High Deductible Health Insurance Plan

[Anonymous]

Apologies if this is not the right forum, but ultimately I'm looking for financial advice.

I am switching jobs and looking at the new health benefits. I am currently a fed, and my family is on my plan (BCBS basic). I would prefer a plan that allows both in and out of network, which is one of the options. That has the highest bi-weekly employee contribution. The high deductible plan is a lower bi-weekly payment, and of course, a higher deductible. My current insurance has no deductible, so I'd love some advice in how to make this choice.

We're relatively healthy, I go to a primary care physician, dermatologist, and gynocologist. Kids have a regular pediatrician, a fairly typical amount of sick visits, and each have seen specialists for discreet issues but nothing long term.

Any thoughts or advice is welcome! It's hard to leave the benefits provided by federal service.

[Anonymous]

Anonymous wrote:Apologies if this is not the right forum, but ultimately I'm looking for financial advice.

I am switching jobs and looking at the new health benefits. I am currently a fed, and my family is on my plan (BCBS basic). I would prefer a plan that allows both in and out of network, which is one of the options. That has the highest bi-weekly employee contribution. The high deductible plan is a lower bi-weekly payment, and of course, a higher deductible. My current insurance has no deductible, so I'd love some advice in how to make this choice.

We're relatively healthy, I go to a primary care physician, dermatologist, and gynocologist. Kids have a regular pediatrician, a fairly typical amount of sick visits, and each have seen specialists for discreet issues but nothing long term.

Any thoughts or advice is welcome! It's hard to leave the benefits provided by federal service.

We’ve had a high deductible for about 10 years. It is a huge mental adjustment to constantly be out of pocket for all healthcare that isn’t preventative. We save more in premiums than we typically spend, but it still stinks. Rx drugs have surprisingly been mostly affordable (other than epinephrine) but doctor visits are typically $120-$150 and that’s assuming they don’t do some sort of minor procedure.

Happy to answer more detailed questions you have.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Apologies if this is not the right forum, but ultimately I'm looking for financial advice.

I am switching jobs and looking at the new health benefits. I am currently a fed, and my family is on my plan (BCBS basic). I would prefer a plan that allows both in and out of network, which is one of the options. That has the highest bi-weekly employee contribution. The high deductible plan is a lower bi-weekly payment, and of course, a higher deductible. My current insurance has no deductible, so I'd love some advice in how to make this choice.

We're relatively healthy, I go to a primary care physician, dermatologist, and gynocologist. Kids have a regular pediatrician, a fairly typical amount of sick visits, and each have seen specialists for discreet issues but nothing long term.

Any thoughts or advice is welcome! It's hard to leave the benefits provided by federal service.

We’ve had a high deductible for about 10 years. It is a huge mental adjustment to constantly be out of pocket for all healthcare that isn’t preventative. We save more in premiums than we typically spend, but it still stinks. Rx drugs have surprisingly been mostly affordable (other than epinephrine) but doctor visits are typically $120-$150 and that’s assuming they don’t do some sort of minor procedure.

Happy to answer more detailed questions you have.

Just so I'm clear, are you paying out of pocket for regular annual physicals? Or just all the other doctors' appointments that pop up in between? With little kids those are a lot.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Apologies if this is not the right forum, but ultimately I'm looking for financial advice.

I am switching jobs and looking at the new health benefits. I am currently a fed, and my family is on my plan (BCBS basic). I would prefer a plan that allows both in and out of network, which is one of the options. That has the highest bi-weekly employee contribution. The high deductible plan is a lower bi-weekly payment, and of course, a higher deductible. My current insurance has no deductible, so I'd love some advice in how to make this choice.

We're relatively healthy, I go to a primary care physician, dermatologist, and gynocologist. Kids have a regular pediatrician, a fairly typical amount of sick visits, and each have seen specialists for discreet issues but nothing long term.

Any thoughts or advice is welcome! It's hard to leave the benefits provided by federal service.

We’ve had a high deductible for about 10 years. It is a huge mental adjustment to constantly be out of pocket for all healthcare that isn’t preventative. We save more in premiums than we typically spend, but it still stinks. Rx drugs have surprisingly been mostly affordable (other than epinephrine) but doctor visits are typically $120-$150 and that’s assuming they don’t do some sort of minor procedure.

