HDHP - How many choose this?

[mistymoney]

Do you pick the HDHP? If so, what motivates you?

In 2020 I opted for the HDHP, enter pandemic - and totally aside from that - one of our most health care user years. I'm questioning if I should do the HDHP plan again.

PPO will cost 4000/yr
HDHP is 2550, and employer kicks in 500 towards the HSA.

Deductible is 1k PPO, 5600 HDHP (2k and 22400 for out of network - that scares me a little! Sometimes - you don't know!)

So premium wise, I estimate total saving with HDHP to be 3300 (premium, employer HSA, and tax savings on maxing HSA contributions)

3300 saved vs 5600 spent if we max out health care use again - with the scary 22400 out of network thingy.

Which way would you go? Typically - we are low users of health care, but this year was different - plus still about 6 months left of a pandemic......

So - I'm a bit torn.

[the_gastropod]

Yea, it’s definitely a little scary. I hate that having a HDHP really incentivizes you to avoid doctor visits unless something’s an emergency.

I do use one, as I’m relatively young and in good health. The MadFientist article about the HSA really resonated with me, and tipped the scales for me opting-in (https://www.madfientist.com/ultimate-retirement-account/)

[HPstache]

I'm a huge advocate for the HDHP at my place of work.  There are lots of factors to look into, I've created a little graph generator that helps people wrap there mind about where the break points are, and I'll say with most employers the HDHP is better up to a break point that is way out there in terms of how much you spend on heath care in a normal given year.  To be able to do this for you though, I'd need to know what the max OOP is for each plan and how each plan behaves after the deductible is hit... do they go into a coinsurance mode where you're responsible for 10, 20, 30% etc.?  Do they go into a copay mode?  Are all expenses covered after the deductible is hit?

HDHP's are also a beautiful shelter from taxes as your contributions to them are free from Federal and FICA taxes, if you max them out and are in a decently high tax bracket, this can represent quite a bit in tax savings.  HDHP also give you the opportunity to bank funds to the point where if you can have a healthy year or two, you'll have enough to cover the worst case scenarios quite quickly.

Let me know the answers to the questions above and I might be able to graphically display the two.

[BeanCounter]

Been using one for years even with kids . Currently have $20k sitting in our HSA for future use. I'm sure we've got a bad year coming, but we're well positioned for it now.

IMHO you're looking at it wrong.
You are are saving $1,450 on premiums. That's guaranteed.
You're max risk is $4,100 (difference in deductible less employers HSA contributions)
About the only time you are going to hit that deductible is if you if you have an inpatient stay, major surgery, childbirth, or cancer treatment (or some other really expensive drugs)

A typical office visit with coverage from a major insurer is roughly $90-$120. Specialists are more. So you can see that even for the $1,450 savings on premiums you afford to pay for a few office visits with no change in your total insurance costs.
But what may end up happening is that you have one or two claims you have to pay and the rest of the time you accumulate dollars in your HSA year over year.

[mistymoney]

Yea, it’s definitely a little scary. I hate that having a HDHP really incentivizes you to avoid doctor visits unless something’s an emergency.

I do use one, as I’m relatively young and in good health. The MadFientist article about the HSA really resonated with me, and tipped the scales for me opting-in (https://www.madfientist.com/ultimate-retirement-account/)

Thanks, that is informative and I believe I've read it before. Hope others can enjoy it. I did pick up something new this time too! I didn't think about saving receipts for use (years?!?) later if need be? who knew!

I'm just torn as we had so many unexpected medical expenses this year. The number crunching I did for this year really has me on the fence, like it is a 50/50 as to which would work out better within the 2021 calendar year.

But - rereading all these advantages has me thinking I'm willing to give it another go and see what happens.

[HPstache]

IMHO you're looking at it wrong.
You are are saving $1,450 on premiums. That's guaranteed.
You're max risk is $4,100 (difference in deductible less employers HSA contributions)
About the only time you are going to hit that deductible is if you if you have an inpatient stay, major surgery, childbirth, or cancer treatment (or some other really expensive drugs)

Not sure I agree with that.  What's at risk depends on the Max OOP above and beyond the deductible.  Unless both plans are 100% coverage after deductible... which I doubt?

[mistymoney]

I'm a huge advocate for the HDHP at my place of work.  There are lots of factors to look into, I've created a little graph generator that helps people wrap there mind about where the break points are, and I'll say with most employers the HDHP is better up to a break point that is way out there in terms of how much you spend on heath care in a normal given year.  To be able to do this for you though, I'd need to know what the max OOP is for each plan and how each plan behaves after the deductible is hit... do they go into a coinsurance mode where you're responsible for 10, 20, 30% etc.?  Do they go into a copay mode?  Are all expenses covered after the deductible is hit?

