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For the HSA, deductible is $5K, which company will pay $4K.
$310 monthly out of paycheck
In network: Co-insurance 80%
office visit 20%
specialist visit 20%
For PPO,
$1500 annual deductible
$640/month out of paycheck
co-insure: 80%
office visit: $20 copay
specialist: $20 copay
ED, outpt surgery and lab/Xray is the same for both.
2 little kids with allergies, etc who seem to visit the Dr moderate to often.
For the HSA, deductible is $5K, which company will pay $4K.
$310 monthly out of paycheck
In network: Co-insurance 80%
office visit 20%
specialist visit 20%
For PPO,
$1500 annual deductible
$640/month out of paycheck
co-insure: 80%
office visit: $20 copay
specialist: $20 copay
ED, outpt surgery and lab/Xray is the same for both.
2 little kids with allergies, etc who seem to visit the Dr moderate to often.
Any advice?????
Either way the health insurance system is fleecing you. But, option one is best.
It depends upon how good the HSA network is in your area. If you are in relatively good health and the network has all the providers you use, then it's best but if you have to go outside the network, they may not pay a penny.
Which is best is going to depend, as Linda pointed out, on whether your doctors are in-network or not. You will also need to know how much their charges are for an office visit.
This is a new job -- are you also in a new location? Or the same location, with the same doctors and the same hospital (the second will be easier, as you already have physicians that you know).
Sit down with your records from last year. Make a chart to compare the two different coverage options. Use that as your starting point for comparisons. Think through the healthcare your family used last year. If you'd had the HSA, how much would you have spent? Now, put the same appointments through the HMO option. Which is better? Is there any upcoming medical costs that you KNOW you'll have that you did't have in 2014? For example, if a family member is going to need elective surgery this year? Or if you are planning another child.
How often did your children go to the doctor? Did they need to see any specialists? Pull out the Explanation of Benefits from their 2015 doctor visits. How much did the doctor charge? Also look at what the negotiated fee was (this is the amount that the insurance company negotiated with the doctor)? The HSA says that you'll need to pay 20% of that. How much would that be if your family had had the HSA last year?
Do either of these plans have in-network and out-of-network hospitals? Is the hospital that you'd choose to use for your family in-network for either of them?
Are you or any family members taking any medications? Check with each plan to see if the medications are Tier 1 or Tier 2 medications. Some plans have higher copayments for medications, depending on which drugs are preferred, which are on different tiers. Are any of the brand name medications your family needs not covered on either coverage?
What are the out of pocket maximums for both plans. Are they with the same carrier, if so, the network is usually the same. With the information you provided, the second plan is going to cost you $3960/year more just in premiums and $500 more in your deductible....unless the OOP max is significantly more than that, plan 1 is a no-brainer.
It depends upon how good the HSA network is in your area. If you are in relatively good health and the network has all the providers you use, then it's best but if you have to go outside the network, they may not pay a penny.
HSA is a bank account, not a network. I think you are thinking of an HMO.
If #1 (the HSA) is an HMO, then I would go with #2 which is the PPO.
I had bad prior experiences when on an HMO and I swore that I would never, ever choose an HMO again unless it was the only option available. With HMO, you have to get a referral by your main doctor (primary doctor) in order to see any other doctors.
I was traveling and needed to see a doctor. I had to call my primary care doctor to get approved. The doctors office had constant busy signal or VM even during working hours. I spent hours trying to contact the primary care doctor for approval. When I finally got through, the nurse had to check with the doctor and then I was stuck waiting several more hours for a return call. This was in a hotel room. They finally got back to me and told me I didn't get approval to go to another doctor or another facility and had to return home to see the primary care doctor.
Also on the HMO in my case, the primary care doctors on the list had way too many paitents. Each visit to the primary care doctor resulted in at least a 2 hour wait. The office was full of patients all waiting for a long time.
I contacted the HMO provider to inquire about the long wait times. Ends up the doctors are paid a monthly fee for each patient, whether they see them or not. The more patients the doctor accepts, the more money they make. The HMO didn't set a limit and they didn't care how many patients the doctor took or how long the wait time.
I was able to switch primary care doctors mid-year but only in the new month and had to follow a process to switch doctors. I switched doctors and the new ones also had waiting rooms full of patients and several hour wait times even when you had an appt. After switching to several different doctors, the next year I switched back to a PPO. Never again will I choose an HMO if a PPO is available. The HMO that I had was a good insurance plan - employer provided via a Fortune 10 corporation.
