The guvment is pushing this like 401K.

[lewdog]

HDHP only makes sense if you are fairly healthy and actually plan to contribute to an HSA. An HSA has many benefits being tax free, rolling over from year-to-year all while providing you a place to put money for future healthcare costs. I think most healthy, single adults should be choosing a plan that allows them to contribute to an HSA.

If you end up needing a costly procedure, however, you'll be paying a large out of pocket sum for the year to meet the deductible. If you have a family, you increase the chances of having to meet that high deductible just in terms of sheer volume of services for 3 or more individuals, so many times having a HDHP makes less sense for a family.

[2bikemike]

I am using a HDHP and an HSA. It is the cheapest plan my company offers. My wife and I are very healthy and don't usually go to the Dr. for more than routine checkups. My company contributes "seed money" $2000 to the HSA account to help meet the deductible.

We max out our contributions and have never taken a dime from the HSA account. We treat it like savings. If we have something come up we just pay out of pocket and keep racking up the savings. It is by far the best deal for my wife and I. Our plan is to use that money to help fund medical expenses in our retirement years.

We have learned that if you hang on to all of your qualifying receipts or load them into the receipt vault with the HSA provider you can go back and make a claim (withdrawal) against that receipt at any time. They don't expire!

[BryanBusby]

Originally Posted by Chief Roundup

It is in print on their color brochure that they gave over 400 of us today.

Oh ok. That's a little unusual which is why I asked.

Does the HDHP cover well being screenings at 100%? And what are the deductibles and MooP costs for the PPO and your age?

[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.

[KCUnited]

You should gather as much info as you can regarding the prescription coverage of the plans offered, specifically around your medications and possible eligible discounts.

I do a HDHP/HSA and take an expensive medication. When the script gets ordered, the total goes towards my deductible, but my plan offers a discount for the medication which only costs me $5 every time it's filled. So literally 2 fills maxes out my out-of-pocket maximum on paper, yet only costs me $10 actual. I keep my out-of-pocket max balance in my HSA just in case something happens between Jan 1 and the time my script maxes out my deductible (4 weeks) then I roll the rest into investments. Every year.

I've had this set up with 2 different carriers.

[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.

[King_Chief_Fan]

This answer won't help but it is just fun to say it!!

Switch to Obamacare

[Nixhex]

Can anyone tell me why the premium for myself and my daughter is the same as another associate and their 4 children?

[blake5676]

Originally Posted by Nixhex

Can anyone tell me why the premium for myself and my daughter is the same as another associate and their 4 children?

Insurance premiums through employers are typically priced out as:

Employee

Employee + Spouse

Employee + Children

Family

I honestly don't know the reason. I can just tell you that is primarily how I seen plans priced. Doesn't matter if it's 1 kid or 5....they are all just "children" in the premium tier.

It's really rather silly when you think about it. I've had patients come in where their are 11 "children" on a working parents plan. Usually bc it's really good insurance, but they'll have like 3 biological, 4 step children and maybe some other loose connection.

From personal experience though, and it's the first time we've had insurance like this now that my wife has a new job, we pay different amounts based on number of kids. We only currently have one, but the cost is more when/if we have another.