HDHP's are also a beautiful shelter from taxes as your contributions to them are free from Federal and FICA taxes, if you max them out and are in a decently high tax bracket, this can represent quite a bit in tax savings.  HDHP also give you the opportunity to bank funds to the point where if you can have a healthy year or two, you'll have enough to cover the worst case scenarios quite quickly.

Let me know the answers to the questions above and I might be able to graphically display the two.

Thanks for this offer! for in network, for the HDHP everything is 100% after deductible is met. if in network. 70% if out of network. This is a BCBS plan.

I did confuse a point in my OP.  For the deductible on the HDHP it is 5600 in network, 11200 out of network. It is the maximum out of pocket total that is different - 5600 in network, and 22400 out of network.

So - max out of pocket for the PPO is 4000 (6000 out of network)
So - max out of pocket for the HDHP is 5600 (22400 out of network)

[HPstache]

I'm a huge advocate for the HDHP at my place of work.  There are lots of factors to look into, I've created a little graph generator that helps people wrap there mind about where the break points are, and I'll say with most employers the HDHP is better up to a break point that is way out there in terms of how much you spend on heath care in a normal given year.  To be able to do this for you though, I'd need to know what the max OOP is for each plan and how each plan behaves after the deductible is hit... do they go into a coinsurance mode where you're responsible for 10, 20, 30% etc.?  Do they go into a copay mode?  Are all expenses covered after the deductible is hit?

HDHP's are also a beautiful shelter from taxes as your contributions to them are free from Federal and FICA taxes, if you max them out and are in a decently high tax bracket, this can represent quite a bit in tax savings.  HDHP also give you the opportunity to bank funds to the point where if you can have a healthy year or two, you'll have enough to cover the worst case scenarios quite quickly.

Let me know the answers to the questions above and I might be able to graphically display the two.

Thanks for this offer! for in network, for the HDHP everything is 100% after deductible is met. if in network. 70% if out of network. This is a BCBS plan.

I did confuse a point in my OP.  For the deductible on the HDHP it is 5600 in network, 11200 out of network. It is the maximum out of pocket total that is different - 5600 in network, and 22400 out of network.

So - max out of pocket for the PPO is 4000 (6000 out of network)
So - max out of pocket for the HDHP is 5600 (22400 out of network)

Hmmm not sure this actually clarified for me.  My definition of Max OOP does not include premiums, I think you are including them.  Let's do it this way:

PPO
Premiums: $4,000
Deductible: $1,000
Max OOP: $4000 (? how does it get here after you meet your deductible?  Co-insurace %?  Copays only?)

HDHP
Premiums: $2,550
Deductible: $5,600
Max OOP: $5,600

[mistymoney]

I'm a huge advocate for the HDHP at my place of work.  There are lots of factors to look into, I've created a little graph generator that helps people wrap there mind about where the break points are, and I'll say with most employers the HDHP is better up to a break point that is way out there in terms of how much you spend on heath care in a normal given year.  To be able to do this for you though, I'd need to know what the max OOP is for each plan and how each plan behaves after the deductible is hit... do they go into a coinsurance mode where you're responsible for 10, 20, 30% etc.?  Do they go into a copay mode?  Are all expenses covered after the deductible is hit?

HDHP's are also a beautiful shelter from taxes as your contributions to them are free from Federal and FICA taxes, if you max them out and are in a decently high tax bracket, this can represent quite a bit in tax savings.  HDHP also give you the opportunity to bank funds to the point where if you can have a healthy year or two, you'll have enough to cover the worst case scenarios quite quickly.

Let me know the answers to the questions above and I might be able to graphically display the two.

Thanks for this offer! for in network, for the HDHP everything is 100% after deductible is met. if in network. 70% if out of network. This is a BCBS plan.

I did confuse a point in my OP.  For the deductible on the HDHP it is 5600 in network, 11200 out of network. It is the maximum out of pocket total that is different - 5600 in network, and 22400 out of network.

So - max out of pocket for the PPO is 4000 (6000 out of network)
So - max out of pocket for the HDHP is 5600 (22400 out of network)

Hmmm not sure this actually clarified for me.  My definition of Max OOP does not include premiums, I think you are including them.  Let's do it this way:

PPO
Premiums: $4,000
Deductible: $1,000
Max OOP: $4000 (? how does it get here after you meet your deductible?  Co-insurace %?  Copays only?)

