Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
I have started a new job recently and they have diff. health insurance plans . The high deductible ones and the traditional ones. The different plans are offered by Kaiser & Aetna ( not too familiar with Kaiser) and the kaiser plans are a few hundreds $$ cheaper than the Aetna plan. I am a single mother of a preschooler so I will need coverage for both I and my child. For that level of coverage , here is what they offer ( prices are annually):
-Traditional Comprehensive Aetna: $4,186
-Aetna Consumer direct: $2,884
-Aetna Consumer Direct High Deductible: $1,294
-Comprehensive Trad. Kaiser: $3,797
-Kaiser consumer direct: $2,633
Kaiser con. dir. High deductible : $1,210
The high deductible plans also come with an HSA where you can contribute pre-tax$$ monthly and the company puts $600/year in the plan. However they only start paying towards your costs once you reach the Deductible which is about $4K i think for the family plan, at which point they will pay 80%. Well visits are covered though and free even before you reach your deductible. For t he regular traditional plans, you have a $15 copay for in-network visits, $25 for specialist visits ect. There is about a $3k difference between the trad & High deduct. plans. So what would you do? i have never had a high. deduct. plan so don't know if this would be huge gamble. I would say that we are reasonably healthy i-e I only go to the DR maybe 3 times a year for myself and those are annual checkups. My child however, has colds multiple times a year that necessitate Dr.visits ( sick visits) especially during flu/cold season. Most of the time they tell us to just go home and keep him hydrated but we had one ER visit last year when DC was very dehydrated due to a cold /vomiting ect. My guess is , yes the high DED. is cheaper but if you have one ER visit that will probably eat up a lot of $$$$ AND then make you even spend more out of pocket than the regular plan. Do you have experience in any of these plans? Those who have the high ded. one, when you go to a regular sick visit to a DR. How much do they charge? since all of those costs are out of pocket? Thank you
First, look at your provider networks. Are your preferred doctors/hospitals in both networks? From that, choose either Kaiser or Aetna.
Then, comparing HSA to Comprehensive - take the difference in premium of:
Aetna/Kaiser Comprehensive v. HSA:
$2,587-$2,892 - Premium difference - you deposit this directly tax-deferred to HSA
$388-444 - federal tax savings on above (deposit this to HSA, too, via increased payroll deposits)
$600 - Employer HSA Contribution tax-free $3,575 - $3936 - Total Savings direct to HSA
for use toward $4k deductible. The 20% after the deductible is the unknown, of course, up to OOP.
You don't mention your max OOP after deductible is met for HD. That additional exposure should be part of the equation.
Doctor visits could be about $200 - probably less - depending on your insurance company's negotiated rates.
Yes, from what people report here, ER visit could easily be $3k and up.
That said, I'm all for tax savings and low premium. A $350/mo. prem. v. only $100/mo, plus tax savings, plus $600 from employer - for me, it's a no-brainer. Every year you don't meet your deductible, that HSA balance grows.
Based on the information provided thus far, I know which one I'd probably take.
HSA:
Low monthly premium
Save premium differential to HSA
Tax Savings
Employer Contribution - tax free
Additional tax-deferred deposits to HSA (if you can afford them) to grow tax-free
Checking your posting history, it appears you may be planning to live in a relatively affluent area of VA. I would think you will, in the end, probably benefit from the tax advantages of an HSA.
I'm sure golfgal will have other valuable insights.
Last edited by Ariadne22; 01-26-2014 at 12:21 AM..
Need more information...what are the out of pocket costs for all the plans (deductible and out of pocket max).
Even with copays on the comprehensive plans you will have other out of pocket costs, especially if you go to the ER so chances are, for that visit, having the comprehensive plan really doesn't save you all that much, but it depends on how the plan is written.
If you can either type out the rest of the plan information or post the summary of benefits it would be easier to answer your question but from the little info you have provided, the HSA plan is the way to go. With just the premium savings alone, you probably save money even if you have an ER visit in there and like Ariadne22 said, once you meet your out of pocket max, everything is covered at 100% for the rest of the plan year.
If you don't need all of the funds you put into your HSA, those funds roll over year after year after year and it's money you can use later. There is a sticky explaining how HSA's work at the top of the main page, read that so you know some of the ins and outs of the HSA's.
Also, assuming you max out your HSA contribution each year, this year you can put in $6550, Ariadne22 underestimated your tax savings by quite a bit. It will be more than double those numbers.