Happy to answer more detailed questions you have.

Just so I'm clear, are you paying out of pocket for regular annual physicals? Or just all the other doctors' appointments that pop up in between? With little kids those are a lot.

No. Physicals and shot-only visits are free. But you pay anytime you need to be seen for a “reason.” Ie: your kid needs antibiotics for strep throat. You need the Derm to freeze a wart. Etc.

[Anonymous]

I have a high deductible plan. For example, I just paid a $25 co pay for a sick visit and will probably get a bill for about $100 for taking my kid in for a sick visit and flu/strep test. They give you the insurance rate, but then you pay the difference. It's not free by any means like you are probably used to. Out of network I pay the whole thing.
If I submitted my therapy bills, which are $230 a week, I would get $0 back, and only about $70 each time goes toward deductible.
Took my kid to physical therapy, they charged my insurance about $400 for basically doing nothing, and I was responsible for $150. It's such a racket.

[Anonymous]

OP, I am the first PP. You have to look at how much the HDHP saves per month in premiums (for us it is a lot; several hundred dollars per month) and if you think that savings will outweigh your out of pocket costs. For us it always has. You also have to weigh if you have the cash flow to fund the out of pocket expenses unexpectedly.

Ironically it seems people with less money want the more expensive plans, because they don’t want surprises financially. We have always come out ahead on the year; but some months we have to outlay a decent amount of money.

[Anonymous]

Anonymous wrote:OP, I am the first PP. You have to look at how much the HDHP saves per month in premiums (for us it is a lot; several hundred dollars per month) and if you think that savings will outweigh your out of pocket costs. For us it always has. You also have to weigh if you have the cash flow to fund the out of pocket expenses unexpectedly.

Ironically it seems people with less money want the more expensive plans, because they don’t want surprises financially. We have always come out ahead on the year; but some months we have to outlay a decent amount of money.

Yes our choices are really only HDHPs and then you have the more expensive ones that are more PPOs and give you more freedom of Provider Choice. So for some folks the HD is the given and you just decide how much you want to pay based on how restricted you are with providers and out of network provider surprises.

[Anonymous]

Anonymous wrote:Apologies if this is not the right forum, but ultimately I'm looking for financial advice.

I am switching jobs and looking at the new health benefits. I am currently a fed, and my family is on my plan (BCBS basic). I would prefer a plan that allows both in and out of network, which is one of the options. That has the highest bi-weekly employee contribution. The high deductible plan is a lower bi-weekly payment, and of course, a higher deductible. My current insurance has no deductible, so I'd love some advice in how to make this choice.

We're relatively healthy, I go to a primary care physician, dermatologist, and gynocologist. Kids have a regular pediatrician, a fairly typical amount of sick visits, and each have seen specialists for discreet issues but nothing long term.

Any thoughts or advice is welcome! It's hard to leave the benefits provided by federal service.

Max out any HSA offered with it and it can work. Just be sure no one has any chronic health needs as you will probably be out of pocket for nearly everything (which is what you use the HSA for).

[Anonymous]

Anonymous wrote:I have a high deductible plan. For example, I just paid a $25 co pay for a sick visit and will probably get a bill for about $100 for taking my kid in for a sick visit and flu/strep test. They give you the insurance rate, but then you pay the difference. It's not free by any means like you are probably used to. Out of network I pay the whole thing.
If I submitted my therapy bills, which are $230 a week, I would get $0 back, and only about $70 each time goes toward deductible.
Took my kid to physical therapy, they charged my insurance about $400 for basically doing nothing, and I was responsible for $150. It's such a racket.

What’s the racket, exactly? Who are you to say a physical therapist “basically” does “nothing?” If you have a shitty PT change … but that’s not a “racket” or even an insurance issue.

[Anonymous]

Anonymous wrote:OP, I am the first PP. You have to look at how much the HDHP saves per month in premiums (for us it is a lot; several hundred dollars per month) and if you think that savings will outweigh your out of pocket costs. For us it always has. You also have to weigh if you have the cash flow to fund the out of pocket expenses unexpectedly.