HDHP
Premiums: $2,550
Deductible: $5,600
Max OOP: $5,600

PPO
Premiums: $4,000
Deductible: $1,000
Max OOP: $4000 - includes deductible, Co-insurance (which is 80% after deductible), office visit and ER Copays

HDHP
Premiums: $2,550
Deductible: $5,600
Max OOP: $5,600 - includes deductible, coinsurance *, and Rx copays


(there isn't any coinsurance, 100% after deductible for everything. these notes are from the benefits info sheet - but there have been several typos - so not sure why Rx copays not noted for OOP

[jrhampt]

I finally bit the bullet and went with the HDHP a few years ago (not that my company offers an alternative anymore, anyway).  Eventually you will no longer have the option and will be forced into one, so you might as well start accumulating in your HSA.  The first couple of years when your HSA is low on funds will be the most annoying, but the younger you start, hopefully the healthier you are, and the less medical costs you have, you can pack your HSA full of money. 

[HPstache]

I'm a huge advocate for the HDHP at my place of work.  There are lots of factors to look into, I've created a little graph generator that helps people wrap there mind about where the break points are, and I'll say with most employers the HDHP is better up to a break point that is way out there in terms of how much you spend on heath care in a normal given year.  To be able to do this for you though, I'd need to know what the max OOP is for each plan and how each plan behaves after the deductible is hit... do they go into a coinsurance mode where you're responsible for 10, 20, 30% etc.?  Do they go into a copay mode?  Are all expenses covered after the deductible is hit?

HDHP's are also a beautiful shelter from taxes as your contributions to them are free from Federal and FICA taxes, if you max them out and are in a decently high tax bracket, this can represent quite a bit in tax savings.  HDHP also give you the opportunity to bank funds to the point where if you can have a healthy year or two, you'll have enough to cover the worst case scenarios quite quickly.

Let me know the answers to the questions above and I might be able to graphically display the two.

Thanks for this offer! for in network, for the HDHP everything is 100% after deductible is met. if in network. 70% if out of network. This is a BCBS plan.

I did confuse a point in my OP.  For the deductible on the HDHP it is 5600 in network, 11200 out of network. It is the maximum out of pocket total that is different - 5600 in network, and 22400 out of network.

So - max out of pocket for the PPO is 4000 (6000 out of network)
So - max out of pocket for the HDHP is 5600 (22400 out of network)

Hmmm not sure this actually clarified for me.  My definition of Max OOP does not include premiums, I think you are including them.  Let's do it this way:

PPO
Premiums: $4,000
Deductible: $1,000
Max OOP: $4000 (? how does it get here after you meet your deductible?  Co-insurace %?  Copays only?)

HDHP
Premiums: $2,550
Deductible: $5,600
Max OOP: $5,600

PPO
Premiums: $4,000
Deductible: $1,000
Max OOP: $4000 - includes deductible, Co-insurance (which is 80% after deductible), office visit and ER Copays

HDHP
Premiums: $2,550
Deductible: $5,600
Max OOP: $5,600 - includes deductible, coinsurance *, and Rx copays


(there isn't any coinsurance, 100% after deductible for everything. these notes are from the benefits info sheet - but there have been several typos - so not sure why Rx copays not noted for OOP

Attached a chart.  How much would you be contributing to your HSA and what is your tax bracket?  I can also update to reflect tax savings.

[mistymoney]

I finally bit the bullet and went with the HDHP a few years ago (not that my company offers an alternative anymore, anyway).  Eventually you will no longer have the option and will be forced into one, so you might as well start accumulating in your HSA.  The first couple of years when your HSA is low on funds will be the most annoying, but the younger you start, hopefully the healthier you are, and the less medical costs you have, you can pack your HSA full of money.

Unfortunately - not so young anymore and didn't have one available for a lot of working life. Would be nice to build it up a bit if I can.

[mistymoney]

I'm a huge advocate for the HDHP at my place of work.  There are lots of factors to look into, I've created a little graph generator that helps people wrap there mind about where the break points are, and I'll say with most employers the HDHP is better up to a break point that is way out there in terms of how much you spend on heath care in a normal given year.  To be able to do this for you though, I'd need to know what the max OOP is for each plan and how each plan behaves after the deductible is hit... do they go into a coinsurance mode where you're responsible for 10, 20, 30% etc.?  Do they go into a copay mode?  Are all expenses covered after the deductible is hit?