Thank you so much Ariadne22 and Golfgal. Here is the additional info:
Aetna Comprehensive Traditional and Kaiser Comp Traditional, both are similar so I'm grouping them Annual Deductible: ind/family
$500 Individual; $1,000 Family; excludes medical and pharmacy copays Out of Pocket Maximum: In Network
$2,000 Individual; $4,000 Family; includes deductible and medical copays, excludes pharmacy copays Lifetime Coverage limit
Limit does not apply Preventive Care
In Network
100% after $15 PCP copay
Out of Network:60% covered after deductible Specialist visit
In Network: 100% after $25 specialist copay
Out of Network :60% covered after deductible
Annual Physical exam: 100% covered, deductible &copay waived. 2 exams/calendar year
Cancer Screening: 100% covered, deductible waived
Cardiovascular screenings: 100% covered
Well Woman exam: 100% covered, 1 routine GYN exam/year with 1 pap smear & related lab fees.
Pediatric exams: 100% covered- frequency depending on plan's schedule
Diagnostic Care: any diagnostic services are subject to deductible & coinsurance
Outpatient surgery: 80% after deductible
Outpatient Lab: 100% covered for preventive; 80% covered after deductible for non-preventive
Outpatient X-Ray: 100% for preventive; 80% after deductible for non-preventive
ER ( not followed by admission) : 80% after deductible; non-emergency use not covered
Urgent care: $50 copay; non-urgent use not covered for Aetna. For Kaiser:$15 copay
Ambulance services: 80% after deductible for emergency- non-emergency use not covered for Aetna. For kaiser: $150 copay/trip for Emergency use
Hospital stay, inpatient physician, inpatient lab and X-ray: 80% after deductible.
Aetna and Kaiser High Deductible, these 2 are almost 99% similar so, i am grouping them Annual Deductible: ind/family
$2250 Individual; $4,500 Family; Out of Pocket Maximum: In Network
$4,000 Individual; $8,000 Family; includes deductible Lifetime Coverage limit
Limit does not apply Preventive Care
In Network
80% after deductible for Aetna, for Kaiser 80% after deductible but any service strictly preventive will be covered at 100% Specialist visit
In Network: 80% covered after deductible for Aetna & Kaiser, but with kaiser any service strictly preventive will be covered at 100%
Annual Physical exam: 100% covered. 2 exams/calendar year for Aetna. Kaiser indicates : frequency according to Plan's schedule
Cancer Screening: 100% covered, deductible waived
Cardiovascular screenings: 100% covered, deductible waived
Well Woman exam: 100% covered, 1 routine GYN exam/year with 1 pap smear & related lab fees.
Pediatric exams: 100% covered, deductible waived for Aetna- for Kaiser, 100% covered only for preventive and frequency depending on plan's schedule. Diagnostic for Kaiser : 80% covered after deductible.
Diagnostic Care: any diagnostic services are subject to deductible & coinsurance
Outpatient surgery: 80% after deductible
Outpatient Lab: 100% covered for preventive; 80% covered after deductible for non-preventive
Outpatient X-Ray: 100% for preventive; 80% after deductible for non-preventive
ER ( not followed by admission) : 80% after deductible; non-emergency use not covered
Urgent care: 80% covered after deductible , non-urgent use not covered
Ambulance services: 80% after deductible for emergency- non-emergency use not covered.
Hospital stay, inpatient physician, inpatient lab and X-ray: 80% after deductible.
Prescriptions:
Retail generic & brand name: 80% covered after deductible,preventive drugs are covered at 80% coinsurance before deductible.
Mental Health: 80% covered after deductible
Like I stated before, I have a 4 year old, so might have fairly frequent pediatric visits, other than that, haven't had any frequent dr visits these past years. One other question I had for the deductible+ OUT OF POCKET mx, will we fall under the Family as opposed to individual? I am asking because for the insurance I do not have the family plan but the one adult+child one which is a dif. price than the family plan. Thanks again for all of your help.
Ok--if you add up the premiums and potential out of pocket max:
Aetna--$2190 annual difference, including the $600 for the HSA plan (savings)
Kaiser $2023
That is instant money into your HSA. If something happens to either your daughter or you, you will have to come up with $4000 (major medical thing--end up in the hospital type deal). Half of that is already in your HSA just in premium savings. If something happens to BOTH of you in the same plan year, you will have to come up with the $8000. ($4000 for each of you).
