CareFirst HDHP — what am I missing?

[Anonymous]

Anonymous wrote:We’re on Carefirst HDHP and it’s been great. It is a little bit of an adjustment when you first start getting bills for pediatrician visits and stuff (though preventative care is still totally free), but the math works out way in your favor. We’ve been on it for 3 years and have I think $21k or so in our HSA, and we’ve paid less in healthcare costs (premium+deductible) than we would have paid only for the premiums on the standard plan.

NP and I just want to note that the bolded is not always straightforward. We have BCBS Basic and, in theory, wellness visits are free / no copay. However, if they do anything beyond an extremely limited set of procedures we get hit with a co-pay and, presumably, if we had a HDHP it would be a separate charge. It's probably not a big deal for older kids that don't go to the doctor very often but for really young kids those charges can add up. Also, COVID-related stuff is supposed to be free as well, but it's the same deal where if they do anything beyond a very limited set of procedures we get hit with a co-pay. As just one example, we took our youngest for a COVID test and it turns out she had RSV. Obviously you want to know when something is wrong so I'm not complaining about the co-pays but just something to be aware of if you choose an HDHP.

[Anonymous]

I've found GEHA HDHP comparable, if not better, than CareFirst HDHP. Only paying 5% of any costs after the deductible is fantastic. We're a family of 5 and I don't think we've ever paid more than a couple hundred out of pocket after the deductible, if we meet the deductible at all for the year. Definitely have come ahead financially vs BCBS Basic. And we don't get dental since GEHA covers basic preventative stuff and necessary oral surgery (though we'll pick up dental once the kids need braces...). Same with vision; no need for a separate policy since GEHA has good vision coverage that covers frames and lens or contacts and there is no need for added coverage.

[Anonymous]

I have a Cigna HDHP (not fed), I meet the deductible every year, and I still come out ahead. People pay a lot for the privilege of paying co-pays. Having to pay the full amount makes you a better healthcare consumer for the things you can control (although out of network trickery is in every plan it seems). Always worth running the numbers (including HSA tax benefits) to see if it would work for your situation.

[Anonymous]

I am on a BCBS HDHP via a private employer. The deductible plus premiums are in my case not far off of the premiums for my regular co-pay plan option. But it still makes sense because of (1) the tax benefits of the HSA, (2) my portion of my doctor and lab bills after the deductible is inevitably much smaller than the co-pay would have been, and (3) I’m on a pricey med with a manufacturer’s coupon the covers out of pockets. The plan counts the manufacturer’s coupon towards my deductible! So if I minimize other expenses the first couple of months of the year (front load other prescriptions to December, no regular checkups/appointments until March) I never pay my deductible at all. Feels like a scam but given how the insurance companies are always trying to minimize their costs on our backs I don’t feel guilty about it.

[Anonymous]

I would be all for the HDHP if there was any price transparency in the healthcare market. There is so much f*ckery that goes on behind the scenes it is extremely difficult to understand what your costs will be.

[Anonymous]

Anonymous wrote:I would be all for the HDHP if there was any price transparency in the healthcare market. There is so much f*ckery that goes on behind the scenes it is extremely difficult to understand what your costs will be.

I don't think the price transparency problem impacts HDHP participants more than PPO participants. What something costs and whether or not it is covered is a function of the Plan/agreement itself (i.e. BCBS' T&C with your company). How much you pay is what is defined by HDHP vs PPO. If you pay more for a particular service, you meet the annual limit sooner.

[Anonymous]

Informative discussion. But it does highlight how complicate insurance and insurance decision-making is in the US. Some years when I had to compare all my open enrollment choices to my DH's options that I wished i could tap an advisor to help run the numbers and long-term impact. It shouldn't be so hard.

[Anonymous]

Anonymous wrote:Informative discussion. But it does highlight how complicate insurance and insurance decision-making is in the US. Some years when I had to compare all my open enrollment choices to my DH's options that I wished i could tap an advisor to help run the numbers and long-term impact. It shouldn't be so hard.

