Author Topic: Help me with health insurance enrollment pleeaasse  (Read 2951 times)

mozar

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Help me with health insurance enrollment pleeaasse
« on: September 08, 2016, 05:14:01 PM »
My job is switching insurers and the plans are worse. I wanted to get surgery for a fibroid this year. The new insurance starts Oct 1 so not enough time to get the surgery. I haven't funded my hsa yet. Should I fund my hsa and then switch to a non-hsa plan? I have attached my benefits. Any thoughts?

Hvillian

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Re: Help me with health insurance enrollment pleeaasse
« Reply #1 on: September 09, 2016, 11:59:11 AM »
Do you have an estimate of the complexity of the Fibroid Surgery (i.e. Outpatient, Inpatient, 2-3 days in the hospital recovering, etc.)?

Also, are you only paying for Single Coverage, or do you cover anyone else through this policy?  If another person, do they have any large expected medical expenses?

Need2Save

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Re: Help me with health insurance enrollment pleeaasse
« Reply #2 on: September 09, 2016, 12:08:45 PM »
mozar, regardless of whether you switch for October or not, you probably want to fund your HSA if you can do so.  Like previous responder, more information would help. Family or single? in-patient or out-patient (probably out-patient I would think).  Have you compared providers yet and will this be done in hospital setting or out-patient surgical center (cheaper). Will you have other ongoing expenses to use up part of the deductible or those expenses of your family members?  Have to tried to find out typical cost of the procedure you need?  CIGNA probably has an estimator tool you can use.  Have you checked?

You PPO choices are not bad in terms of over all value but I don't know what was available before now, either. 

Why do you say 'worse', specifically? 

mozar

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Re: Help me with health insurance enrollment pleeaasse
« Reply #3 on: September 09, 2016, 12:14:47 PM »
Single Coverage
Inpatient can be from 8k to 16k all inclusive.
My options are focused ultrasound, embolization, or myomectomy. I think the last two would be inpatient.
When it comes to health insurance though, generally you pay up to a cap for hsa, and then free afterward, but if you get a non-hsa they only pay a portion?
So if I went with hsa I would only pay 2k no matter what. But with non-hsa I could end up paying thousands more?

Worse because previous hsa was copay for specialist visit, now its deductible then copay.
I will call billing to ask them too.

« Last Edit: September 09, 2016, 12:32:47 PM by mozar »

Sibley

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Re: Help me with health insurance enrollment pleeaasse
« Reply #4 on: September 09, 2016, 12:30:57 PM »
No, you don't know what a HSA is. HSA is simply a fancy, tax advantaged savings account for medical expenses. How much you actually pay depends on the benefits and terms of your health insurance policy.

If you have surgery and you have to pay $5k and the insurance pays the rest, then you have to pay $5k. You can use money in a HSA to pay, in part or full, but if you exhaust the HSA then you still have to pay the rest.

Are you sure the new plan is effective 10/1? That's a really odd time, usually employer plans start 1/1 from what I've seen.

mozar

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Re: Help me with health insurance enrollment pleeaasse
« Reply #5 on: September 09, 2016, 12:35:28 PM »
I mean the deductible. Say the deductible is 2k and plan says deductible then no charge, that would be better than no deductible but only a portion of the surgery is covered? That's what I'm having trouble understanding.

Sibley

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Re: Help me with health insurance enrollment pleeaasse
« Reply #6 on: September 09, 2016, 12:46:39 PM »
The deductible is not the same as the out of pocket max. You pay the deductible before the insurance kicks in. But you also have to factor in the out of pocket maximum - copays, etc.

"Coverage" is different. First, is a procedure "covered" - will insurance pay anything at all? Second, how much is covered before you have to pay anything (co-insurance/co-pays), but that's capped by the out of pocket max.

I wish I knew a good website that broke down what all the terms mean and how to calculate health insurance stuff. It's not self-explanatory.

mozar

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Re: Help me with health insurance enrollment pleeaasse
« Reply #7 on: September 09, 2016, 01:28:29 PM »
Oh duh, I need to ask what's covered. I'm an accountant and I find medical billing mind blowing-ly complicated. I did find out that I have 100% coinsurance. So I just have to pay the deductible. Which brings me to my original question. I could fund my hsa within this month, then switch to a non hsa plan Oct 1, then next oct switch back to hsa. That would save me 900 bucks while still continuing to fund hsa.

mozar

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Re: Help me with health insurance enrollment pleeaasse
« Reply #8 on: September 09, 2016, 01:58:52 PM »
I won't be able to know what's covered until I get the code and my doctor hasn't gotten back to me.
No matter what I can contribute 2233.33 to my hsa (prorated ).  Will have to do the math to figure out if its worth staying on the hdhp.

Axecleaver

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Re: Help me with health insurance enrollment pleeaasse
« Reply #9 on: September 09, 2016, 02:13:33 PM »
Typically open enrollment starts in October for the next calendar year. So you are probably keeping your current plan through 12/31, then starting your new plan on 1/1/17. You may still have time to schedule it this year while your better insurance is available. Every year corporate health insurance benefits transfer more cost from employer to employee - it's been heading this way for a long time, and private payors are happy to respond to corporate demands to facilitate this. Your employer does have better plans available, they choose not to buy them.

Generally speaking, you're better off taking the HDHP and fully funding your HSA every year. Then you can use the HSA funds to pay your deductible, Rx, and copays at the doctor. You pay 100% of cost until the deductible is met, then share costs with insurance (copays, sometimes a percentage of costs via coinsurance) until you hit the out of pocket maximum. So a typical plan may have a $2000 deductible, $4000 oop max, 20% coinsurance. You'll pay 100% of the bills up to 2k, then 20% of the bills from 2-4k, then anything above that is free to you.

mozar

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Re: Help me with health insurance enrollment pleeaasse
« Reply #10 on: September 09, 2016, 02:17:27 PM »
If I leave the hsa I will lose 279 in tax benefits  (3350-2233=111625%=279).
If I leave the hsa I will pay an extra 384 per benefit year for higher premiurm (38-5=3211=384).
Add those together and get 663. I would save 1500 because the deductible is 500. 1500-663 is 837 in savings.
Then lose tax benefits for the first 9 months of next year. So hsa costs 350 more.
I can't know how it relates to out of pocket max because I don't know how many visits each surgery is.
I will double check but my hr person said they change oct 1. I have 100% coinsurance.
« Last Edit: September 09, 2016, 03:03:49 PM by mozar »