Ironically it seems people with less money want the more expensive plans, because they don’t want surprises financially. We have always come out ahead on the year; but some months we have to outlay a decent amount of money.

+1 Agree. We've had one for the past 15 years because I crunched the numbers. Yes, we pay full price for doctors visits. Last year was the first year we hit the deductible because DH had some medial stuff at 59. Never had dental insurance because it's always more expensive. I think a pp said it's a mental shift, and I agree. Lately CVS has been advising me if I should go through ins or not. They said the colonoscopy prep was much cheaper off ins, so I didn't put it through because we probably won't meet our deductible anyhow.

[Anonymous]

First of all, Basic is one of the best health plans out there, well, after Standard. They are expensive for a reason. You have excellent coverage and you pay little during DR visits. Surgeries and such are also covered quite quell. In the same boat, so totally understand what it means to leave such a plan. Sorry you have to go through this.

If you know your medical services utilizations then it is easier to do the math about high-deductible plans. Say for Basic you pay 500 premiums per month. Then 6K per year. There is still some out-of-pocket, but a dr visit is 20 or 30 for specialist vs. paying the full price - 150-400 per visit depending on the type of specialist. So let's say you pay 1000 extra out of pocket for annual medical services for the Basic - it comes to about 7K total out of pocket.

High-Deductible Plan would be say 200 per month. So 2400 per year. But you have 4000 deductible. This means, you will be paying 4000 out of pocket (excluding any preventative services). Since Obamacare, all preventative is FREE for high-deductible plans. Annual Physical is free, but the blood work you will have to pay out of pocket - some blood works go 500-600 out of pocket. Especially watch out these Vitamin D tests. So, if you manage to spend up to 4000 out of pocket for the year, and then 2400 cost, you are 6400 vs. 7000 for the Basic. If you spend more than 4000, then you get lower costs - you will be paying typically only 30-40% of the service fee. So office visit is 80 and not 200 after you hit deductible. Companies have all sorts of hoops what qualifiers against deductible. Especially under a Family Plan. You have to make sure 4000 deductible is for the full family and not for a single member on the plan.

Biggest issue is paying upfront and full price until you reach the deductible. If you have kids then a visit to PM Pediatrics for example is 140 on a high-deductible plan vs. 25 on Basic. However, if you are relatively health and do not use medical services, high-deductible plans work well. You pay for what you use and pay a much lower monthly premium. I am not 100% sure how high-deductible will work if you need surgeries and hospitalizations. You will need to read all brochures and details.

In short, when you decide, try to make annual out of pocket comparisons to the best of your knowledge. Most plans have in-network and out-of-network coverage. When I was on a BCBS high-deductible plans, network was the same as on an older PPO plan. You can check networks on each company website - use the Find a Doctor search usually.

[Anonymous]

I had a high deductible HSA compatible plan and really loved it: could invest in stock market (still have a lot in there, usually doing great though obviously not right now!), pay with HSA card so it psychologically felt better and I dreaded expenses less, liked that they were separate. I'd recommend that if available to you.

[Anonymous]

The best part is the health savings account, which, if you save and don't spend the money in the account, can be another vehicle for retirement savings.

And it's "triple tax advantaged"

1. Contributions go into the HSA tax-free. If you make contributions through payroll deductions, they are also not subject to Social Security or Medicare taxes.

2. You can invest that money and enjoy tax-free growth potential.

3. Withdrawals for qualified health expenses don’t incur taxes.

DH and I are in our late 50's, and we have >$200,000 if our HSA.

[Anonymous]

Something to watch out for is that certain hospitals (especially teaching hospitals that serve a lot of highly needy patients) really squeeze insured patients to make up for all the free care they provide. If you have a standard insurance, it can be totally fine—the hospital is in network and so I don’t pay any more than I would anywhere else. But if you have a HDHP, you are going to be paying a lot more of the jacked up prices.

I agree that HDHP can be cost effective if you keep in mind the premium savings. But you do have to be cognizant of healthcare prices with them (which is by design).

[Anonymous]

HDHP is almost always a better deal, but you have to get used to shelling out money knowingly vs. it all being taken out of your paycheck without you paying attention.