HDHP's are also a beautiful shelter from taxes as your contributions to them are free from Federal and FICA taxes, if you max them out and are in a decently high tax bracket, this can represent quite a bit in tax savings.  HDHP also give you the opportunity to bank funds to the point where if you can have a healthy year or two, you'll have enough to cover the worst case scenarios quite quickly.

Let me know the answers to the questions above and I might be able to graphically display the two.

Thanks for this offer! for in network, for the HDHP everything is 100% after deductible is met. if in network. 70% if out of network. This is a BCBS plan.

I did confuse a point in my OP.  For the deductible on the HDHP it is 5600 in network, 11200 out of network. It is the maximum out of pocket total that is different - 5600 in network, and 22400 out of network.

So - max out of pocket for the PPO is 4000 (6000 out of network)
So - max out of pocket for the HDHP is 5600 (22400 out of network)

Hmmm not sure this actually clarified for me.  My definition of Max OOP does not include premiums, I think you are including them.  Let's do it this way:

PPO
Premiums: $4,000
Deductible: $1,000
Max OOP: $4000 (? how does it get here after you meet your deductible?  Co-insurace %?  Copays only?)

HDHP
Premiums: $2,550
Deductible: $5,600
Max OOP: $5,600

PPO
Premiums: $4,000
Deductible: $1,000
Max OOP: $4000 - includes deductible, Co-insurance (which is 80% after deductible), office visit and ER Copays

HDHP
Premiums: $2,550
Deductible: $5,600
Max OOP: $5,600 - includes deductible, coinsurance *, and Rx copays


(there isn't any coinsurance, 100% after deductible for everything. these notes are from the benefits info sheet - but there have been several typos - so not sure why Rx copays not noted for OOP

Attached a chart.  How much would you be contributing to your HSA and what is your tax bracket?  I can also update to reflect tax savings.

thank you! this is wonderful.

I am in the 24% tax bracket, this year I did max the HSA and would intend to do so next year as well. 7200 family level (after 500 for work contribution).

premiums for both plans would be before tax, if that matters.

[HPstache]

I'm a huge advocate for the HDHP at my place of work.  There are lots of factors to look into, I've created a little graph generator that helps people wrap there mind about where the break points are, and I'll say with most employers the HDHP is better up to a break point that is way out there in terms of how much you spend on heath care in a normal given year.  To be able to do this for you though, I'd need to know what the max OOP is for each plan and how each plan behaves after the deductible is hit... do they go into a coinsurance mode where you're responsible for 10, 20, 30% etc.?  Do they go into a copay mode?  Are all expenses covered after the deductible is hit?

HDHP's are also a beautiful shelter from taxes as your contributions to them are free from Federal and FICA taxes, if you max them out and are in a decently high tax bracket, this can represent quite a bit in tax savings.  HDHP also give you the opportunity to bank funds to the point where if you can have a healthy year or two, you'll have enough to cover the worst case scenarios quite quickly.

Let me know the answers to the questions above and I might be able to graphically display the two.

Thanks for this offer! for in network, for the HDHP everything is 100% after deductible is met. if in network. 70% if out of network. This is a BCBS plan.

I did confuse a point in my OP.  For the deductible on the HDHP it is 5600 in network, 11200 out of network. It is the maximum out of pocket total that is different - 5600 in network, and 22400 out of network.

So - max out of pocket for the PPO is 4000 (6000 out of network)
So - max out of pocket for the HDHP is 5600 (22400 out of network)

Hmmm not sure this actually clarified for me.  My definition of Max OOP does not include premiums, I think you are including them.  Let's do it this way:

PPO
Premiums: $4,000
Deductible: $1,000
Max OOP: $4000 (? how does it get here after you meet your deductible?  Co-insurace %?  Copays only?)

HDHP
Premiums: $2,550
Deductible: $5,600
Max OOP: $5,600

PPO
Premiums: $4,000
Deductible: $1,000
Max OOP: $4000 - includes deductible, Co-insurance (which is 80% after deductible), office visit and ER Copays

HDHP
Premiums: $2,550
Deductible: $5,600
Max OOP: $5,600 - includes deductible, coinsurance *, and Rx copays


(there isn't any coinsurance, 100% after deductible for everything. these notes are from the benefits info sheet - but there have been several typos - so not sure why Rx copays not noted for OOP

Attached a chart.  How much would you be contributing to your HSA and what is your tax bracket?  I can also update to reflect tax savings.

thank you! this is wonderful.

I am in the 24% tax bracket, this year I did max the HSA and would intend to do so next year as well. 7200 family level (after 500 for work contribution).

premiums for both plans would be before tax, if that matters.

