High-Deductible Health Plan Question

[Hail2Pitt]

My employer is now offering a high-deductible health plan (HDHP) in addition to a traditional health plan. The premium for the HDHP is considerably lower, and also my employer makes a sizeable contribution to an HSA if I go with the HDHP. So, they try to make it very tempting, but I'm not sure I understand which plan is better for my situation.

My family has very large medical bills - I have CF, and my wife and son both have chronic issues as well. Every year, we easily exceed both our deductible and out-of-pocket max. I've always had a traditional plan, but as I compare the two, it appears I may save money by going with the HDHP. With the traditional plan, we get co-paid to death on doctor appointments and prescription drugs after we meet the out-of-pocket max. With the HDHP, it seems that once you hit the out-of-pocket max, you don't pay any coinsurance for either doctor appointments or prescription drugs anymore. So, it appears my costs would actually be $0 once I hit the max, and not $100s to $1000s more due to co-pays.

Does anyone have any experience with this? Since I always hit the out-of-pocket max, I'm not worried about the higher deductible with the HDHP. But, my fear is that I am misunderstanding the plan, and I would continue to pay coinsurance on prescription drugs after hitting the out-of-pocket max. Since I'm used to always paying co-pays, I'm having trouble believing I would pay $0 on prescriptions after hitting the max. If I make a mistake here, it would be really bad for us. For example, if in the near future I'd be able to take Kalydeco, the $50 monthly co-pay with the traditional plan would be doable. But, if I actually had to pay coinsurance on the Kalydeco after hitting the out-of-pocket max, the $30,000 coinsurance would make it cost prohibitive.

Any advice you can provide would be great.

Thanks!

 

[Printer]

Hale 2:

I think that this is a math problem. Compare the total number of co-pays that you (and family) had this year. Add in any hospital co-pays and deductibles, etc. Compare this to the cost factors of the two insurance plans.

With my plan (medicare B) I have chosen to pay the higher premium and no co-pays, it has worked to my benefit over the past several years.

You need to do the math.

Bill

 

[Doglover]

We have a high deductible HSA plan and love it. Once you hit your max (ours is 6000.00) you do not ppay another penny for anything. The only downside is you usually pay 100% of all bills for first 3000.00 or so and then 20% of office visits and a copay until you hit the remaining deductible. You might need to come up with a large amount at beginning of the year, but pay nothing from then. We just plan for it. We usually hit our max in Jan or Feb due to paying full amount of pulmozyme. Our premiums are significantly lower and it is 100% tax deductible . We figure we save 4-5 thousand out of pocket per year.

 

[triples15]

Hi Pitt,

We switched to a HDHP w/HSA a couple years ago. I was just like you, sooooo nervous I was doing the math wrong, or understood the plan wrong. But I took the leap, and it has worked out super well!!

You are reading it correctly that after you've met the out-of-pocket max you will pay ZERO. After filling my Cayston and Pulmozyme in January we met our $3,300 deductible, and were on our way to meeting our $6,600 out of pocket max. Also, I receive assistance from the CFPAF for my those two copays, so a good chunk of our deductible did not come out of our pocket. By March we had met the out of pocket max, and we have paid nothing since. It's really strange to not get ANY bills in the mail, and to pay NOTHING at the pharmacy!

We are definitely saving money doing it this way. I think HDHP are the way for most CFers to go if it's possible to swing the up-front costs.

Let me know if you have any other questions I could help with!

Also, wanted to second what Doglover said, the premiums are MUCH lower, and the contributions to the HSA are not taxed.

Take Care and good luck!

Autumn 33 w/CF

 

[Hail2Pitt]

Thanks all!

It's definitely a simple math problem. But, it seemed the result was too good to be true. With zero costs after the out-of-pocket max, it looks like I'll save quite a bit of money. You all have confirmed that I'm not doing it wrong!

I'm going to take the plunge!

Jim

 

[triples15]

You're welcome Jim! You won't be sorry.

 

[c410berry]

Just to chime in in agreement: We also have a high deductible plan and it has been a great move for us. We usually meet our deductible in January. I heard that last year, the sweet new cashier at the pharmacy felt so bad for us having to pay out of pocket for my daughter's January meds, that after we left, she asked the pharmacist if they should take up a collection for us. The pharmacist, who knows us well, reassured her that the rest of the year, we would have NO copayments! We made the switch because we could not afford the 40% coinsurance on brand meds like Pulmozyme every month on our old plan. Also, this year we have put away enough in our HSA that we are prepared to pay our deductible next January.

 

[LittleLab4CF]

Your HR department is supposed to be able to do the math with employee benefits like health insurance. Health insurance was the first employment incentive we offered when starting our business in 1983. Like most employers, we offered an HMO and a PPO option. the Preferred Provider Offering or PPO is equivelent to your HDHP. On average, younger employees opted for the lower cost and lower benefit HMO while older employees chose the higher premium high deductable PPO.

The two employees that were a shoe in for the PPO were me with CF and our machinist who's daughter was born with osteogenisis imperfecta a medically expensive bundle of love. When employees or their spouses were planning for a child or having just committed parenthood, switched to the higher deductable PPO because of the maternity benefits package. These are trends I see and if insurance is true to form, you may find trade-offs above cost savings, like less time spent getting to the doctor you need.

LL

 

[Beccamom]

We do well with a high deductible health plan. I basically paid m max out of pocket expense with one CF and endocrine appointment. My daughter maxed out our families deductible with one lab work, clinic, medical equipment bill. The rest of the year we pay our high monthly fee and nothing else. We know we will always hit the max out of pocket expense as a family so it works for us. If you don't hit the max out of pocket expense then it may not be the right plan for you. I can only guess most CF patients hit the max of most plans. We even pay quarterly for a supplement and hit the max on that and so we pay $300 a year less even by paying for two insurance plans. The key is what the max is and what it includes such as company's, prescriptions, and durable medical equipment.