Help! yet aother PPO vs HDHP plan

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hmw
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Help! yet aother PPO vs HDHP plan

Post by hmw » Sat Nov 10, 2018 6:19 pm

It's time to enroll in my work place health insurance plan. We have always purchased the regular family PPO plans in the past. I have taken a closer look at the HDHP/HSA plan, and I think HDHP is a better deal. I just want to make sure that I am not missing anything and end up cost us more if we choose HDHP.

Our PPO and HDHP plans have the same network of physicians and hospitals.

We are a family of three and our son and I have had no health expenses at all in the last few years. My wife has a chronic condition and requires regular doctor visits. DW had several visits to specialists and one minor surgery this year. Our out of pocket expenses for 2018 is approaching $6000 which is the maximum individual out pocket expense for our PPO plan. I am anticipating that DW will spend around 6k, or more in health expenses in 2019.

PPO annual premiums: $9530 vs HDHP premiums of $4840. Saving of $4690. HSA is available but no employer contribution to HSA.

Out of pocket maximum for individual/family in the PPO plan are 6000/12000.

Out of pocket maximum for individual/family with the HDHP plan are $6450/$12900.

Since there is very little difference out of pocket maximum between the PPO and HDHP, and I am anticipating that DW will spend 6k or more next year, I think it is a better deal for me to pick HDHP and contributing 7k to HSA. Am I missing anything?


Thanks

ResearchMed
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Re: Help! yet aother PPO vs HDHP plan

Post by ResearchMed » Sat Nov 10, 2018 6:57 pm

hmw wrote:
Sat Nov 10, 2018 6:19 pm
It's time to enroll in my work place health insurance plan. We have always purchased the regular family PPO plans in the past. I have taken a closer look at the HDHP/HSA plan, and I think HDHP is a better deal. I just want to make sure that I am not missing anything and end up cost us more if we choose HDHP.

Our PPO and HDHP plans have the same network of physicians and hospitals.

We are a family of three and our son and I have had no health expenses at all in the last few years. My wife has a chronic condition and requires regular doctor visits. DW had several visits to specialists and one minor surgery this year. Our out of pocket expenses for 2018 is approaching $6000 which is the maximum individual out pocket expense for our PPO plan. I am anticipating that DW will spend around 6k, or more in health expenses in 2019.

PPO annual premiums: $9530 vs HDHP premiums of $4840. Saving of $4690. HSA is available but no employer contribution to HSA.

Out of pocket maximum for individual/family in the PPO plan are 6000/12000.

Out of pocket maximum for individual/family with the HDHP plan are $6450/$12900.

Since there is very little difference out of pocket maximum between the PPO and HDHP, and I am anticipating that DW will spend 6k or more next year, I think it is a better deal for me to pick HDHP and contributing 7k to HSA. Am I missing anything?


Thanks
Double check that for the HDHP plan you don't need to get to the *family* OOP max before that kicks in.
Her "extra" costs might need to head toward the combined OOP max before it is satisfied.

RM
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StopIroningShirts
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Re: Help! yet aother PPO vs HDHP plan

Post by StopIroningShirts » Sat Nov 10, 2018 7:49 pm

Does your HDHP kick in at a lower threashold with a co-pay or is it 100% until you hit the max?

Mine requires $5,000 spend then its 80/20 up to the Out of Pocket Max of 10k.

The challenge is you have to tally up your actual healthcare spend last year. The deisgn usually makes the HDHP the best at the lowest and highest users of healthcare then the robust plan below is best if you fall in between.

At first glance I find it hard to see how you loose on the HDHP with the premium difference. Consider googling saving HSA receipts too

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fortfun
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Re: Help! yet aother PPO vs HDHP plan

Post by fortfun » Sun Nov 11, 2018 4:37 pm

hmw wrote:
Sat Nov 10, 2018 6:19 pm
It's time to enroll in my work place health insurance plan. We have always purchased the regular family PPO plans in the past. I have taken a closer look at the HDHP/HSA plan, and I think HDHP is a better deal. I just want to make sure that I am not missing anything and end up cost us more if we choose HDHP.

Our PPO and HDHP plans have the same network of physicians and hospitals.

We are a family of three and our son and I have had no health expenses at all in the last few years. My wife has a chronic condition and requires regular doctor visits. DW had several visits to specialists and one minor surgery this year. Our out of pocket expenses for 2018 is approaching $6000 which is the maximum individual out pocket expense for our PPO plan. I am anticipating that DW will spend around 6k, or more in health expenses in 2019.

PPO annual premiums: $9530 vs HDHP premiums of $4840. Saving of $4690. HSA is available but no employer contribution to HSA.

Out of pocket maximum for individual/family in the PPO plan are 6000/12000.

Out of pocket maximum for individual/family with the HDHP plan are $6450/$12900.

Since there is very little difference out of pocket maximum between the PPO and HDHP, and I am anticipating that DW will spend 6k or more next year, I think it is a better deal for me to pick HDHP and contributing 7k to HSA. Am I missing anything?


Thanks
As long as you and your son don't have any major issues, and you have 12k to cover the worst case scenario, you are probably correct. One downside is that you may avoid going to the doctor when you would otherwise (to not eat into the 5k savings).

texasdiver
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Re: Help! yet aother PPO vs HDHP plan

Post by texasdiver » Sun Nov 11, 2018 5:49 pm

What are your co-pays in the PPO plan?

We have a similar choice between HDHP and non-HDHP plans.

