NWR: Health Insurance Plans

SmileDamnit · November 2014

cupcait927 said:

jenna8984 said:

lolo883 said:

Actually @cupcait927 or anyone who knows more about this than I do... is it possible to withdraw from an FSA (we'll just call it that) for unapproved expenses and just pay the tax penalty? So if we put some money in there and I don't end up procreating before the end of the year, we don't lose it since there's no way we can spend that much on contact solution and acupuncture?

I really don't think so. My dog bite happened in 2012 and I had a stack of medical bills. When I got a new job in 2013, I thought perfect I can do an FSA for $1,000 and pay off some of my bills with it untaxed. The FSA company denied every claim because it wasn't in the coverage period. I was beyond livid and was like but it's medical?! They were like no, the medical didn't happen in our coverage period. So I tried every way in hell to get that $1,000 back and spend it on other things and they wouldn't let me/ denied everything. I had a few co-pays here and there but ended up losing about $800 and I was so pissed.

That's the shitty thing about FSAs. You can only use the funds on expenses that occured within the plan year that you elect the FSA. So if you have an FSA in 2013, you can only use it for service dates within 2013. So even if you don't get the bill until the next plan year, you can't use the FSA to pay it since you didn't incur the service within that plan year. I HATE FSA accounts, unless you have planned monthly expenses like prescriptions or you know you need glasses or your kid needs braces.

Our FSA actually has a grace period of 2 & 1/2 months each year to submit claims (e.g. if I have a 2013 bill come in Feb of 2014, they will still cover it).

cupcait927 · November 2014

@SmileDamnit that's awesome! Some employers are smart and offer the grace period to employees but I know a lot them don't. Any funds that aren't used at the end of the go back to the employer to help offset future healthcare costs, so they're not really incentivized to help employees out.

SmileDamnit · November 2014

cupcait927 said:

@SmileDamnit that's awesome! Some employers are smart and offer the grace period to employees but I know a lot them don't. Any funds that aren't used at the end of the go back to the employer to help offset future healthcare costs, so they're not really incentivized to help employees out.

Is it the employer? We're in enrollment now so I pulled that off of the UHC website. That said, my org does a good job at trying to make it easier on us. They give us $500 in the account each year, then we can add any additional funds we want (up to the $2550 that is currently allowed by the govt for medical expenses). UHC also allows for a $500 rollover from year to year, but since we have fewer than 100 employees it doesn't pertain to us (...which is why I think the company give us the 500 bucks in the first place, to off set that).

cupcait927 · November 2014

@SmileDamnit yes, your employer is generally the decision maker on things like grace periods and rollover amounts. FSAs can be a pain on the employer as well, since all of your FSA dollars are available day one of the plan year. So an employee could spend all $2550 on January 2nd and then quit January 5th and potentially not even have one deduction taken from their paycheck for the account. So then the employer has to eat that $2550. Usually it's a wash at the end of the year with people who didn't spend their full amount, so a lot of employers don't want to offer a grace period to let employees finish spending down their accounts, because then they have less to offset what they could be out due to employees quitting or being fired.

arrippa · November 2014

My FSA is through Wageworks and they have been known to deny deny deny. I did use up all my 2014 money because I ended up buying an expensive pair of glasses. I really want to buy prescription sunglasses next year, so I am trying to figure out how much to allocate to that and to the rest of my expenses. My company does only HSA for health insurance. I am always so confused trying to figure out the differences between the HSA options. I hate benefits enrollment time.

daria24 · November 2014

We had a choice of either a HDHCP or a more traditional PPO. We opted for the high deductible because H's company pays $1200 into your HSA for the employee and $600 for the spouse. Our total deductible is $4000 so that extra $2200 we would possibly have to pay evens out to basically the higher cost of the PPO.

Our yearly physicals and my yearly pap were 100% covered, and my BC doesn't have a copay. I did end up having to go to the orthopedist for x-rays/exam. With a HDHCP you pay the insurance's negotiated rate for the doctor, not the full amount. So for my orthopedist, the initial claim submitted by my doctor was over $800. But the negotiated rate was under $200 (I fucking hate this system, it's so dumb). The x-rays alone were billed for $150 but negotiated for $59.90. So thankfully those HSA dollars pay for that bill.

If I was TTC/pregnant though I don't think I would chose the HDHCP. There's too many variables, too much that could potentially go wrong that would require you to need more care.

alpacalunch · November 2014

All this thinking and calculating in this thread makes me extra glad to be Canadian.

sarahufl · November 2014

daria24 said:

We had a choice of either a HDHCP or a more traditional PPO. We opted for the high deductible because H's company pays $1200 into your HSA for the employee and $600 for the spouse. Our total deductible is $4000 so that extra $2200 we would possibly have to pay evens out to basically the higher cost of the PPO.

Our yearly physicals and my yearly pap were 100% covered, and my BC doesn't have a copay. I did end up having to go to the orthopedist for x-rays/exam. With a HDHCP you pay the insurance's negotiated rate for the doctor, not the full amount. So for my orthopedist, the initial claim submitted by my doctor was over $800. But the negotiated rate was under $200 (I fucking hate this system, it's so dumb). The x-rays alone were billed for $150 but negotiated for $59.90. So thankfully those HSA dollars pay for that bill.