With those inputs, there are no yearly spending scenarios where the PPO will be the better option.  See attached:

[terran]

For us the premium savings and the employer HSA contribution is greater than the difference in out-of-pocket max between the available plans, so we'd actually be better off with the HSA eligible plan in a high use year (out of network care might change that math, I'm not sure, so that could be an issue). Very low spend years also favor the HSA plan, of course. So it's really only a mid-spend year consisting mostly of regular appointments (primary and/or specialist) and not procedures that the PPO plan would work out better thanks to the low copays. I've seen this pattern quite a few times when evaluating plans people post on forums, but it sounds like yours might not follow this pattern.

Edit: Actually, looking at your follow up posts, it looks like your plan actually does follow this common pattern. The OOP max is only $1600 different which is just about the same as the $1550 premium savings. So it's really only the amount between the PPO deductible and the HSA deductible where the PPO works out better (plus some savings on regular non-procedure appointments assuming you only pay a copay).

[SimpleCycle]

We are never in the low spending scenario (thanks expensive chronic condition) so I run an "expected" scenario and a "worst case" scenario and decide from there.  I usually base my decision on "expected" and make sure I can stomach "worst case".

That said, there is not, in my experience, much risk of a large out of network bill if your HDHP uses the BCBS PPO network.  I did once have a provider decide to not take insurance at all (WTF?) and did OON reimbursement, but every other provider I've ever had has been in network with BCBS even if they are OON with most health plans.

[mistymoney]

I'm a huge advocate for the HDHP at my place of work.  There are lots of factors to look into, I've created a little graph generator that helps people wrap there mind about where the break points are, and I'll say with most employers the HDHP is better up to a break point that is way out there in terms of how much you spend on heath care in a normal given year.  To be able to do this for you though, I'd need to know what the max OOP is for each plan and how each plan behaves after the deductible is hit... do they go into a coinsurance mode where you're responsible for 10, 20, 30% etc.?  Do they go into a copay mode?  Are all expenses covered after the deductible is hit?

HDHP's are also a beautiful shelter from taxes as your contributions to them are free from Federal and FICA taxes, if you max them out and are in a decently high tax bracket, this can represent quite a bit in tax savings.  HDHP also give you the opportunity to bank funds to the point where if you can have a healthy year or two, you'll have enough to cover the worst case scenarios quite quickly.

Let me know the answers to the questions above and I might be able to graphically display the two.

Thanks for this offer! for in network, for the HDHP everything is 100% after deductible is met. if in network. 70% if out of network. This is a BCBS plan.

I did confuse a point in my OP.  For the deductible on the HDHP it is 5600 in network, 11200 out of network. It is the maximum out of pocket total that is different - 5600 in network, and 22400 out of network.

So - max out of pocket for the PPO is 4000 (6000 out of network)
So - max out of pocket for the HDHP is 5600 (22400 out of network)

Hmmm not sure this actually clarified for me.  My definition of Max OOP does not include premiums, I think you are including them.  Let's do it this way:

PPO
Premiums: $4,000
Deductible: $1,000
Max OOP: $4000 (? how does it get here after you meet your deductible?  Co-insurace %?  Copays only?)

HDHP
Premiums: $2,550
Deductible: $5,600
Max OOP: $5,600

PPO
Premiums: $4,000
Deductible: $1,000
Max OOP: $4000 - includes deductible, Co-insurance (which is 80% after deductible), office visit and ER Copays

HDHP
Premiums: $2,550
Deductible: $5,600
Max OOP: $5,600 - includes deductible, coinsurance *, and Rx copays


(there isn't any coinsurance, 100% after deductible for everything. these notes are from the benefits info sheet - but there have been several typos - so not sure why Rx copays not noted for OOP

Attached a chart.  How much would you be contributing to your HSA and what is your tax bracket?  I can also update to reflect tax savings.

thank you! this is wonderful.

I am in the 24% tax bracket, this year I did max the HSA and would intend to do so next year as well. 7200 family level (after 500 for work contribution).

premiums for both plans would be before tax, if that matters.

With those inputs, there are no yearly spending scenarios where the PPO will be the better option.  See attached:

Thanks so much! I guess that makes it an easy decision!

[charis]

We normally hit the deductible by May due to chronic conditions, so the beginning of the year is expensive but we always save money (3k deductible/1800 employer has contribution/5% coinsurance after deductible/310 monthly premium). This year was very different and not as advantageous bc of low medical (for us) costs.  We hit the deductible next week 🙄.  But we still come out ahead compared to ppo.