Thanks for that perspective. The cheapest plan that offers an emergency room copay before the deductible is ~$600/mo more so that's out of consideration.
$600/mo is $3600/year (I know you know this, just spelling it out for simplicity's sake). That's what you would have spent on a SINGLE ER visit if you hadn't had insurance when your husband had his heart attack scare, and it's a fraction of what you would've spent--with an HSA or without insurance--if he actually had had a heart attack. Ditto the cost if anyone in your family has a car accident or other ER-worthy health scare.
Plans that cover ER visits before the deductible generally also cover a whole lot more (e.g., $10 to see a PCP or pediatrician, $50 to see a specialist, discounts on mail-order prescription drugs, etc.). So let's say you have another 9 specialist visits this year, like you did last year. Those typically run $150 and up when you're on a high-deductible plan, but more like $50-$70 when you're on normal insurance. So right there you're saving $720-$900/year. How many PCP/pediatrician visits did you have last year? Let's say 10, for easy math? Those could be $10-$20 on normal insurance, vs. $90-$125 (in my area, let me know what it is in yours) on a high-deductible plan (and, of course, more if you're not insured at all). So there's another $1200 or so savings over a high-deductible plan.
And if you didn't spend down your entire HSA from this year/previous years, you can still use it next year for dental and eye care (though in my state at least Obamacare plans include dental and basic vision for children, just not for adults--is it different where you are?).
Cheapest plan with specialist copays is $35/mo more. It would cost $420/year more plus a loss of $2000 in tax deductions for no HSA (that seems high but that's what my spreadsheet is saying), so $2.4k total. It looks like the HSA is still the better deal.
Not sure that's true. See above paragraph about ER visits, specialists, etc.: if you have 9 specialist visits and 10 PCP/pediatrician visits that are not the free kind (i.e., not the well baby/annual physical stuff), you're already close to saving $2.4k/year by having traditional insurance vs. a high-deductible plan. And that's just routine stuff. If any of you need prescription drugs, an ER visit, physical therapy (I know you don't anticipate needing that but there's no way to be sure), etc., you're better off with that $35/mo more plan.
Also, are you guys deducting your insurance premiums from your taxes? Are you factoring that into your calculations? As self-employed people you ought to be able to deduct premiums. Read this thread, for instance:
http://forum.mrmoneymustache.com/taxes/starting-an-llc-or-s-corp-to-avoid-self-employment-taxes/?topicseenConvenience is a large factor as the doctor's office is literally 3 min down the street. There have been many times where they've been able to fit me in because I was able to get there immediately. The doctor understands our family and who I am as a parent and we have developed a good relationship over time that I'd like to keep.
Are none of the Kaiser HMO doctors conveniently located? And is convenience worth the extra, what, $1000+ a year?
While researching this stuff this morning, I think my 2 person, husband/wife business can get a business plan from Aetna. It's only a little more per month but has all of our doctors.
This nation's health insurance situation is ridiculous. Why on earth can't a person over 30 get a catastrophic plan? I may be prone to more problems but I also can better afford it. Why can't EVERYBODY get HSAs to help save for medical costs? Why can't we have an HSA and a plan that allows for a couple of copay visits a year? So much craziness.
The Aetna thing sounds worth looking into. I agree that HSAs should be available to people on any type of plan. Maybe with lower limits to reflect the lower out of pocket cost of traditional insurance plans, but they shouldn't just be UNAVAILABLE.