Author Topic: Fed Employee HDHP Experiences  (Read 2807 times)

mrigney

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Fed Employee HDHP Experiences
« on: November 02, 2017, 09:40:38 AM »
Open season is about to be upon us. I'm wanting to switch from my BCBS Basic to a HDHP. Looks like the best choice might be the GEHA PPO HDHP? I"m hoping that some folks here have used it and have opinions. Any drawbacks to the plan? Any feds use other HDHPs? Experiences with those?

doggyfizzle

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Re: Fed Employee HDHP Experiences
« Reply #1 on: November 02, 2017, 09:59:13 AM »
I'm presently insured through the GEHA Standard Plan (and was on the High plan in 2016); my experience with GEHA so far has been stellar - their customer service has been fantastic whenever I had an issue with physician billing, and because they use the AETNA Signature network, I've never come across a doctor or pharmacy who doesn't accept their insurance.  I also use GEHA for dental.  Once my kid gets a little bit older I will probably switch over to the GEHA HDHP.  I think GEHA kicks in $1200/year in premium passthrough to the HSA.  Check and see what other HDHPs are offered in your area, as a couple plans are a bit more generous with premium passthrough (I think AETNA is up to $1800/year in some cases).

mrigney

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Re: Fed Employee HDHP Experiences
« Reply #2 on: November 02, 2017, 10:10:47 AM »
Yeah...Aetna has a HMO HDHP available in my area....I'm always leery of HMOs. There is also a MHBP - consumer Option HDHP available. The MHBP provides $1800 (vs $1500 on the GEHA) as a pass through, but is offset by having a ~$500 higher premium for the year (and a higher deductible, higher out of pocket maximum). Looks like the advantage of the MHBP plan is that you pay a flat fee for office visits ($15) vs 5% on the GEHA HDHP. Same for emergency care. The MHBP is a flat $50 fee for emergency care, $0 for inpatient surgery, room & board charges, etc, whereas you pay 5% on the GEHA.

Actually, I'll have to scroll through, but the flat fees on all care on the MHBP plan make it pretty attractive. Obviously doesn't matter if you don't hit your deductible (which we probably wouldn't most years). Here's a link comparing some plans if anybody wants to look and offer some thoughts: https://www.opm.gov/healthcare-insurance/healthcare/plan-information/compare-plans/fehb/PlanDetails?zipcode=35803&FFSSearch=on&Medicare=False&oldPlans=112AL342ALLS2AL&empType=a&payPeriod=c&rateCoverage=Self%20%26%20Family&plans=225AL112AL342AL482AL

kendallf

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Re: Fed Employee HDHP Experiences
« Reply #3 on: November 02, 2017, 10:52:46 AM »
Yeah...Aetna has a HMO HDHP available in my area....I'm always leery of HMOs. There is also a MHBP - consumer Option HDHP available. The MHBP provides $1800 (vs $1500 on the GEHA) as a pass through, but is offset by having a ~$500 higher premium for the year (and a higher deductible, higher out of pocket maximum). Looks like the advantage of the MHBP plan is that you pay a flat fee for office visits ($15) vs 5% on the GEHA HDHP. Same for emergency care. The MHBP is a flat $50 fee for emergency care, $0 for inpatient surgery, room & board charges, etc, whereas you pay 5% on the GEHA.

Actually, I'll have to scroll through, but the flat fees on all care on the MHBP plan make it pretty attractive. Obviously doesn't matter if you don't hit your deductible (which we probably wouldn't most years). Here's a link comparing some plans if anybody wants to look and offer some thoughts: https://www.opm.gov/healthcare-insurance/healthcare/plan-information/compare-plans/fehb/PlanDetails?zipcode=35803&FFSSearch=on&Medicare=False&oldPlans=112AL342ALLS2AL&empType=a&payPeriod=c&rateCoverage=Self%20%26%20Family&plans=225AL112AL342AL482AL

I'm currently on the MHBP HDHP, and it's been excellent for us for the past 3-4 years.  I picked it primarily because of the high premium pass-through into the HSA.  The Aetna coverage here in Jacksonville is good, and we haven't had any problems with it at all, basically.  I hit the deductible a couple of years due to shoulder surgeries my daughter and wife each had to go through, and running the numbers against BCBS we're still ahead.  I like the Health Equity HSA which has decent investment options, and I'm currently maxing out the HSA each year and investing it all.

