Insurance - Another to HSA or Not? Thread

[abovethewaves]

I work for a very small company with just a few employees. We have a small business group plan, but I’m the only one who utilizes this plan so I can choose which plan to get. I’m early 40s female and would only be covering myself.

I have two main insurance co’s to choose from. Insurer #1 is a local company that is owned by the hospital network in my area. This seems like a conflict of interest to me, but from what I’ve read this vertical integration seems to be becoming more popular. I’ve seen estimates that they cover about 50-70% of non-military people in my area so everyone seems to take them. They are HMO only - out-of-network coverage is limited to emergencies and telehealth. Insurer #2 is a Blue Cross Blue Shield Company.

I’m currently on Insurer #1 plan. I spend about 2-3 months a year out of state, so during those times I have only emergency coverage and telehealth. This hasn't been an issue so far. I’ve been wanting to switch to an HSA plan. In recent years, I haven’t used a lot of healthcare (in hindsight should have been on HSA these past few years). This year I plan to catch up and see “all the doctors” including specialists like the dermo, so it’s possible I could have more expenses this year. Also, I used to do therapy but haven’t in a long time and have been thinking about picking that back up. From what I gather any Specialists and mental healthcare on the HSA would be all out of pocket until the deductible is met?

I don’t have a great handle on how to evaluate the plans. I tend to look at the yearly deductible and out of pocket maximums for a “worst case scenario” situation. I’ve looked at a ton of plans and the ones below I think are my best options. To me it seems like I should stick with the plan I’m on with the very low deductibles and forgo the HSA and PPO options? I attached the costs I'm looking at. Any suggestions?

[LightStache]

This is pretty easy to model out if you want to provide some additional data and assumptions.

Recommend reading this first to get an idea of the considerations: https://forum.mrmoneymustache.com/ask-a-mustachian/high-deductible-vs-traditional-health-insurance-for-pregnancy

And then come back here if you want to provide those details so we can run numbers for you.

ETA: The right decision will probably be driven by whether you go back to therapy and whether s/he is in network for each of the plans.

[abovethewaves]

Thank you for your response. I started to break everything out and include the additional details, but got frustrated because I found it difficult to find all the various data points. Getting info from my broker is like pulling teeth so I’m having to search for plan details online and look at various comparison tools, pdfs, etc.

What I was noticing in various insurance threads on here (including the one you sent) was that many people end up better off with the HSA plan even if they meet the deductible, but that doesn’t seem to be the case for me.

I thought about it today and I really do want to go back to therapy so I think it’s a moot point. I’ve fared well so far during the pandemic, but I’m definitely feeling like I've lost a little sparkle. I’m also noticing that some items I thought I “addressed” years ago have lately just been manifesting themselves in different ways. It’s definitely time for a check-in/tune-up. I found a therapist today that might be a good fit and she does take both Insurer #1 and #2. I will find a few more that take my insurance and hopefully one of them will work out.

There is also a chance I could need a minor surgery this year and because I’m making the rounds at the doctors, if there is any year that will be a higher spend it will likely be this one. So, I will stick with the higher premium/zero deductible/low MOOP. If all goes well, I can re-evaluate next year and hopefully start an HSA then with lower premiums.

My “employer’ (essentially me) pays 100% of the premiums and if I had an HSA, they could fully fund the HSA. I could also elect to forgo the small group plan and take that money as salary and then I would have to go on an ACA plan. I’m grateful to have so many options, but it’s a racket to sort through it all and try to figure out the best choice.

I need to find a new broker which may help. My broker accidentally copied me on an internal email to a staff member apologizing that I was probably wasting their time asking what my options were beyond my current plan (which I'd been on for several years)! Until this year, I’ve been super low maintenance and haven’t really asked any questions. I know you can see all details and pricing for ACA plans online. I wish you could do the same for small group plans so I didn’t have to “bother” the brokers.

[LightStache]

Ugh, I'm sorry your broker sent that email! If it's stressing you out, seems fine to go with the HMO that you know and then look into other options over the next 12 months.