Help me decide on a health plan

[seaturtle]

We have a new medical plan option for next year and I'm trying to figure out what's best between 2: a high deductible with HSA or PPO with optional FSA (what we currently have).

Relevant info:
- this is only for me and DS (almost 3), H is on his own plan as he's rarely sick and it's more cost effective for him alone to be on his company's plan
- neither DS nor I have any chronic health conditions/meds, although DS currently goes to PT weekly (no idea for how long) and he's in full time daycare so we have quite a few sick visits yearly
- paycheck costs are the same with both


Key plan details (PDQ)

HD
- family deductible $3k, have to meet before plan pays anything. OOP max is $6400
- company contributes $1k in the HSA, I can add an additional $6300
- office/sick visits 20% after deductible, same with urgent care
- rx 20% after deductible

PPO
- family deductible $2k, OOP max is $8k
- company matches $500 into FSA if you contribute $500. IRS limit is $2750
- office/sick visits covered, urgent care $60 copay
- rx $10 copay for generic


Happy to provide any additional details!

[longtimenopost]

What's the monthly difference in the cost of the plans?

How much do you pay for PT now?

I'd be worried about regular sick visits and PT. A sick visit with our pedi runs $150 and PT is $250, so those would add up paying in full until the 3k deductible is hit!

[nicolewi]

Here's where someone should just tell me if I am wrong, b/c I don't understand how HSAs can really work for most people with kids. Tell me if I am missing something major here. I would do plan 2, hands-down, no doubt.

Here's my logic.
You pay the same out of each check for either plan.
Let's assume your kid has like 7 office visits, 1 trip to urgent care, and you have 3 over the course of the year. Let's say you get three antibiotic prescriptions.

So with plan A, you've paid out of pocket...let's assume something like 250/visit x 10, plus urgent care let's say $400 (that might all be low or high, but office visits were pretty expensive the year we paid instead of doing co-pay). So that's like 2900...and you still didn't quite hit the deductible!!! So you've also paid maybe $100 for the Rx...so finally now you hit the deductible, but now you still pay 20% of the costs of office visits.

Same thing, other plan:
On top of what was withheld from your check, you paid $60 for urgent care, and $30 for Rx.

This does not even take into account the PT. You have to find out how you are charged for that, for sure. Does it count as a regular office visit, with a co-pay? If not, approximately how much is each session going to run? Could be a LOT.

[luckystar2]

Oct 18, 2021 12:42:44 GMT -5 nicolewi said:

Here's where someone should just tell me if I am wrong, b/c I don't understand how HSAs can really work for most people with kids. Tell me if I am missing something major here. I would do plan 2, hands-down, no doubt.

.

Well a HSA plan can work if the monthly premiums are cheaper. Generally that’s what I’ve seen. I am surprised that a HSA high deductible plan has the same monthly premium cost as a more traditional HMO/PPO plan. Mine is significantly cheaper. A family plan for me for PPO is $325/month. The HSA plan is $25/month. The HSA is always a better deal for me because of the huge difference in premiums. If premiums really are the same then yeah I wouldn’t go with an HSA unless there was a huge benefit like a ton of employer contribution to HSA. In OP’s situation id choose 2 IF monthly premiums are the same.

[mccallister84]

If the premium costs are truly the same I think the PPO is the right choice unless you really want to leverage the tax savings with the HSA.

We have an HSA HDHP and I absolutely hate it. It makes sense financially for us, since the premium costs is much lower, but I hate debating whether someone is sick enough to go to a doctor because it’s going to cost us $$$$. But knock on wood this is the first year we haven’t hit the deductible (and had to funnel money in to the HSA to pay bills) so we are actually finally getting ahead with the HSA. I mean some years it was obvious we were going to hit it (childbirth) but I haven’t had a baby since 2018 and we still hit it in 2019 (in January when DD2 was hospitalized with RSV) and in 2020 when DD1 broke her arm.

But again, at the end of the day it’s still cheaper than the high premiums for the PPO plan.

[seaturtle]

Yes the monthly cost is the same. Per our HR person it was deliberate because "we know that the tax saving opportunities of an HSA will be an attractive choice but don't want to encourage enrolling in the plan if an associate would avoid or delay the care they need while in the plan".

nicolewi thanks for the walk through. The only consideration I had was that the company provides $1k to the HSA. So in my mind if we expect to use that or less, we make out. Plus anything we spend after is pre as opposed to post tax.

But I hate to play the guessing game and will be pissed if something comes up, plus the hassle of actually paying for visits with a sick kid or whatever. I really wanted to make sure I wasn't missing an obvious reason to pick the HD plan.

[awkwardpenguin]

If the premiums are the same there's almost no scenario where the HDHP makes sense.

[redheadbaker]

Oct 18, 2021 12:42:44 GMT -5 nicolewi said:

Here's where someone should just tell me if I am wrong, b/c I don't understand how HSAs can really work for most people with kids. Tell me if I am missing something major here.

It hasn't been an issue for us in the 4 years we've had an HDHP. We're required to have an HSA, and my employer contributes a significant amount to it. Maybe I'd feel differently if DS had a chronic condition beyond his ADHD, or was accident-prone -- we haven't need to go to the ER in the years we've had it. 

[cherry1111]

I did the math last year when we hit the $6,000 deductible between gall bladder surgery for me and DD hospitalized with an infection. We actually still came out ahead with the high deductible plan because the premiums are that much cheaper plus the $1,000 my company put in my HSA.

But if your premiums are the same I would definitely do the PPO.

[seaturtle]

Oct 18, 2021 16:26:19 GMT -5 @kar said:

It doesn't look to me like you have the full picture on the PPO - are office/sick visits really fully covered? What about hospital visits? How would you even get close to the OOP max with $60 urgent care, $10 prescriptions? Under our PPO plan option, we pay a portion of PT/sick visits/etc - even at $150 a visit and 40 visits a year, you've exceeded your deductible just with PT.

I have the PPO now and OOP costs really are minimal. Office visits are fully covered, even CVS minute clinic. DS's PT copays and 1 Dermatologist copay for me are the only costs I've paid this year. Hospital visits are a lot. I hit the OOP max the year DS was born as it included a short NICU stay plus IVF in the same calendar year.

[sent]

We have the HDHP but the premium is definitely at least $200 cheaper than the PPO plan. I made my husband send the difference in premium automatically from his paycheck to the HSA and then I contribute the rest to top it off to $7100 or whatever the max limit is each year. The HDHP is seen as a vehicle to help with retirement planning since you get to keep that money forever and it can grow with the market versus the FSA where you are constantly guessing how much to put in so you don't lose it. If you can max out the HSA, then you'd want to do the math if it's worth the tax benefit to the HDHP over the PPO plan.

[orval]

Just an fyi, on our HDHP our annual exams are covered. My yearly visit to my primary doc and gyn are no charge along with usual labs. We also have a discounted price for an office visit and urgent care $35. We don't go to the doctor much more than annual exams so it is great for us. We probably have upwards of $30k in our account since we have had it for years.

[longtimenopost]

Yeah, if the monthly premiums are the same, the PPO hands down. Maybe if they contributed 2-3k to the HSA for the HDHP, but not for $1k!

[jennistarr1]

plan 2 for sure, it looks like you pay less OOP to have things mostly covered than plan one where it's more out of pocket to only continue to pay pretty heftily for each thing

also 20% of (whatever) makes me nervous...I would be anxious about how much this will cost me. I rather just know so I can decide "is it worth a 60$ urgent care visit