Health ins. options help

[mommin]

We need to pick health insurance for DH’s new job and we’ve really not had to make a choice before. Our experience has been, “Here is your one and only HMO option” or “One HMO or one PPO and nothing else.” We’ve always had an HMO because it made sense but I don’t think it does in this case. Now we have one HMO and three PPO options.
Basics on us- family of 6, DH and I are 40 and healthy, kids range from 15-7 and healthy as well. 7 year old is right about at the end of treatment for amblyopia and strabismus (lazy eye and eye cross) but may need to see an ophthalmologist 1-2 more times. Afterward, this will strictly become an optometry issue via separate vision insurance. Other than preventative care we usually make a total of 2-3 urgent care visits per year. No one is on prescription medication. We’ve had a couple broken bones over the years but no major issues.

Options:
PPOs all offer the same percentage to providers (100% for company providers, 75% for in-network, 55% out of network), all have the same out of pocket max including prescriptions ($5k/$10k), preventative covered 100%, coinsurance of 25%, all exactly the same except for deductibles.

PPO 1- $600 ind./$1200 fam. deductibles. Costs $436/month

PPO 2- $1500/$3000 deductibles. Costs $234/mo

PPO 3- $2800/$5600 deductible. Costs $192/mo This is the only option with an HSA. The employer will put in $1k annually and we can add to it.

HMO- no deductibles, Costs $594/mo. $30 office visits/$50 specialists. Also covers preventative at 100%. OOP max $4100/$8200.

All options offer a discount program for prescriptions if we need them at some point.

I’m leaning toward PPO 3 and adding to the HSA. We rarely need medical care and I’m FOR SURE done having babies. $10k oop max would not be fun to pay but wouldn’t be a problem. Am I off base? Is there something I’m missing? Like I said, we’re PPO newbies and access healthcare for my kids is a huge deal to me even if we don’t utilize it often.

[AdaraMarie]

I think I would do option 2 in your case. Even after the $1k from the employer, the additional $42/month is way less than the extra $1600 deductible. (ETA: for option 3. I would never consider 1 or 4) I also believe that with a $3k deductible you would be able to open an hsa even if it is not company sponsored.
You could do this for a year or two and see where your expenses land. If you really never use it, option 3 might be better, but I don't think it would take much to hit a $3k deductible with a family of 6.
I have a $3k deductible with a family of 3 and we hit it every year sometime between August and October. But we do have more issues than some.

[ellipses84]

Not 1 or 4. Option 2 is a really great value, but I also love having an HSA and the employer $1k helps bridge the gap between the cost of those two options. The first year on an HSA can be a little rough if you end up with a lot of unexpected medical issues. If most years your deductible is minimal and you can bank $10k+, it won’t seem so awful when you need to use it. For things you can put off or plan for, you can try to schedule them all in the same year.

Are 2 and 3 the same company? If not, I’d take that into consideration. What is their local reputation, are there good preferred hospitals and Dr offices nearby?

[mommin]

Aug 13, 2021 1:06:24 GMT -5 ellipses84 said:

Are 2 and 3 the same company? If not, I’d take that into consideration. What is their local reputation, are there good preferred hospitals and Dr offices nearby?

All PPO options are Blue Cross Blue Shield. I’m not entirely sure on the doctor options so I’ve put DH on that task. He works in healthcare but we’re new to the area so, while he doesn’t know off the top of his head, he should know the right people to ask.
2 and 3 are the only ones I’ve considered and I’ve bounced back and forth a bit with numbers and such. It reassuring that I’m not off base
Thank you both for the input on the HSA too. That is unfamiliar water for us and I appreciate the real life experiences.

[ohgillian]

If you can afford to fund them and not use the money in the short term, HSA's are a gold mine for retirement savings. Here's a recent thread; I'd pick that plan so I could get the HSA.

pandce.proboards.com/thread/625534/using-long-term-investment-benefits

[mommin]

Aug 13, 2021 9:16:49 GMT -5 ohgillian said:

If you can afford to fund them and not use the money in the short term, HSA's are a gold mine for retirement savings. Here's a recent thread; I'd pick that plan so I could get the HSA.

pandce.proboards.com/thread/625534/using-long-term-investment-benefits

This is great information! Never having access to HSAs I never gave them much thought but this could be a huge benefit down the road. It also made me realize that I could use the money tax-free for braces for my younger two kids when the time comes.

[ohgillian]

Aug 13, 2021 9:56:54 GMT -5 mommin said:

Aug 13, 2021 9:16:49 GMT -5 ohgillian said:

If you can afford to fund them and not use the money in the short term, HSA's are a gold mine for retirement savings. Here's a recent thread; I'd pick that plan so I could get the HSA.

pandce.proboards.com/thread/625534/using-long-term-investment-benefits

This is great information! Never having access to HSAs I never gave them much thought but this could be a huge benefit down the road. It also made me realize that I could use the money tax-free for braces for my younger two kids when the time comes.

Same. We were offered them one year (only) at my work, but I had a kid with a serious medical condition and never even considered the high deductible plan. But I'm planning to look into DH's at open enrollment this year. 

[mich1]

What are the OOP max for all the other options?

Medical problems do not happen nicely between the start of an insurance year. When my hips got infected, I fell exactly halfway between our insurance year so I wound up paying OOP max for 2 insurance years. I had 2 surgeries the first half, 2 the second half.

Most people can handle an OOP max once, but back to back it gets kinda rough.

[sadlebred]

Aug 13, 2021 19:20:45 GMT -5 goldengirlz said:

I just want to say that the point of insurance is that you never know what will arise. DH was incredibly healthy his entire life — I was always the one with sporadic (and random) medical problems here and there — and then, bam, out of the blue, he had severe stomach pain and doctors found a mass in his colon. He’s your age.

Plan for the worst case scenario. If those numbers are right, 2 seems like the best deal to me, assuming the other plan details are the same. I have never regretted paying extra for better coverage, but I have had the experience of being grateful to have it.

I also was underwhelmed with my HSA when I had one — fees galore and I had to use what my company offered while I was employed there — so I’m a bit biased against them. I know they can be helpful for retirement planning, so just make sure you read all the fine print and know your options if you go that route.

THIS. Ask me about my 2020 and how expensive it was. (nothing COVID related, some know my story). Good insurance is invaluable if you are lucky enough to have the option.

[lessel]

I’m kind of risk averse in this dept, so I wouldn’t go the HSA route. But man, I wish I could do a HSA with the insurance I have now.

[niq]

I feel like with kids the accident risk is high enough that I'd just do PPO 1. I know PPO 3 + HSA is the winning choice, but kids do weird shit and get hurt, sometimes they end up going to urgent care and needing X-rays or stitches or something, and then you've blown through the employer HSA contribution.