My two littles seem to visit the Dr on a semi-regular basis. We just went in this Sat for an ear infection, obviously very common.
So, my OOP expenses toward my current deductible in 2015 were approx. $3800. That's with an FSA plan where the company contributes $1000/yr and I have an annual deductible of $6000. There was only 1 urgent care visit and one minor outpatient procedure in 2015 (knock on wood).
So, with my current plan, I spent $320/month out of paycheck ($3840/yr) and about $3800 OOP -$1000 employer contribution= $6640 total.
With new employer's plan, assuming a 5% increase in my OOP expenditures.
Option 1: $3720 out of paycheck + $1000 OOP (company contributes $4000 to the $5000 deductible). So, $4720 OOP before expenses covered.
Option 2: $7680 out of paycheck, $1500 deductible OOP + office/specialty copay $20.= $9180 before any office visits outside of deductible.
If nothing else, with all else being almost equal, it will definitely save me some money over my current employer's plan, right?
Can anyone follow that...? Am I calculating/analyzing that correctly? Thanks....
My two littles seem to visit the Dr on a semi-regular basis. We just went in this Sat for an ear infection, obviously very common.
So, my OOP expenses toward my current deductible in 2015 were approx. $3800. That's with an FSA plan where the company contributes $1000/yr and I have an annual deductible of $6000. There was only 1 urgent care visit and one minor outpatient procedure in 2015 (knock on wood).
So, with my current plan, I spent $320/month out of paycheck ($3840/yr) and about $3800 OOP -$1000 employer contribution= $6640 total.
With new employer's plan, assuming a 5% increase in my OOP expenditures.
Option 1: $3720 out of paycheck + $1000 OOP (company contributes $4000 to the $5000 deductible). So, $4720 OOP before expenses covered.
Option 2: $7680 out of paycheck, $1500 deductible OOP + office/specialty copay $20.= $9180 before any office visits outside of deductible.
If nothing else, with all else being almost equal, it will definitely save me some money over my current employer's plan, right?
Can anyone follow that...? Am I calculating/analyzing that correctly? Thanks....
It's pretty clear which plan to take. With the size of your company contributions, you might not see much difference in billing, but it's a bit of a sticker shock when you first move to an HSA plan vs paying a $20 co-pay. You would be surprised how many people will spend $5000 more on a plan just to pay that $20 co-pay though. As a family, you can contribute up to $6750 in 2016 for your HSA, including what your employer provides, so if these were my choices, I would put the excess up to the $6750 ($2750 in your case) for the extra tax savings for you and then try not to spend your HSA as much as you can to save for future expenses. Some people like to keep their company contribution in the account, for example.
I'm still wondering if there is an out of pocket cost after your deductible on either or both plans. Is there anything that mentions co-insurance, 80% or anything like that?
It's pretty clear which plan to take. With the size of your company contributions, you might not see much difference in billing, but it's a bit of a sticker shock when you first move to an HSA plan vs paying a $20 co-pay. You would be surprised how many people will spend $5000 more on a plan just to pay that $20 co-pay though. As a family, you can contribute up to $6750 in 2016 for your HSA, including what your employer provides, so if these were my choices, I would put the excess up to the $6750 ($2750 in your case) for the extra tax savings for you and then try not to spend your HSA as much as you can to save for future expenses. Some people like to keep their company contribution in the account, for example.
I'm still wondering if there is an out of pocket cost after your deductible on either or both plans. Is there anything that mentions co-insurance, 80% or anything like that?
When they compare the 2016 and 2015 plans side by side, they look like this: (assuming in-network)
2016 2015
Coinsurance 80% 100%
Office visit 20% Covered in full after ded.
Specialist visit 20% " "
Prevent care $0 copay $0 copay
inpat hospz 20% Cov in full after ded
Outpt surg 20% " "
ER 20% $100 per visit +20%
DX/Xray 20% Cov in full after ded.
Annual dectbl $5K $5K
Ann Out pock Max $6K $7K
prescript drugs (both the same)
Thanks for your help Qwerty, greatly appreciated.
(sorry, formatting got messed up after I posted. Can you still see everything? )
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