If I was TTC/pregnant though I don't think I would chose the HDHCP. There's too many variables, too much that could potentially go wrong that would require you to need more care.

So, H's is sort of similar. The premium is about $40/month for the 2 of us but his employer gives them $3,000 into the HSA. The deductible is something like $3600.

We used the care calculator thing and the total out of pocket (even with pregnancy factored in) was far less with the HDHCP than with the regular PPO. It was contrary to what I thought, hence the post.

daria24 · November 2014

sarahufl said:

daria24 said:

We had a choice of either a HDHCP or a more traditional PPO. We opted for the high deductible because H's company pays $1200 into your HSA for the employee and $600 for the spouse. Our total deductible is $4000 so that extra $2200 we would possibly have to pay evens out to basically the higher cost of the PPO.

Our yearly physicals and my yearly pap were 100% covered, and my BC doesn't have a copay. I did end up having to go to the orthopedist for x-rays/exam. With a HDHCP you pay the insurance's negotiated rate for the doctor, not the full amount. So for my orthopedist, the initial claim submitted by my doctor was over $800. But the negotiated rate was under $200 (I fucking hate this system, it's so dumb). The x-rays alone were billed for $150 but negotiated for $59.90. So thankfully those HSA dollars pay for that bill.

If I was TTC/pregnant though I don't think I would chose the HDHCP. There's too many variables, too much that could potentially go wrong that would require you to need more care.

So, H's is sort of similar. The premium is about $40/month for the 2 of us but his employer gives them $3,000 into the HSA. The deductible is something like $3600.

We used the care calculator thing and the total out of pocket (even with pregnancy factored in) was far less with the HDHCP than with the regular PPO. It was contrary to what I thought, hence the post.

Hmm given the employer HSA contribution/your deductible, the only other thing I would research is whether your OBGYN/hospital is in network or out of network, and how that would affect your costs. And if there is a difference in coverage for things like birthing centers, midwives, etc. Most of your out of pocket expenses come from lab tests, so you should look into that coverage as well. My old PPO covered all but a few dollars of blood work, whereas I get hit for a pretty high amount by my HDHCP.

theartistformerlyknownas · November 2014

daria24 said:

sarahufl said:

daria24 said:

We had a choice of either a HDHCP or a more traditional PPO. We opted for the high deductible because H's company pays $1200 into your HSA for the employee and $600 for the spouse. Our total deductible is $4000 so that extra $2200 we would possibly have to pay evens out to basically the higher cost of the PPO.

Our yearly physicals and my yearly pap were 100% covered, and my BC doesn't have a copay. I did end up having to go to the orthopedist for x-rays/exam. With a HDHCP you pay the insurance's negotiated rate for the doctor, not the full amount. So for my orthopedist, the initial claim submitted by my doctor was over $800. But the negotiated rate was under $200 (I fucking hate this system, it's so dumb). The x-rays alone were billed for $150 but negotiated for $59.90. So thankfully those HSA dollars pay for that bill.

If I was TTC/pregnant though I don't think I would chose the HDHCP. There's too many variables, too much that could potentially go wrong that would require you to need more care.

So, H's is sort of similar. The premium is about $40/month for the 2 of us but his employer gives them $3,000 into the HSA. The deductible is something like $3600.

We used the care calculator thing and the total out of pocket (even with pregnancy factored in) was far less with the HDHCP than with the regular PPO. It was contrary to what I thought, hence the post.

Hmm given the employer HSA contribution/your deductible, the only other thing I would research is whether your OBGYN/hospital is in network or out of network, and how that would affect your costs. And if there is a difference in coverage for things like birthing centers, midwives, etc. Most of your out of pocket expenses come from lab tests, so you should look into that coverage as well. My old PPO covered all but a few dollars of blood work, whereas I get hit for a pretty high amount by my HDHCP.

Make sure the lab they use is in-network too. My OB/GYN is in-network, but uses an out of network lab so I had to pay a bit more for some biopsy stuff. I really like my doc though so it wasn't worth switching.

SmileDamnit · November 2014

lolo883 said:

daria24 said:

sarahufl said:

daria24 said:

We had a choice of either a HDHCP or a more traditional PPO. We opted for the high deductible because H's company pays $1200 into your HSA for the employee and $600 for the spouse. Our total deductible is $4000 so that extra $2200 we would possibly have to pay evens out to basically the higher cost of the PPO.

Our yearly physicals and my yearly pap were 100% covered, and my BC doesn't have a copay. I did end up having to go to the orthopedist for x-rays/exam. With a HDHCP you pay the insurance's negotiated rate for the doctor, not the full amount. So for my orthopedist, the initial claim submitted by my doctor was over $800. But the negotiated rate was under $200 (I fucking hate this system, it's so dumb). The x-rays alone were billed for $150 but negotiated for $59.90. So thankfully those HSA dollars pay for that bill.

If I was TTC/pregnant though I don't think I would chose the HDHCP. There's too many variables, too much that could potentially go wrong that would require you to need more care.

