Anyone else NOT go with the HDHP (employer medical insurance)

[Sugaree]

Like the previous poster have said, it's very situational.  I have a ton of choices, but for many years I was on the super duper BCBS FFS plan.  I switched to a HDHP this year and the premiums are almost half of the old plan and nearly half of the premiums are passed through to my HSA.  I've been keeping a running total and so far, we're about $2000 ahead of where we would have been if we'd stayed on the old plan, even using the HSA debit card like it's intended. 

Where I find the HDHP to have drawbacks is that I'm spending a lot more time dealing with billing.  Part of it is that it's not a plan that many people are familiar with (and don't always know how to submit things correctly to).  And part of it is because I now have to make sure everything that should count towards the deductible does.  With the old plan, I showed up, paid a co-pay and let the doctor's office deal with the behind the scenes stuff.  Now there's a new tab on my spreadsheet to track that shit.  I just, today, finally got a bill from January straightened out.  Sorta.

But can I just say, holy hell, at least they require the doctor's office to charge the negotiated rates.  I just got a bill from my kid's speech therapy.  That $200 doesn't look too bad when they billed over $1000.

Hate to break it to you - but the billing was always screwed up. You just didn't have to deal with it the same way.

Oh, I know.  But the doctor's office seems more motivated to jump through the right hoops when they have to do it to get paid. 

[ixtap]

Like the previous poster have said, it's very situational.  I have a ton of choices, but for many years I was on the super duper BCBS FFS plan.  I switched to a HDHP this year and the premiums are almost half of the old plan and nearly half of the premiums are passed through to my HSA.  I've been keeping a running total and so far, we're about $2000 ahead of where we would have been if we'd stayed on the old plan, even using the HSA debit card like it's intended. 

Where I find the HDHP to have drawbacks is that I'm spending a lot more time dealing with billing.  Part of it is that it's not a plan that many people are familiar with (and don't always know how to submit things correctly to).  And part of it is because I now have to make sure everything that should count towards the deductible does.  With the old plan, I showed up, paid a co-pay and let the doctor's office deal with the behind the scenes stuff.  Now there's a new tab on my spreadsheet to track that shit.  I just, today, finally got a bill from January straightened out.  Sorta.

But can I just say, holy hell, at least they require the doctor's office to charge the negotiated rates.  I just got a bill from my kid's speech therapy.  That $200 doesn't look too bad when they billed over $1000.

Hate to break it to you - but the billing was always screwed up. You just didn't have to deal with it the same way.

Oh, I know.  But the doctor's office seems more motivated to jump through the right hoops when they have to do it to get paid.

We have had zero additional paperwork due to the HDHP. We did have a problem with an HSA payment through the portal because they wouldn't take the electronic payment and gave the wrong address for a check to be sent to. To be fair though, the treatment we received was also horrendous, with one of the prescriptions being for a recalled drug and another for an unrelated condition (I even spent time researching off label uses). Gotta love spending a day at urgent care while on vacation!

[Schaefer Light]

If I had a choice, I'd take the PPO.  I have a chronic health condition that requires a visit to a hospital twice a year, and those visits cost me $750-1000 each on a HDHP.  I also got charged $450 for a freaking physical, so now I'm reluctant to schedule another one.  And that might be the biggest argument against HDHPs...that they make people so price-sensitive that they avoid or delay seeking medical help.  In some cases (i.e. when a doctor isn't really necessary), maybe that's a good thing.

I really wish I'd had access to an HSA when I was younger and never needed to go to the doctor.  I could have saved a lot of money then.  Now that I have some health issues and go to various doctors more frequently, I'd rather have the PPO.

[Sugaree]

Like the previous poster have said, it's very situational.  I have a ton of choices, but for many years I was on the super duper BCBS FFS plan.  I switched to a HDHP this year and the premiums are almost half of the old plan and nearly half of the premiums are passed through to my HSA.  I've been keeping a running total and so far, we're about $2000 ahead of where we would have been if we'd stayed on the old plan, even using the HSA debit card like it's intended. 