For the non-HSA account, you have to come up with $2000/4000 PLUS the extra $2000 for premiums..so, if one of you gets sick (maxing out the plan sick) you are still ahead with the HSA because of the tax savings. If you both land in the hospital, the HSA will cost you about $2000/year more...but if you max out the HSA contributions, you will save at least that on taxes depending on your tax bracket so while you won't see that until the end of the year, you are still saving money.
Now, if you just go in for annual physicals and a couple ear infections, the HSA plan is less because of the premium savings. Those appointments aren't likely to add up to $2000+ whatever tax savings.
You get the benefit of contributing the $6550 into your HSA and if you can do that, I would strongly suggest you do. Build that account up to at least the $8000 over the next couple years so you don't have to worry about paying the medical bills. The more money you can keep putting into your HSA over the years, the happier you will be when you retire . This is assuming you contribute to your retirement accounts, etc. already. If you can't put the full contribution into the HSA, at least put the premium difference in there each year and build that account up over the next 2 or 3 years.
The only noticeable difference if you meet your out of pocket max on either plan is that with the comprehensive plans you keep paying for your medications where on the HSA plan you won't. That may or may not make a difference--right now it doesn't but it might.
Does this make sense? Feel free to ask more questions if you need more help.
Ok--if you add up the premiums and potential out of pocket max:
Aetna--$2190 annual difference, including the $600 for the HSA plan (savings)
Kaiser $2023
That is instant money into your HSA. If something happens to either your daughter or you, you will have to come up with $4000 (major medical thing--end up in the hospital type deal). Half of that is already in your HSA just in premium savings. If something happens to BOTH of you in the same plan year, you will have to come up with the $8000. ($4000 for each of you).
For the non-HSA account, you have to come up with $2000/4000 PLUS the extra $2000 for premiums..so, if one of you gets sick (maxing out the plan sick) you are still ahead with the HSA because of the tax savings. If you both land in the hospital, the HSA will cost you about $2000/year more...but if you max out the HSA contributions, you will save at least that on taxes depending on your tax bracket so while you won't see that until the end of the year, you are still saving money.
Now, if you just go in for annual physicals and a couple ear infections, the HSA plan is less because of the premium savings. Those appointments aren't likely to add up to $2000+ whatever tax savings.
You get the benefit of contributing the $6550 into your HSA and if you can do that, I would strongly suggest you do. Build that account up to at least the $8000 over the next couple years so you don't have to worry about paying the medical bills. The more money you can keep putting into your HSA over the years, the happier you will be when you retire . This is assuming you contribute to your retirement accounts, etc. already. If you can't put the full contribution into the HSA, at least put the premium difference in there each year and build that account up over the next 2 or 3 years.
The only noticeable difference if you meet your out of pocket max on either plan is that with the comprehensive plans you keep paying for your medications where on the HSA plan you won't. That may or may not make a difference--right now it doesn't but it might.
Does this make sense? Feel free to ask more questions if you need more help.
Thank you for breaking it down for me I guess my only confusion is about the deductible and OPM, if only one of us ends up in the hospital would we be considered under individual or family, i-e let's say my child gets sick and has to go to the hospital will the out of pocket max number be the one for individual or Family since it is a family plan? Same for deductible? will it just be individual or family? After your and Ariadne's explanation, I am starting to lean more towards the HSA plan while before i was leaning towards the comprehensive plans just becoz of fear . Also between the Kaiser & Aetna HSA plans, which one would you recommend? Thanks
It's both--you have an individual deductible for one person and the family for "everyone" else in the family. Since it's just you two, you each meet half of the family or what is listed there for the individual deductible. Say your daughter goes into the hospital in Feb for whatever and the bill is $100,000. You will have to pay a total of $4000 of that bill. Say you then go into the hospital for whatever in June, and your bill is $100,000, you pay another $4000 (assuming you haven't been to the dr yet). Then say your daughter goes back into the hospital in July and the bill is $200,000..you pay nothing for that bill because you have met your out of pocket max.
As for Kaiser vs Aetna....what is the out of network coverage--are they the same? Do you have to get referrals for either or both or neither? Have you looked to see if your doctors are in either network yet? How about the likely hospitals you would use? Look into those things and report back
It's likely that Kaiser you will need referrals and Aetna you won't but if they are both HMO plans, you will need them for both companies. If they are PPO plans, you won't need referrals most likely.