So, H's is sort of similar. The premium is about $40/month for the 2 of us but his employer gives them $3,000 into the HSA. The deductible is something like $3600.

We used the care calculator thing and the total out of pocket (even with pregnancy factored in) was far less with the HDHCP than with the regular PPO. It was contrary to what I thought, hence the post.

Hmm given the employer HSA contribution/your deductible, the only other thing I would research is whether your OBGYN/hospital is in network or out of network, and how that would affect your costs. And if there is a difference in coverage for things like birthing centers, midwives, etc. Most of your out of pocket expenses come from lab tests, so you should look into that coverage as well. My old PPO covered all but a few dollars of blood work, whereas I get hit for a pretty high amount by my HDHCP.

Make sure the lab they use is in-network too. My OB/GYN is in-network, but uses an out of network lab so I had to pay a bit more for some biopsy stuff. I really like my doc though so it wasn't worth switching.

This x100! My OB does use an in network lab facility, but I did the MateriniT21 test because of my "advanced maternal age" (e.g. 35+) and it was considered out of network and ended up costing me nearly $1600 out of pocket.

princessleia22 · November 2014

The best type of plan really depends on your medical needs and what how good you are at saving. I always thought deductible plans were stupid... until I actually sat down and assessed how each type of plan affected me. I have chronic back problems, so I have had to look into my options more thoroughly than most people. A few years ago my back was worse and required more treatment than it currently does. At that time, my plan had a $1500 deductible, which I would meet in about 6 months. So, I initially put $1500 in my HSA and then put in $125 each month all year, so at the beginning of the year my HSA balance was back to $1500. So that covered my deductible cost, and any higher cost treatments or tests would be covered 100% after deductible. And it didn't hurt as much since I spread that cost out through the year. So, yes, I had to pay out of pocket for that first $1500, but I knew that my max. out of pocket costs would be my monthly premiums + $1500... no matter what happened, I'd never pay more than that. My meds at that time were pretty expensive, so if I went with a copay plan, my monthly doctor visits and meds would cost me over $100/month anyway. Plus, I'd have additional copays and costs for additional tests and treatments, so costs could easily get higher than what I would pay with a deductible plan. And worse case scenario, if something big happens at the beginning of the year, I knew it would only cost me $1500 at most and I had that money in my HSA. And I like knowing that I will never have to pay more than that.

DH has a similar plan with $5000 deductible. He has never goes to doctor (even if he should) so very few medical expenses for him. He would never come close to his deductible with normal preventative care costs, so anything like that would be out of pocket. But, typical doctor appointment is maybe $50-70 so we can afford that once a year or whatever. But, it would cost us more for higher premiums on copay plan that what it costs to pay the rare out-of-pocket expenses toward his deductible. Really, his coverage is more for if something big were to happen or a major illness. If there were big expenses, we would have to pay the first $5k, but that's better than $50k or more, and within a range that should be possible to pay.

My big thing with choosing insurance is that I don't want a coinsurance (where you are responsible for 10%-20% of all bills). About 12 years ago I had surgery, which resulted in infection and multiple surgeries... totaling over $500,000 in medical bills. Luckily I had 100% coverage at the time. But if I had a 20% coinsurance, which is very common, that would have meant $100k that I would have been responsible for. DH had cancer many years ago and had 20% coinsurance and just never paid the medical bills, because it would have been impossible to do so. It's a lot easier and more affordable to find no coinsurance with high deductible plans. If nothing big happens, which many people live their whole lives without big medical emergencies, then coinsurance isn't really a problem, but if there is a big incidence, it can be devastating and stressful to see those high value bills in the mail. And I'd hate to be in a situation where they deny treatment because we can't afford the coinsurance. So, I'd rather not risk that one and would rather have higher deductible or premium and know that I have 100% coverage.

But, really, determining the best plan for you depends on your situation and history. Add up total cost of what your typical medical expenses are. Say if you go to doctor twice a year, add the copays you would pay, coinsurances, prescription costs, etc... then add what total cost would be of premiums + deductible if you went with that plan... which one has total cheaper cost? Also look at coverage of each. Do you have family or personal history of certain problems (mental illness, heart problems, cancer, etc.), which plan provides better coverage if those happen to you? And look at how good you are at saving money. Are you the type that can put aside and save deductible money without touching it? If something big happened in January, could you come up with the full deductible payment at once? I had this discussion with my sister when she was choosing a medical plan. She decided that copay was best because she didn't want to take the chance of not having the deductible money available when needed, even if total overall cost was more. She just felt more comfortable with a copay plan. Each type of plan has pros and cons and neither works for everyone.

With pregnancy, you have to expect that there will be high expenses (even just standard hospital cost). So, if you went with a deductible plan, you would have to plan on paying the whole deductible amount. But, you also would know that any costs after that deductible are 100% covered, which is good if there are complications or something like that. But, most people saying to avoid deductible plans for pregnancy is probably a result of knowing that you will likely have to pay that whole deductible cost. And taking that into account, a copay plan with good maternity coverage may be better in that case if the deductible is really high.

NWR: Health Insurance Plans

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