OP here and I totally agree that the problem is the entire US health insurance industry. The amount of time and effort I put in to figuring out what makes the most FINANCIAL since for my family’s HEALTH is ridiculous. But since I’m not moving to Europe anytime soon and since we don’t have single payer, I grit my teeth and come here for the wisdom of the DCUM financial crowd. Thanks again, everyone, for chiming in with your experiences.

[Anonymous]

^^^^ sense, not since

[Anonymous]

Anonymous wrote:

Anonymous wrote:I've had it for the past 2 years and am switching to GEHA standard as I am hoping for a more straightforward plan.

I felt like I've had to pay a lot out of pocket even after the deductible. Some of it could be because I had imaging done and the radiologist ended up being out of network which is annoying. For example, I got an MRI at Sibley and the imaging was covered but not the radiologist's fees. A mammogram that was diagnostic not preventive was not covered.

That's a function of the Insurance agreement and not the plan. For example, my company has BCBS PPO and HDHP offerings. The network and rules are exactly the same. However, the deductible and copay for covered services are different. If I was in the same boat as you, BCBS would not have covered the radiologist or the mammogram in both plans. Check the rules.

Right, I should have done my due diligence. One of the reasons I'm switching to GEHA standard though is that they will cover out of network (a percentage of) after the $700 deductible. The GEHA HDHP has an out of network deductible of $6000, similar to Carefirst's. I have 2 doctors that don't accept insurance and for situations like the MRI situation, I think GEHA standard will be better for me.

[Anonymous]

Anonymous wrote:I thought most feds have BCBS basic. Seems like that’s the smartest plan for young, relatively healthy families

So BCBS Standard was the smart plan for the young when my parents were young. Then they got old, stayed with the same plan and the premiums shot up so it was no longer the best. BCBS Basic was the smart plan for the young when I was young. Premiums have been shooting up and it’s no longer the best and will get worse and worse the next few years.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I would be all for the HDHP if there was any price transparency in the healthcare market. There is so much f*ckery that goes on behind the scenes it is extremely difficult to understand what your costs will be.

I don't think the price transparency problem impacts HDHP participants more than PPO participants. What something costs and whether or not it is covered is a function of the Plan/agreement itself (i.e. BCBS' T&C with your company). How much you pay is what is defined by HDHP vs PPO. If you pay more for a particular service, you meet the annual limit sooner.

PP here and it seems like it does impact HDHP more if you're paying the entire cost to meet your deductible vs a $30 copay regardless of cost. Also, that's not really true about what determines how much something costs. WSJ did a piece on this a while back and health care providers will use different codes with different insurance providers for the same procedure to maximize the reimbursement from insurance so the cost of your procedure is going to vary depending on how they code it.

[Anonymous]

^edit: I guess if you are planning to meet the annual limit this doesn't matter but if you want to shop services and stay under the limit it does. Perhaps if the price of the HDHP even after meeting the annual limit is still cheaper than the PPO plan it also doesn't matter.

[Anonymous]

NP. I’m thinking ahead to 2023 and have a few related questions about CareFirst HDHP that I hope someone can answer:

— Is the preferred provider network the same as for BCBS Standard and Basic?

— For married couples who want to max out your pre-tax contributions, how do you do it? Do both spouses have HSAs, or just the subscriber?

[Anonymous]

Anonymous wrote:NP. I’m thinking ahead to 2023 and have a few related questions about CareFirst HDHP that I hope someone can answer:

— Is the preferred provider network the same as for BCBS Standard and Basic?

— For married couples who want to max out your pre-tax contributions, how do you do it? Do both spouses have HSAs, or just the subscriber?

I'm not a Fed but can answer your second question. We split the HSA between us although the insurance itself is with the spouse. HSAs are not a shared account and need to be maintained individually so we thought we'd do it this way. Note that HSA is a pre-tax deduction and you'd end up paying less Medicare tax if deducted through payroll. If that's important to you, make sure the HSA deduction comes out of the paycheck of the spouse that carries the Insurance.