Imustacheyouaquestion

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Re: Fed Employee HDHP Experiences
« Reply #4 on: November 02, 2017, 12:35:03 PM »
I have self-only HDHP coverage with GEHA. They pass through $750 annually to my HSA, which is administered through HSA bank (formerly Webster?). The website is a little clunky. I have this set up to automatically sweep funds into TD Ameritrade for an investment account connected to the HSA. There's a setting that enables you to buy Vanguard ETFs with no commission fee. Either GEHA pays the fees for the HSA account (or they are waived for GEHA members), but either way there's no monthly cost.

They will give you a $75 gift card annually for filling out a health survey, then up to $100 points redeemable for an FSA-type store for logging things like exercise, eating vegetables, etc. I got an additional $75 in points by signing up for a biometric screening - basically a blood draw that takes 10 minutes and screens for cholesterol, blood sugar, blood pressure, BMI, etc.

United Health Care is the preferred provider network in my area, and it includes the large university hospital network that I use for everything. No problems self-referring to make specialty appointments. They did require some justification for a set of PT visits, but it was easy to handle. Basic vision/dental care are included, but are both administered through different connection accounts. For example, I had to submit an out-of-network claim for contact lenses to EyeMed rather than GEHA.

I had very high (for me) health care usage this year, and determined that I actually paid less than I would have under the traditional 80/20 BCBS plan...Once I hit the $1500 deductible, I was only paying 5% out of pocket. So I even had an ER visit that cost me less than $100 total.

Overall, I think it's the best HDHP/HSA option for Feds.

doggyfizzle

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Re: Fed Employee HDHP Experiences
« Reply #5 on: November 02, 2017, 04:29:36 PM »
I had very high (for me) health care usage this year, and determined that I actually paid less than I would have under the traditional 80/20 BCBS plan...Once I hit the $1500 deductible, I was only paying 5% out of pocket. So I even had an ER visit that cost me less than $100 total.

Overall, I think it's the best HDHP/HSA option for Feds.

Is your responsibility 5% of what the provider bills or 5% of what GEHA "allows" for the service?  I always get a statement from GEHA with  "allow" and "disallow" breakdowns for charges, and then a patient responsibility amount.

Imustacheyouaquestion

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Re: Fed Employee HDHP Experiences
« Reply #6 on: November 02, 2017, 06:00:36 PM »

Is your responsibility 5% of what the provider bills or 5% of what GEHA "allows" for the service?  I always get a statement from GEHA with  "allow" and "disallow" breakdowns for charges, and then a patient responsibility amount.

5% of the amount GEHA negotiated with the provider (aka the "allowed amount") for each billing code. The provider makes up the difference between the two amounts as a charge-off. But you owe 100% of the allowed amount until you hit the $1500 deductible. HDHPs make the most sense if you are very healthy and almost never use healthcare, or if you use a lot of healthcare. I run the numbers against the traditional BCBS plan every year to see if I should switch, and it's always worked out that the HDHP plan was better. This happens to be the first year it was better because of my weird high usage this year. 

kimmarg

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Re: Fed Employee HDHP Experiences
« Reply #7 on: November 02, 2017, 08:31:23 PM »
I'm presently insured through the GEHA Standard Plan (and was on the High plan in 2016); my experience with GEHA so far has been stellar - their customer service has been fantastic whenever I had an issue with physician billing, and because they use the AETNA Signature network, I've never come across a doctor or pharmacy who doesn't accept their insurance.  I also use GEHA for dental.  Once my kid gets a little bit older I will probably switch over to the GEHA HDHP.  I think GEHA kicks in $1200/year in premium passthrough to the HSA.  Check and see what other HDHPs are offered in your area, as a couple plans are a bit more generous with premium passthrough (I think AETNA is up to $1800/year in some cases).

