Author Topic: Is everyone tired of open season questions yet?  (Read 1594 times)

Sugaree

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Is everyone tired of open season questions yet?
« on: November 25, 2019, 07:33:29 AM »
      Family:

Me:  Late 30s.  Generally healthy, might see a doctor once a year.  1000% done having kids so maternity coverage is a non-issue.  Also just had a three-year BC implant put in so I'm good there for awhile.

Husband:  Early 40s.  Having some health issues lately that are concerning, mostly because no one knows which ones are being caused by what and it's taking a lot of appointments with specialists and a decent amount of lab work to figure out what's going on.  We could be looking at a major surgery in the near term, but it's not certain yet.  He currently takes one medication long term and will likely be adding at least one more, maybe several more. 

Son:  6, no known health issues or major allergies.  Sees his doctor maybe twice a year not including shots. 



Current plan:
  • FFS
  • Premiums: $7455/year
  • OOP Max: $5k/person, $10k/family
  • Deductible: $350/person, $700/family
  • Office visit co-pay: $25 primary, $35 specialist
  • Surgical: we pay 15% of allowance after deductible
  • Pharmacy: Retail is either $7.50 copay for generics or 30-50% of the allowance for everything else, after deductible I assume.  Mail order is a $15, $50, $70, $90, or $125 co-pay based on tier. 

So far this year, we've spent $992 OOP as a family, but only have $402 that's been applied to the deductible (I think he's reached his deductible for the year so I need to see if we can get anything squeezed in before the end of the year).  That tells me we've spent nearly $600 in co-pays in addition to the premiums. 

Plan I want to switch to:
  • HDHP/HSA
  • Premiums: $3901/year
  • Premium Passthrough: $1800/year
  • OOP Max: $5k/person, $10k/family
  • Deductible: $1500/person, $3000/family
  • Office visit: 5% after deductible
  • Surgical: 5% after deductible (plus 25% of allowance, after deductible, for drugs used)
  • Pharmacy: 25% of allowance after deductible

Third option
  • FFS
  • Premiums: $4972/year
  • OOP Max: $5.5k/person, $11k/family
  • Deductible: No deductible, but no out-of-network coverage either.
  • Office visit co-pay: $30 primary, $40 specialist
  • Surgical: $150-200 plus 30% of allowance on any drugs used plus any hospital charges
  • Pharmacy: Retail is $10, $55, $65, $75, or $90 copay based on tier.  Mail order not available to non Medicare members.


When I run the numbers on my current plan vs. the HDHP it's a no-brainer.  The difference in premiums alone is enough to cover the deductible for the family.  Once you add in the premium passthrough it's enough to cover the OOP max on my husband and have a tiny bit left over.  I'd be maxing out the HSA.  With health issues cropping up now, my husband is worried about having a whole lot of bills before the HSA is set up and funded.  We have an emergency fund that we could use for this until we can be reimbursed and I have an old tIRA that I'm holding off on making a decision about until I see if I need to use the once-in-a-lifetime rollover option.  Unfortunately, I don't see us being able to cashflow his healthcare until everything is properly diagnosed and stabilized.  But I do see us having money left in the HSA at the end of the year anyway.

The third option seems like a compromise between the two.  It's the lower coverage version of my current plan.  The premiums aren't so high, but I would expect at least the same level of OOP that we had this year, maybe a little more due to slightly higher co-pays and all of the pharmacy tiers having a co-pay rather than co-insurance.  That will put the OOP cost below the current plan's, but probably higher than the HDHP.  The surgical coverage and no out-of-network coverage worries me in the event that the worst-case scenario of my husband having to have surgery comes to pass.  Though I imagine that we'll be looking at the OOP max for all three plans in that case.  The biggest draw for this option would be the no deductible and not having a bunch of big bills all at once (and a less worried husband).

I'm still leaning towards the HDHP, but I need a gut check.  Am I failing to consider anything important? 

Morning Glory

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Re: Is everyone tired of open season questions yet?
« Reply #1 on: November 25, 2019, 07:50:26 AM »
I usually use premium+ OOP max to compare plans. The HDHP wins in this case.

Sugaree

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Re: Is everyone tired of open season questions yet?
« Reply #2 on: November 25, 2019, 07:56:43 AM »
I usually use premium+ OOP max to compare plans. The HDHP wins in this case.

That's where I'm at too.  My husband is just freaking out a tiny bit.  I think he's heard horror stories from his friends who switched (or were made to switch) to a HDHP, but didn't use the HSA portion of the equation.

terran

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Re: Is everyone tired of open season questions yet?
« Reply #3 on: November 25, 2019, 08:14:59 AM »
As usual, HSA wins for very low spending (save premiums, get an employer HSA contribution, don't spend much) and very high expenses (save premiums, get an employer HSA contribution, OOP max is the same), so it's only in the middle that the copay plan can win (while you're paying lots for office visits within the OOP max on the HSA instead of copays on the copay plan). Even in the middle, the copay plan costs $5,354 more out of the gate between premium differences and the passthrough (I assume that's an employer HSA contribution?), which would more than pay for your husband's OOP max, and that doesn't even consider tax savings from the HSA.

Sugaree

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Re: Is everyone tired of open season questions yet?
« Reply #4 on: November 25, 2019, 08:28:05 AM »
As usual, HSA wins for very low spending (save premiums, get an employer HSA contribution, don't spend much) and very high expenses (save premiums, get an employer HSA contribution, OOP max is the same), so it's only in the middle that the copay plan can win (while you're paying lots for office visits within the OOP max on the HSA instead of copays on the copay plan). Even in the middle, the copay plan costs $5,354 more out of the gate between premium differences and the passthrough (I assume that's an employer HSA contribution?), which would more than pay for your husband's OOP max, and that doesn't even consider tax savings from the HSA.


Yeah, it's an HSA contribution, but it comes from the insurance company rather than my employer so they call it a premium passthrough. 

mistymoney

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Re: Is everyone tired of open season questions yet?
« Reply #5 on: November 25, 2019, 08:47:53 AM »
If the plans are coming from the same company, generally they are priced to kinda sorta be the same total expenditure for a heavy-use year. The insurance company saves money in non-heavy use years, with the insured picking up more of the tab but also potential investing some and or saving money on very low-use years.