Where I find the HDHP to have drawbacks is that I'm spending a lot more time dealing with billing.  Part of it is that it's not a plan that many people are familiar with (and don't always know how to submit things correctly to).  And part of it is because I now have to make sure everything that should count towards the deductible does.  With the old plan, I showed up, paid a co-pay and let the doctor's office deal with the behind the scenes stuff.  Now there's a new tab on my spreadsheet to track that shit.  I just, today, finally got a bill from January straightened out.  Sorta.

But can I just say, holy hell, at least they require the doctor's office to charge the negotiated rates.  I just got a bill from my kid's speech therapy.  That $200 doesn't look too bad when they billed over $1000.

Hate to break it to you - but the billing was always screwed up. You just didn't have to deal with it the same way.

Oh, I know.  But the doctor's office seems more motivated to jump through the right hoops when they have to do it to get paid.

We have had zero additional paperwork due to the HDHP. We did have a problem with an HSA payment through the portal because they wouldn't take the electronic payment and gave the wrong address for a check to be sent to. To be fair though, the treatment we received was also horrendous, with one of the prescriptions being for a recalled drug and another for an unrelated condition (I even spent time researching off label uses). Gotta love spending a day at urgent care while on vacation!

It's not so much that I had to do any additional paperwork, but that I've had to make sure other people do theirs.  For this appointment in January, he saw a doctor who sent him four floors down to the radiology department.  At this system, the doctors fees are billed separately from the facilities fees.  So for a single visit he had two doctor fees and two facility fees.  The doctor fees can be seen and paid online so that was all cool and paid by March.  The facilities billing is only available if you call in or wait for a bill.  Somehow, despite the two charges being on the same day in the same building, the billing department managed to bill one correctly and send the other to the wrong company.  Twice.  After being told exactly what was wrong they submitted it incorrectly in the exact same way.  So there's been a bunch of phone calls to various places to coordinate everything so that this charge gets applied to the deductible.  I can't help but think that the hospital would be more likely to do things the right way if they knew their getting paid depended on it.

[joleran]

I also got charged $450 for a freaking physical

This isn't allowed to be billed under an ACA plan unless you're doing it too often or come up with a complaint at the visit.  (I know, it's super fun that if you have anything to talk to a doctor about it's not free anymore)

[Schaefer Light]

I also got charged $450 for a freaking physical

This isn't allowed to be billed under an ACA plan unless you're doing it too often or come up with a complaint at the visit.  (I know, it's super fun that if you have anything to talk to a doctor about it's not free anymore)

Most of the $450 was for the "office visit" and "first time patient visit" charges, which aren't considered part of the physical exam.

[joleran]

Most of the $450 was for the "office visit" and "first time patient visit" charges, which aren't considered part of the physical exam.

Bleh, definitely worth calling your insurance about to clarify this was intended as a "well-visit" and just happened to be the first time you saw the doctor to see if that helps.

[caracarn]

We once looked at a HDHP, but we have stuck with a PPO for me and HMO for DH/kids.  Number of reasons:

...

2.  My PPO is free -- my employer pays full freight for the insurance.  So I incur no extra costs associated with the higher PPO premiums.

...

This was the only time I ever saw the PPO be better.  We have chronic items in the family so we always fund our HSA to the max and typically use it all in a given year, so never did it for the savings, as we have never had any.  The HDHP was just always $3-$4K cheaper a year.

[FrugalFisherman10]

I've currently been on the phone with first my benefits department, then the pharmacy provider for our health plans (envolve), then the Medical provider for the health plans (Cigna), for about an hour, all to answer the question of:
"How much will my generic prescription cost under the plan?"
I take Omeprazole (generic Prilosec), once a day, pretty much for forever. This is like the most common drug and the simplest question.

But everyone has an aneurysm when I ask it because I'm still in my "enrollment" stage and haven't yet selected a plan. They're like "eh..ffukkckk what is your IDEE nUMber??"
Me: "I don't have one. I'm trying to evaluate my options here and make an informed decision"
Them: "right but what is your ID NUMBER?"

Lol what.