I had the 100% opposite experience to this with GEHA standard plan. Their customer service was awful - they denied the few claims I submitted and I had to do battle. They wanted me to try a perscription medication that hadn't worked in the past before they covered the one that did work. Despite having lots of options listed on the website they wanted me to travel 2+ hours for an MRI when there are at least 4 options within 20min.  Basically I hated them so much I went back to BCBS which has been flawless. I like the theory of a HDHP but I'm unexcited about GEHA. 

crimwell

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Re: Fed Employee HDHP Experiences
« Reply #8 on: November 04, 2017, 12:44:38 AM »
I'm presently insured through the GEHA Standard Plan (and was on the High plan in 2016); my experience with GEHA so far has been stellar - their customer service has been fantastic whenever I had an issue with physician billing, and because they use the AETNA Signature network, I've never come across a doctor or pharmacy who doesn't accept their insurance.  I also use GEHA for dental.  Once my kid gets a little bit older I will probably switch over to the GEHA HDHP.  I think GEHA kicks in $1200/year in premium passthrough to the HSA.  Check and see what other HDHPs are offered in your area, as a couple plans are a bit more generous with premium passthrough (I think AETNA is up to $1800/year in some cases).

A heads up: GEHA's standard basic insurance refuses to cover certain "automated" lab expenses associated with hospital stays and serious illnesses

I had an experience about 5 years ago where this added up to the mid tens of thousands of dollars. I didn't have to personally pay it because it was covered by other means (not GEHA) but it was an eye opener.  nothing that I could control, since they were routine and required lab tests at an in network hospital. I decided it was a rare occurrence and stuck with GEHA and then got hit with the same issue for an unrelated set of occurrences the next year. After that I decided it was too risky. Your mileage may vary...

Imustacheyouaquestion

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Re: Fed Employee HDHP Experiences
« Reply #9 on: November 04, 2017, 09:47:04 PM »
The GEHA is not paying for commission fees nor are they waived for GEHA members.  Vanguard ETFs are on a list of commission free ETFs at TD Ameritrade until the 21st of this month.  You may want to look at the other ETFs right now, or you will pay a trading fee on every Vanguard ETF pretty soon (Vanguard is no longer on the commission free list as of the 21st).

Sorry, I meant there are no monthly fees for the HSA bank account, not that GEHA was paying commission fees. I think there are monthly fees if you move an HSA account to them without having a connected plan
But thanks for the heads up on the ETF commission switch too!

mrigney

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Re: Fed Employee HDHP Experiences
« Reply #10 on: November 06, 2017, 06:21:15 AM »
Quote
A heads up: GEHA's standard basic insurance refuses to cover certain "automated" lab expenses associated with hospital stays and serious illnesses

I had an experience about 5 years ago where this added up to the mid tens of thousands of dollars. I didn't have to personally pay it because it was covered by other means (not GEHA) but it was an eye opener.  nothing that I could control, since they were routine and required lab tests at an in network hospital. I decided it was a rare occurrence and stuck with GEHA and then got hit with the same issue for an unrelated set of occurrences the next year. After that I decided it was too risky. Your mileage may vary...

This is one of those things that "scares" me about health insurance in general (not just GEHA). I consider myself pretty savvy compared to the average consumer (as are most folks on the forum, I think). You probably had no real way of knowing about this particular quirk of GEHA before it happened. Likewise, there are probably quirks like this with BCBS, Aetna, etc that you wouldn't know about until it happened. It is almost (completely?) impossible for consumers to know everything that their insurance does/doesn't cover in advance.

The GEHA is not paying for commission fees nor are they waived for GEHA members.  Vanguard ETFs are on a list of commission free ETFs at TD Ameritrade until the 21st of this month.  You may want to look at the other ETFs right now, or you will pay a trading fee on every Vanguard ETF pretty soon (Vanguard is no longer on the commission free list as of the 21st).

