It's open enrollment and our family has experienced some recent changes such that I am re-evaluating our health plan. We are currently on Blue Shield PPO. I've been trying to do the math about switching to a HDHP and it's making my head spin. Would very much appreciate some help.
First, here is a comparison of the plan basics:
Basics | BS-CA PPO 500 CA - Enrolled plan | BS-CA HDHP 2500/2600 CA - Eligible plan |
Overview | The plan pays 90% of in-network eligible charges and 70% of out-of-network eligible charges for most covered expenses.
You will pay a copay for certain expenses. | The plan pays 90% of in-network eligible charges and 70% of out-of-network eligible charges for most covered expenses.
You will pay a copay for certain expenses. |
Coinsurance | In-network: Plan pays 90%
Out-of-network: Plan pays 70% | In-network: Plan pays 90%
Out-of-network: Plan pays 70% |
Office copay | In-network: $25
Out-of-network: No copay | No copay in-network or out-of-network |
Deductible | There is a combined network deductible. Individual: $500 Family: $1,000 | In-network: Individual: $2,600 Family: $5,200 Out-of-network: Individual: $2,600 Family: $5,200
|
Out-of-pocket maximum | In-network: Individual: $3,500 Family: $7,000 Out-of-network: Individual: $6,500 Family: $13,000 | There is a combined network out-of-pocket limit. Individual: $5,000 Family: $10,000 |
Premiums: PPO = $405/month, HDHP = $5/month
Our family: 4 people, DH and I in our early 30s, two children 5 and 3
Health conditions: 5-year-old is autistic and getting speech therapy, which costs $600/month. This is out-of-network and about $200 is reimbursed by insurance. We pay for the rest out of pre-tax dollars via Healthcare FSA.
This is the only “regular” medical expense for our family, beyond preventive care. Of course with two young children, the occasional office visit is guaranteed to happen (like recently my son got a fungal infection on his big toe :(). My husband also sometimes has minor health problems that he will consult a doctor for.
My concern is that it looks like the in-network and out-of-network deductibles are calculated separately. Will we really save money in the end? The current premiums are paid pre-tax. Or will it depend on whether or not we have significant unforeseen healthcare expenses, like a trip to the ER?
To be honest I'm not even entirely sure how I should go about my calculations. Any help is greatly appreciated.