New to HSA

[jpdx]

For my ACA exchange coverage, I'm thinking of going with a HSA next year. Can someone provide some clarity on how this works, specifically regarding the benefits listed below? Say I go to the doctor for something minor, and there are no tests or labs, is this office visit really covered for free with no copay? Or do I pay the full contracted cost of the doctor visit? Thanks.

***
Are there services
covered before you meet
your deductible?

Yes. In-network primary care visits,
outpatient diabetes services,
breastfeeding support, pediatric vision
care, and most preventive care, as well as
in and out of network routine nursery care,
and breastfeeding supplies are covered
before you meet your deductible.

This plan covers some items and services even if you haven’t yet met the deductible
amount. But a copayment or coinsurance may apply. For example, this plan covers
certain preventive services without cost-sharing and before you meet your deductible.
***

[BTDretire]

For my ACA exchange coverage, I'm thinking of going with a HSA next year. Can someone provide some clarity on how this works, specifically regarding the benefits listed below? Say I go to the doctor for something minor, and there are no tests or labs, is this office visit really covered for free with no copay? Or do I pay the full contracted cost of the doctor visit? Thanks.

***
Are there services
covered before you meet
your deductible?

Yes. In-network primary care visits, office
visits, urgent care visit, outpatient
rehabilitation, outpatient mental health and
chemical dependency services, outpatient
diabetes services, biofeedback,
breastfeeding support, pediatric vision
exam, and most preventive care...
***

 I'm not sure if you answered your own question or what, but I'm not sure the answer is correct.
First, I'd say it depends on the plan you have.
Second here's a quote from a Healthcare.gov website.
"
Deductible

The amount you pay for covered health care services before your insurance plan starts to pay. With a $2,000 deductible, for example, you pay the first $2,000 of covered services yourself.

After you pay your deductible, you usually pay only a copayment or coinsurance for covered services. Your insurance company pays the rest.

    Many plans pay for certain services, like a checkup or disease management programs, before you've met your deductible. Check your plan details.
    All Marketplace health plans pay the full cost of certain preventive benefits even before you meet your deductible.
    Some plans have separate deductibles for certain services, like prescription drugs.
    Family plans often have both an individual deductible, which applies to each person, and a family deductible, which applies to all family members."

  Some of us that can afford it, just pay out of pocket and don't use our HSA. It is a great tax free savings vehicle.
Save all your deductible medical receipts, later you use those expenses to withdraw tax free income.

[Bourbon]

Typically you are covered for preventative care - i.e. annual checkup - with no deductible.  If you are going because you have a cold - deductible

Everything else runs through the deductible until it is met, and then coinsurance kicks in up to your out of pocked maximum.

For our family and our employer subsidies, when we compare the up-front premium savings to our expected costs, it always makes sense to do the HDHP and max out the HSA.

[jpdx]

You say only preventative care is covered before the deductible, but the language in the 'Summery of Benefits and Coverage' seems to say otherwise. Please take a look:

https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardBronze_SBC_2018_OR.pdf

This is what I find difficult to believe: it seems like the HSA plan has no copay for doctor visits (like colds) whereas the more expensive non-HSA plans all have copays. I love the idea of a HSA an an investment vehicle, bit want to confirm that my interpretation is correct before I take the plunge.

[kudy]

There is no co-pay for a doctor visit because you are paying for the full cost. For example, I have a high deductible plan with a $2000 annual deductible. All medical costs, doctor visits, prescriptions, labs, etc. (except for an annual wellness exam) need to be paid directly by me or out of my health savings account balance, until I've spent $2k in a calendar year. After I've spent $2k, they will cover 80% of the cost, and I am responsible for 20% (up to my out-of-pocket max, which is $4k).

[MDM]

Perhaps the "In-network primary care visits" wording is misleading.  If this coverage really is an HSA-compliant HDHP, by definition it doesn't pay for non-preventive care.  But one needs to understand the definition of preventive care as applied here.

See https://www.irs.gov/pub/irs-pdf/p969.pdf:

An HDHP may provide preventive care benefits without a deductible or with a deductible less than the minimum
annual deductible. Preventive care includes, but isn’t limited to, the following.
1. Periodic health evaluations, including tests and diagnostic procedures ordered in connection with routine
examinations, such as annual physicals.
2. Routine prenatal and well-child care.
3. Child and adult immunizations.

...and it goes on.

I'm guessing that "In-network primary care visits" means routine physicals, but it seems worthwhile for you to call and get specifics from the carrier.

[Bourbon]

You say only preventative care is covered before the deductible, but the language in the 'Summery of Benefits and Coverage' seems to say otherwise. Please take a look:

https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardBronze_SBC_2018_OR.pdf

This is what I find difficult to believe: it seems like the HSA plan has no copay for doctor visits (like colds) whereas the more expensive non-HSA plans all have copays. I love the idea of a HSA an an investment vehicle, bit want to confirm that my interpretation is correct before I take the plunge.

I tried googling for the full legal document backing the plan, but stopped when I found this summary -

https://www.modahealth.com/pdfs/plans/individual/Moda_Beacon_OregonStandardBronze_2018_OR.pdf


Looks a little clearer. If you wanted 110% certainty, call Moda.  There are weird exceptions all over healthcare, but for an HDHP, the list of things that don't go through the deductible is small and set.

[Lanthiriel]

There is no co-pay for a doctor visit because you are paying for the full cost. For example, I have a high deductible plan with a $2000 annual deductible. All medical costs, doctor visits, prescriptions, labs, etc. (except for an annual wellness exam) need to be paid directly by me or out of my health savings account balance, until I've spent $2k in a calendar year. After I've spent $2k, they will cover 80% of the cost, and I am responsible for 20% (up to my out-of-pocket max, which is $4k).

This is consistent with my experience with HSAs.

[jpdx]

Bourbon, thanks for that document. Indeed that is more clear!

I hope I am making the right choice going with a HSA next year. I'm healthy and in my mid 30's. My spouse has different healthcare needs and will be on a Gold plan.

[Bourbon]

Bourbon, thanks for that document. Indeed that is more clear!

I hope I am making the right choice going with a HSA next year. I'm healthy and in my mid 30's. My spouse has different healthcare needs and will be on a Gold plan.

The problem generally is that the only way to make the correct decision is to know what your healthcare needs are for a given year, and we don't have perfect information on that.

A good starting point is to look at all of the plans available to you, and figure out what the premiums will be for the year.  For most employers I've been with, this alone is enough to push me into the HDHP.  I'm starting out $2-$4k ahead of the game, and I know that I generally don't need medical services, and even if I do I expect to be in the <$500 annually on expenses.  There is risk that something major happens and I will be out the deductible and more, but it's unlikely.  In the meantime I max out the HSA and build that up, so that if the day ever comes I'm covered.

Open Enrollment should always involve an excel document.