Tell me about high-deductible plans/HSAs

[Deleted]

I don't have the specifics of either of our plans yet, but am planning to look into it for the first time this year.

Is there a good link to explain how it works in very easy to understand terms?

Would you recommend the plan for a couple where one person is on no meds and goes to the doctor only once a year for a physical, but the other is on a few meds and goes to the doctor maybe 4-5 times a year (but usually for nothing serious) and is accident-prone enough to end up in the ER with something minor and stupid maybe once every two years?

Thanks for any advice!

[ijack]

how much are the meds? is it an FSA or an HSA (HSA is better)?
the main point will be the premium cost between the 2 plans.

[Deleted]

Right now I'd say $50 a month on meds, but that's after insurance. No idea what the retail price would be (does that matter?)

I think it would be an HSA either way... I already have an FSA (my husband doesn't because he doesn't spend money on healthcare... I don't know if I've ever even see him need a band-aid).

[ijack]

the retail price does matter because that's what they're going to cost you until you hit your deductible. Like my generic adderall costs $150/month, but my generic celexa is only $4/month. If you want to DM me the info I can check on our website for you.

[evans]

Do you mean HSA or FSA? They are different and I have different advice depending on which it is.

Do you know if your company will be contributing to the HSA/FSA or will you be the only contributor?

The basics is that you pay all costs until you reach your deductible.


This is how my HSA plan works:
The family deductible is $2,500. I pay all costs including prescriptions until I reach this.
From $2,501 to $5,000 I pay 20% and co-insurance pays 80%
From $5,001 + I pay 0%. (5k is my out of pocket max)
Preventive prescriptions (there is a list) and well visits are 100% covered.

This works great for me because we're both healthy and my employer gives $2500 to the HSA, which is enough to cover my entire deductible.

My advice is to find out how much total cost each plan will cost. Once you have the premiums this is easy to do: premiums + out of pocket max - any employer money = total cost of the plan.

[Deleted]

Sorry, I meant HSA -- edited the post title to fix it!!!

[jaylea]

I would look into the prescription costs.

For example, my son has asthma. Fairly common. His meds were $200 per month on our HDHP. On my current PPO, they are $20/3 months. The ~ $20 increase in premiums per pay period is more than worth it based on the med cost alone.

Likewise, his eczema ointments (2 of them) were $50 each. Now they are $10 each.

[evans]

Nov 13, 2012 11:39:03 GMT -5 v said:

Right now I'd say $50 a month on meds, but that's after insurance. No idea what the retail price would be (does that matter?)

I think it would be an HSA either way... I already have an FSA (my husband doesn't because he doesn't spend money on healthcare... I don't know if I've ever even see him need a band-aid).

HSAs are better because they roll over from year to year, unlike FSA which is a use it or lose it deal. I think you do not need both.
So even if your employer isn't contributing to an HSA for you, they are still better.

I have to run to lunch but I'm happy to answer any questions I can later. I've been seeing a lot of these posts this time of the year and I like helping.

[definitelyO]

Nov 13, 2012 11:41:08 GMT -5 ijack said:

the retail price does matter because that's what they're going to cost you until you hit your deductible. Like my generic adderall costs $150/month, but my generic celexa is only $4/month. If you want to DM me the info I can check on our website for you.

I have to disagree here. We are on a HDHP/HSA and our Rx are reviewed at the point of service and reduced based on the insurance carrier contract. So we don't pay 100% - we still have the advantage of the insurance discount. example:

[evans]

Nov 13, 2012 11:39:03 GMT -5 v said:

Right now I'd say $50 a month on meds, but that's after insurance. No idea what the retail price would be (does that matter?)

I think it would be an HSA either way... I already have an FSA (my husband doesn't because he doesn't spend money on healthcare... I don't know if I've ever even see him need a band-aid).

You can call and get the insurance negotiated price (which is often less than retail).
Also see if your plan has "preventive prescriptions" covered and get the list.