It's both--you have an individual deductible for one person and the family for "everyone" else in the family. Since it's just you two, you each meet half of the family or what is listed there for the individual deductible. Say your daughter goes into the hospital in Feb for whatever and the bill is $100,000. You will have to pay a total of $4000 of that bill. Say you then go into the hospital for whatever in June, and your bill is $100,000, you pay another $4000 (assuming you haven't been to the dr yet). Then say your daughter goes back into the hospital in July and the bill is $200,000..you pay nothing for that bill because you have met your out of pocket max.
As for Kaiser vs Aetna....what is the out of network coverage--are they the same? Do you have to get referrals for either or both or neither? Have you looked to see if your doctors are in either network yet? How about the likely hospitals you would use? Look into those things and report back
It's likely that Kaiser you will need referrals and Aetna you won't but if they are both HMO plans, you will need them for both companies. If they are PPO plans, you won't need referrals most likely.
Yes, they each have in and out of network prices. I did not quote the out of network prices because more than likely we will stay in-network, I mean why do people go out of network if they can help it? We also need new doctors as I have to move closer to work so we won't be using our current doctors anyways. The main difference I see between Aetna & Kaiser is that Kaiser has their own list of doctors while Aetna has a bigger list of doctors available. The other thing i noticed for pediatric care is that Aetna lists that all pediatric care is covered at 100%, i wonder if that includes sick visits? since it doesn't really say… If that's the case that might be a huge advantage as we usually go to the dr because DC is sick so if pediatric sick visits are included int he Aena plan, that would be golden . The other advantage for Kaiser from what I read online is that they have a 24/7 nurse hotline which is good when you have a sick child i suppose.
Now going back to your deductible example. In your first example, lets say its the same person that gets sick again during the same year, then is it free the 2nd time once we reach the $4k limit, or does it have to be an $8k limit?
Yes, they each have in and out of network prices. I did not quote the out of network prices because more than likely we will stay in-network, I mean why do people go out of network if they can help it? We also need new doctors as I have to move closer to work so we won't be using our current doctors anyways. The main difference I see between Aetna & Kaiser is that Kaiser has their own list of doctors while Aetna has a bigger list of doctors available. The other thing i noticed for pediatric care is that Aetna lists that all pediatric care is covered at 100%, i wonder if that includes sick visits? since it doesn't really say… If that's the case that might be a huge advantage as we usually go to the dr because DC is sick so if pediatric sick visits are included int he Aena plan, that would be golden . The other advantage for Kaiser from what I read online is that they have a 24/7 nurse hotline which is good when you have a sick child i suppose.
Now going back to your deductible example. In your first example, lets say its the same person that gets sick again during the same year, then is it free the 2nd time once we reach the $4k limit, or does it have to be an $8k limit?
From what you wrote--it looks like one person meets $4000 and then costs are covered for the rest of the year. Double check that with HR but usually if there is an individual/family deductible listed like that, it usually means each person only meets the $4000 at the most.
The out of network coverage comes if you are out of town and don't have a choice of where you go but it's not really an emergency--maybe your child gets sick-not an emergency but she needs to see someone--ear infection or whatever.
Kaiser is in a limited number of states where Aetna has a nationwide network.
It's doubtful that the plan covers all pediatric care but it doesn't hurt to ask about that for clarification. I've never seen a plan that does that. I'm guessing that means all of their well checks.
Thank you for clarifying. I will call them tomorrow and get more information for the pediatric costs ad the deductible, still leaning towards HSA though. Thanks a bunch
Please register to post and access all features of our very popular forum. It is free and quick. Over $68,000 in prizes has already been given out to active posters on our forum. Additional giveaways are planned.
Detailed information about all U.S. cities, counties, and zip codes on our site: City-data.com.
Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
. This is assuming you contribute to your retirement accounts, etc. already. If you can't put the full contribution into the HSA, at least put the premium difference in there each year and build that account up over the next 2 or 3 years.
I guess my only confusion is about the deductible and OPM, if only one of us ends up in the hospital would we be considered under individual or family, i-e let's say my child gets sick and has to go to the hospital will the out of pocket max number be the one for individual or Family since it is a family plan? Same for deductible? will it just be individual or family? After your and Ariadne's explanation, I am starting to lean more towards the HSA plan while before i was leaning towards the comprehensive plans just becoz of fear 