Sorry, I meant there are no monthly fees for the HSA bank account, not that GEHA was paying commission fees. I think there are monthly fees if you move an HSA account to them without having a connected plan
But thanks for the heads up on the ETF commission switch too!

The investing mechanisms with HSAs have always seemed a bit clunky, at least from the outside looking in. @Imustacheyouaquestion -- what do you mean/how are you sweeping your HSA funds into the TD Ameritrade account? If you don't do that, what are your investment options?

« Last Edit: November 06, 2017, 06:50:39 AM by mrigney »

Imustacheyouaquestion

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Re: Fed Employee HDHP Experiences
« Reply #11 on: November 06, 2017, 08:14:06 AM »
You can pick any institution to hold your HSA, since they belong to you and not your employer, and they are portable if you leave your job. You can even have than one HSA account (just like you can have more than one 401k or IRA), but your total contributions for the year are still subject to the same IRS cap. However, GEHA (as I'm sure other HDHP providers do), has an arrangement with a specific HSA account provider, HSA Bank. I've never paid a monthly maintenance fee or maintained a balance over $100 to qualify for the waiver, so I assume GEHA is paying the monthly fees on my behalf, or HSA Bank waives them for GEHA members. http://www.hsabank.com/hsabank/business/fees-e

GEHA passes through $750 of the premium into the HSA account administered by HSA Bank, and I contribute the rest up the IRS cap via payroll deduction. Then I opened an HSA Investment Account with TD Ameritrade, which is linked to my HSA Bank account. My HSA Bank account has a setting for "auto-sweep and recurring transfers" that I have set to move all funds anytime the account is over $100 (the lowest threshold setting available) over to the TD Ameritrade account. Then I have to login to the TD Ameritrade account and buy ETFs 2-3 times a month, depending on how many paychecks I got that month or when the pass-through contribution hits the account.

In short, it's a fairly clunky system compared to other "set and forget" retirement contributions. There are probably automatic trading rules I could enable in the TD Ameritrade account, but I haven't bothered to do that yet. I imagine the average customer is not focused on early retirement, and they haven't put resources into making the investing experience seamless because most people don't care.

Most people are probably using their HSA like an FSA with better rollover rules. They're paying for expenses with the debit card attached to the HSA account, or reimbursing themselves at the end of the year. I doubt most people are paying cash for all out of pocket health expenses, using it as a triple tax-advantaged retirement savings account, investing the $3400 in contributions per year, and maintaining a detailed log of expenses/receipts so that they can withdraw years down the line.

My other option for investing the HSA funds if I didn't want to go this route? I'd have to find a different HSA provider, open my own account, pay their monthly fees, and then set up some equally cumbersome method for transferring the $750 pass-through contribution from the HSA Bank account to my second HSA account. So I've stuck with the default account options so far. Even if the commission-free ETFs available through TD Ameritrade wouldn't be my top choice, not paying investment fees or HSA account fees, or having to deal with transferring the pass-through contribution to a different account are enough reason for me.




Fomerly known as something

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Re: Fed Employee HDHP Experiences
« Reply #12 on: November 07, 2017, 05:45:42 AM »
I have the AETNA HDHP, I've been happy with it, but I'm healthy and haven't really ever tried to "use it."  My yearly sick visits come out to a couple of hundred dollars so I just don't bother.

rockeTree

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Re: Fed Employee HDHP Experiences
« Reply #13 on: November 07, 2017, 08:27:53 AM »
It’s not obvious for some of these choices what the investment options are.... united healthcare for instance says they’ll tell you 90 days after enrollment. Which is a little late! Does anyone have a sense of plans with particularly good options?

Also bummed to see that I am not eligible for pretax personal contributions and the list of who is hasn’t been expanded in ten years. Assume I can just mail a check and deduct that portion at tax time?