[SJ]

I am confused because we have a HDHP with a HSA and we do NOT pay 100% out of pocket for well visits & meds, even before we hit the deductible.

We love the HSA.

[pitterwoo]

yep, the retail price on the meds matters. My plan pays a good portion of generics and less of brand names. I only signed up for this because I knew one of my meds was due to come off patent in a couple months. So my generics are $15 a month, but the one that was brand name was $165 for the month that I needed it before generics were available.

[Deleted]

Nov 13, 2012 11:49:18 GMT -5 definitelyO said:

Nov 13, 2012 11:41:08 GMT -5 ijack said:

the retail price does matter because that's what they're going to cost you until you hit your deductible. Like my generic adderall costs $150/month, but my generic celexa is only $4/month. If you want to DM me the info I can check on our website for you.

I have to disagree here. We are on a HDHP/HSA and our Rx are reviewed at the point of service and reduced based on the insurance carrier contract. So we don't pay 100% - we still have the advantage of the insurance discount. example:

This is how our HSA works too. The retail cost doesn't matter, because although you are paying the full cost of the med, you are still getting the insurance discount. The insurance discount is usually pretty large.

[ijack]

I guess we do get an "insurance" discount, but I think it's like $10 for my adderall, so I don't really count it.

[GailGoldie]

retail prices of drugs vary depending on what pharmacy you go to - and your HSA will have a negotiated price that you'll pay - which is still pretty close to the retail price (if discounted at all)... until you hit your deductible.

If your company puts some money into the account, and you do, too (which is pre-tax, lowering your taxable income, another benefit)... you can use that to pay for your meds and doc visits (you'll get a debit card and/or checks) If you don't have that with you you can pay cash (or with another means) and then reimburse yourself from the HSA account.

if there is money left over at the end of the year it rollls over - and can build up pretty big if you are pretty healthy - then if something big happens a few years later and you haven't hit your deduct yet - you will have a nice lump to pay for that.

My plan's deduct is $3200. We have hit it pretty fast both years b/c our kids get sick, had surgery, etc. It sucks those first few months for us b/c we have never been able to build up anything in the account so we are paying OOP and reimbursing ourselves later when it's deposited (each paycheck some goes in from the copmany and me). If we could actually make it a while without needing to get meds- it wouldn't feel so sucky those first few months b/c we could build up something in the account, lol.

but in the end it's still much cheaper for us - we pay much less for premiums and the company chips in more, etc.

[80sjunkie]

Are you set on having the same insurance coverage for you and DH? Given what you have described it might make sense for him to have a HDHP and max out the HSA (for tax sheltering if he never gets sick) and for you to have a different plan. I can't say for sure because it truly depends on the difference in premiums, coverage, etc between the two plans. When I was deciding whether or not to switch for my MRI, I calculated the difference in premiums for a year between the two insurance plans, looked at my annual out of pocket spending on the HDHP (it's been a few years), and then roughly calculated what I would have spent out of pocket if I was on the non-HDHP. It made sense to switch out of the HDHP for now.

[80sjunkie]

Nov 13, 2012 11:50:56 GMT -5 SJ said:

I am confused because we have a HDHP with a HSA and we do NOT pay 100% out of pocket for well visits & meds, even before we hit the deductible.

We love the HSA.

I believe you pay 100% out of pocket based on the discounted rate your insurance company has negotiated, so it looks like you are paying less than 100%.

[SJ]

Nov 13, 2012 12:10:07 GMT -5 80sjunkie said:

Nov 13, 2012 11:50:56 GMT -5 SJ said:

I am confused because we have a HDHP with a HSA and we do NOT pay 100% out of pocket for well visits & meds, even before we hit the deductible.

We love the HSA.

I believe you pay 100% out of pocket based on the discounted rate your insurance company has negotiated, so it looks like you are paying less than 100%.

This makes sense. In addition well visits are still covered so we don't pay 100%.

[80sjunkie]

I think the well visit exclusion is relatively standard for HDHPs as well (yay for no copay).