[ixtap]

I've currently been on the phone with first my benefits department, then the pharmacy provider for our health plans (envolve), then the Medical provider for the health plans (Cigna), for about an hour, all to answer the question of:
"How much will my generic prescription cost under the plan?"
I take Omeprazole (generic Prilosec), once a day, pretty much for forever. This is like the most common drug and the simplest question.

But everyone has an aneurysm when I ask it because I'm still in my "enrollment" stage and haven't yet selected a plan. They're like "eh..ffukkckk what is your IDEE nUMber??"
Me: "I don't have one. I'm trying to evaluate my options here and make an informed decision"
Them: "right but what is your ID NUMBER?"

Lol what.

And yet folks keep telling me that we have a free market system. More like a hermetically sealed market.

[Sugaree]

I've currently been on the phone with first my benefits department, then the pharmacy provider for our health plans (envolve), then the Medical provider for the health plans (Cigna), for about an hour, all to answer the question of:
"How much will my generic prescription cost under the plan?"
I take Omeprazole (generic Prilosec), once a day, pretty much for forever. This is like the most common drug and the simplest question.

But everyone has an aneurysm when I ask it because I'm still in my "enrollment" stage and haven't yet selected a plan. They're like "eh..ffukkckk what is your IDEE nUMber??"
Me: "I don't have one. I'm trying to evaluate my options here and make an informed decision"
Them: "right but what is your ID NUMBER?"

Lol what.

That's annoying.  Both of the companies I was considering last year used CVS Caremark to handle their Rx processing, so I was able to compare costs pretty easily for my husband's stuff. 

Have you seen this:  https://www.cigna.com/static/medicare-2020-cigna-com/docs/formulary-ea-mapd.pdf

It may answer some of your questions. 

[FrugalFisherman10]

Thanks yeah something like that would be helpful. This one is not for my plan and doesn't have my state listed (I'm not Medicare and I live in Missouri).
 I found one like that for my plan "a formulary", but it doesn't have dollar amounts listed...maybe i can get someone on the phone to track down the right formulary for me

[joleran]

And yet folks keep telling me that we have a free market system. More like a hermetically sealed market.

I'm curious about the history behind it.  At some point, you went to a doctor directly who worked for themselves (or maybe not?), and could presumably know exactly how much they charged because there were no health care plans (or maybe there always have been?).

[ixtap]

And yet folks keep telling me that we have a free market system. More like a hermetically sealed market.

I'm curious about the history behind it.  At some point, you went to a doctor directly who worked for themselves (or maybe not?), and could presumably know exactly how much they charged because there were no health care plans (or maybe there always have been?).

My understanding is that the current billing system can largely be traced to law changes in the 1970s that opened the healthcare industry up to profits.

[FrugalFisherman10]

Fwiw, I ended up going with the $1500 HDHP, based on all we discussed here and my own calculations.
Just wanted to close the loop on this since some of you helped so much. I know often times we help each other on the internet and then never hear from that person again.

Now I need to identify a PCP in my area I guess

Thank you for your input!


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[MissPeach]

The HDHP works better in my situation. My employer pays the premium for me so I pay only about $20 to insure my kid. I am a single parent so I can withhold into the HSA at the family level which is much higher than the single one. I'm also high income and very rarely use anything except preventative care which is covered at 100%. So in my case I have to hit the deductible in non-covered costs before I break even on tax savings and premium when comparing it to my company's PPO (and that's assuming the PPO covered what I needed at 100% which would be rare). I've only had high bills one year when kiddo broke a bone and still didn't hit the deductible so I take the risk. I think it's a great option if you're in a position where you don't use care much. Lack of good prescription coverage is where I'm most covered with my plan. I'm more likely to need a round of eye drops or antibiotics if I need anything.

If I used more medical care, needed it for mental health support, etc. I would totally make a different decision. I would probably go with the HMO or EPO options first with my plans. Where I am the PPO is the highest in premiums and high in deductibles.

I also don't hold onto my receipts for retirement. Another FIRE blog (I think Go Curry Cracker) uses them as college tuition savings. I just keep a portion of my HSA in cash and pay out of that. I'm in a state that taxes HSA earnings so I don't want to realize income and keep my deductible in cash.