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Hopper

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Re: Fed Employee HDHP Experiences
« Reply #14 on: June 06, 2018, 05:19:09 AM »
I currently have the GEHA HDHP and am happy with it. Really only used it so far for pediatrician visits.  I made the switch years ago from BCBS to Kaiser, and then (after pregnancies and other expenses I thought might be high) made the switch to GEHA.  No complaints with GEHA but I wish we had more options.  I like Kaiser, because the service model is so easy/streamlined and costs were not bad.  But apparently Kaiser won't be offering an HDHP anytime soon.   A self-proclaimed 30+ year member of the Kaiser Federal team was at my agency for a presentation yesterday .  After the presentation, I went up to her and asked if Kaiser was going to be offering any Federal HDHP plans because I really liked their service, but financially HDHPs are a no-brainer for me.  She told me that "Oh well, you may not know this, but OPM picks the plans Fed employees get to choose."  I told her I was aware that OPM selects the final health insurance offerings and asked if she was saying that Kaiser had given a HDHP plan to OPM but that it was not chosen.  She admitted that they hadn't, and then said "You know, we have found that Fed Employees do not want HDHPs."   Bah.   

LorettaLynn

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Re: Fed Employee HDHP Experiences
« Reply #15 on: November 06, 2018, 07:19:49 PM »
Hi, resurrecting this thread for open season...is the GEHA HDHP still a good choice for 2019?  Iím debating between GEHA and United Healthcareís HDHP plans.  I would love to hear firsthand experiences.  Iím 40 with an autoimmune eye disease but reasonably healthy other than that. 

ThatGuy

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Re: Fed Employee HDHP Experiences
« Reply #16 on: November 06, 2018, 07:56:32 PM »
Since the "pass through" feature was brought up in this thread I'll ask a question that's been bugging me.  Does the pass through amount count towards your contributions or is it in addition to?  In other words for 2019 the limits are $3500/$7000, if your HDHP passes through $1200 will you be able to contribute a total of $4700/$8200?

Fomerly known as something

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Re: Fed Employee HDHP Experiences
« Reply #17 on: November 07, 2018, 08:05:07 PM »
Hi, resurrecting this thread for open season...is the GEHA HDHP still a good choice for 2019?  Iím debating between GEHA and United Healthcareís HDHP plans.  I would love to hear firsthand experiences.  Iím 40 with an autoimmune eye disease but reasonably healthy other than that.

I'd look at what state you are in.  I'm in a state where GEHA uses the AETNA network; my other choice was the AETNA HDHP but with GEHA I have a slightly cheaper plan with a better pass through and the same network.

doggyfizzle

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Re: Fed Employee HDHP Experiences
« Reply #18 on: November 08, 2018, 09:34:04 AM »
Hi, resurrecting this thread for open season...is the GEHA HDHP still a good choice for 2019?  Iím debating between GEHA and United Healthcareís HDHP plans.  I would love to hear firsthand experiences.  Iím 40 with an autoimmune eye disease but reasonably healthy other than that.

I'd look at what state you are in.  I'm in a state where GEHA uses the AETNA network; my other choice was the AETNA HDHP but with GEHA I have a slightly cheaper plan with a better pass through and the same network.

My GEHA Standard rate jumped about $18 per pay period this year, and coupled with the increase in max out of pocket to $13k, I think I'm going to jump to the GEHA HDHP next year.  Also, I believe GEHA increased the premium pass-through amount as well.  I might look into the MHBP HDHP as well, since it also provides coverage through the Aetna network, and has a $2400 premium pass-through.

the_fixer

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Re: Fed Employee HDHP Experiences
« Reply #19 on: November 13, 2018, 09:39:26 AM »
I am trying to help my wife (a Fed) figure out her insurance, way too many options it is insane.

When she started we ended up just picking the Blue Cross high plan but would like to see about a high deductible to qualify for the HSA.

Where are you seeing the money that they are giving you towards the HSA?

She went to the fair that they had but any question she had the just told her to call or look at the website.

Thanks!

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marion10

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Re: Fed Employee HDHP Experiences
« Reply #20 on: November 13, 2018, 11:57:01 AM »
Consumers Checkbook publishes an FEHB guide every year. Google it. Many Federal agencies also provide access to employees. Worth checking out or buying a copy for yourself.