Author Topic: Enrollment time for Health Benefits, please help me choose  (Read 1739 times)

Emergo

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Enrollment time for Health Benefits, please help me choose
« on: November 07, 2016, 11:34:46 AM »
Hi all,

I normally choose the lowest costing option I can get from my benefits at work. But this year might be different. I really dont have a good grasp of what most of the terms in my benefits are, hoping i can learn a little bit from yall. Anyway, the reason this year might be different for me is because i might get a couple things done through my doctors. Here is the list:

So for next year i plan to:

Get lasik by using groupon
Get accutane for my skin
Get a mri scan for my liver (this was an ongoing thing that happened this year. I had an enlarged liver and went thru different scans already and didnt see anything. My doc still suggested i get an mri to be sure but i ran out of money for 2016. So plan to get it next year.)
And if theres something really wrong about my liver, whatever treatment or procedure i need to get.
Remove my wisdom teeth

As you guys can see, it might end up a very costly year. Now i realize some of the above might not be covered because they arent necessary medical needs like lasik, in which case ill need yalls help identifying which is and which arenr. And i want to be sure i choose the right thing for me during this enrollment period for benefits next year. I will go on below what options i have on my benefits.

Three different medical plans: PPO plan (low deductible), hra1 plan (mid deductible/employer fund), (hra2 plan (high deductible/ employer fund)
^what do these mean and which one should i choose?

For ppo plan, annual deduct is $800 in network and $2400 out of network
For hra1 plan, $1500 in network, $3000 out network
For hra2, $2500 in network, $4500 out network

Medical plan premium rates per pay :
$86.11 for ppo
$61.49 hra1
$40.19 hra2

For dental i have an enhanced plan and a standard plan. Only difference is enhanced includes orthodontia...whatever that means

Now i have this thing called Flex spending which i dont know how it benefits me
It says i can choose to have a health and/or dependent care spending account (i dont have dependents btw)
It says for my flex health account i can choose an annual election which is deducted back through payroll on a biweekly basis. Deductions are pretax, loweringmy annual income. It says it can cover eligible health related expenses such as doctor visits, out of pocket dental and vision expenses, out of pocket medical expenses. The annual election limit for health is $2600.


Emergo

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Re: Enrollment time for Health Benefits, please help me choose
« Reply #1 on: November 07, 2016, 02:51:01 PM »
Crickets.. :(

MDM

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Re: Enrollment time for Health Benefits, please help me choose
« Reply #2 on: November 07, 2016, 03:02:04 PM »
Crickets.. :(
Perhaps because this question can be difficult to answer.  E.g., how much of your spending next year will be in-network and how much out-of-network?  What co-pay percentage applies to amounts above the deductible?  Etc.

To get you started, you might look at the 'HDHP analysis' tab in the case study spreadsheet.   Those calculations might not apply to you, because an HRA is not the same as an HDHP - see Publication 969 (2015), Health Savings Accounts and Other Tax-Favored Health Plans - but they might give you some idea of the questions you should be asking yourself.

laka

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Re: Enrollment time for Health Benefits, please help me choose
« Reply #3 on: November 07, 2016, 03:16:47 PM »
Emergo, it really depends on what your insurance, specifically, covers. I think you need to dig into your plan documents and see what is covered in each scenario. Your HR department should be able to get those for you. 

Most big insurance companies have tools on their website to estimate costs for different procedures based on your location.  Using that and your insurance plan documents, you should be able to get a ballpark of what your out of pocket costs would be on each plan (although the possible liver treatment will be an unknown, obviously).

The other big cost factor is if the doctor/provider you use is part of your health insurance network. Health insurance companies have agreements with some clinics/doctors who agree to take their insurance. The clinics can only charge a certain amount for a procedure (based on their agreement with the insurance company) and you have a lower deductible if you use those providers. A deductible is the amount you have to pay before your insurance company will start paying for your costs.

Two of your options are HRAs. This stands for Health Reimbursement Account. Usually this means that your employer will provide an account with a certain amount of money in it for you to use for your health costs. Find out about that - very important when calculating costs!

Other costs to consider are co-pays and prescriptions.

So, take all that information and figure out which one costs you the least over the year. Easier said than done, I know. :) For the part that you have to pay you can use the flex spending (FSA). A FSA and a HRA are similar, in that you use them to pay your out of pocket health costs. But the HRA is an account that is a set amount deposited by your employer.  Typically that money can roll over from year to year, but check and make sure with HR. A FSA is a use-it-or-lose-it plan and you decide how much to put in (up to a certain amount). The amount you put in is pre-tax, lowering your taxable income. But, if you decide to put in $2600 but only spend $100, you lose the $2500. So be careful. 

This is a lot of info. If your employer offers individual consultations you should take them up on it.

Emergo

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Re: Enrollment time for Health Benefits, please help me choose
« Reply #4 on: November 18, 2016, 09:19:49 AM »
So i took the hra 1 because i felt it was the best option. It looks like accutane will require a lot of prescription and hra1 fits that best. I also put in $1700 in FSA. It is kind of a gamble since i could easily be turned down for lasik and accutane. Time will tell.

laka

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Re: Enrollment time for Health Benefits, please help me choose
« Reply #5 on: November 20, 2016, 04:19:48 PM »
If your insurance doesn't cover either the lasik or accutane, you may still be able to use the FSA for them. You won't get your insurance to pay for any of it, but you can use the money you set aside. Don't let that FSA money disappear - definitely use it!