The HDHP plan has no co-pays because you are paying for everything up to the deductible
The non-HDHP plan had $25-50 co-pays for different categories of appointments up to the annual deductible after which the co-pays drop.

The co-pays aren't generally huge but they are another point on the ledger in favor of the HDHP plan. Or put another way, they are a somewhat hidden cost in the non-HDHP plan that you need to account for when trying to do a direct comparison.

I think it comes down to what kind of user you are. My family has averaged less than $700 in medical costs annually for the past 10 years so for us the HDHP plan has been a spectacular savings and we have enough in our HSA to pay annual deductibles for half a decade if we needed to. On the other hand, had we been heavy users over the past decade we probably would have come close to breaking even.

In my mind? If you have the resources to get through the first year or two until your HSA starts to accumulate then there are really very little downsides to the HDHP but a very real upside if you don't use a lot of care.

Papago
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Re: Help! yet aother PPO vs HDHP plan

Post by Papago » Sun Nov 11, 2018 7:05 pm

Same thing with my employer, and I was going in the same direction UNTIL I LOOKED AT THE MEDICATION COVERAGE.

PPO has the usual $10-$30 co-pays for meds, picking up the remainder of the costs. However, the HDHPs make you pay 100% of all medication costs until you meet the full (very high!) deductible, at which point the subsidized coverage for meds begins. Depending on your family medications, this could blow the roof off your costs. Or, God forbid, you're well now but during the year you or your loved one needs some really high-cost med, taking you to your high deductible very quickly.

Made me realize that insurers aren't all that worried about how many times you see the doctor. It's the medication costs they're really trying to contain by incentivizing you to do the HDHP plan.

SteveinVanvcouverWA
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Re: Help! yet aother PPO vs HDHP plan

Post by SteveinVanvcouverWA » Sun Nov 11, 2018 11:27 pm

You might consider choosing the HDHP and pairing it with a Direct Primary Care (DPC) practice, if available in your area. In this type of practice, you pay an affordable monthly fee, like a gym membership, for enhanced access to the physician. Visits are typically 30-60 minutes, and you can access the MD by text, email, phone, Skype, etc. These DPC practices do not charge insurance, but are a "direct" contract between the patient and physician. The number of patients the doctor takes care of is about 1/3 to 1/4 the size of a typical panel, so the doctor has plenty of time for you.

stimulacra
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Re: Help! yet aother PPO vs HDHP plan

Post by stimulacra » Sun Nov 11, 2018 11:38 pm

I feel like an HDHP plan (paired with an HSA) is of most value to low consumers of healthcare or very high consumers of healthcare. Families that are moderate consumers of healthcare it's a bit of a toss-up between the two options.

For me, I feel the HDHP/HSA provides the most value, flexibility and an opportunity to tuck away a significant amount of pre-tax dollars in a tax-advantaged space that I can invest.

hmw
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Re: Help! yet aother PPO vs HDHP plan

Post by hmw » Mon Nov 12, 2018 11:05 am

OP here. Thanks for all your replies.

I called HR this am and confirmed that there is an individual out of pocket maximum within a family plan.

Our HDHP pays 80% of physician visits/labs etc after the deductible is met. We pay 10% of med cost before deductibles if the meds are for maintenance. I am pretty sure that DW will spend way more than her deductible.

DW has spent close to 6k outpocket this year with our traditional PPO plan. I anticipate that her next year’s expenses will be similar or higher. Like people have said, HDHP is good for low and high level users of health care. Unfortunately DW will be a high level user. I have come to the conclusion that HDHP is a better deal for us. I plan to use HSA for investment and pay health expenses out of pocket.

hmw
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Re: Help! yet aother PPO vs HDHP plan

Post by hmw » Mon Nov 12, 2018 11:11 am

Papago wrote:
Sun Nov 11, 2018 7:05 pm
Same thing with my employer, and I was going in the same direction UNTIL I LOOKED AT THE MEDICATION COVERAGE.

PPO has the usual $10-$30 co-pays for meds, picking up the remainder of the costs. However, the HDHPs make you pay 100% of all medication costs until you meet the full (very high!) deductible, at which point the subsidized coverage for meds begins. Depending on your family medications, this could blow the roof off your costs. Or, God forbid, you're well now but during the year you or your loved one needs some really high-cost med, taking you to your high deductible very quickly.

Made me realize that insurers aren't all that worried about how many times you see the doctor. It's the medication costs they're really trying to contain by incentivizing you to do the HDHP plan.
I have thought about this. Sometimes the medication cost quoted by our drug plan cost way more than what you can get yourself with a
GoodRx coupon. It is ridiculous. In order to fill up your deductible/out of pocket maximum, you are almost forced to pay the inflated prices quoted by your drug plan.

For example, DW takes one generic med which cost $10 a month. It cost about $55 a month at local pharmacy with a GoodRx coupon without using insurance. If we buy though our insurance plan, the drug price quoted is $480!

chazas
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Re: Help! yet aother PPO vs HDHP plan

Post by chazas » Mon Nov 12, 2018 12:07 pm

Seems to me the less you pay overall the better, even if you hit the deductible later in the year. I use the coupon price and then, later in the year once I've hit the deductible because of other expenses, submit the receipts for reimbursement.
hmw wrote:
Mon Nov 12, 2018 11:11 am
I have thought about this. Sometimes the medication cost quoted by our drug plan cost way more than what you can get yourself with a
GoodRx coupon. It is ridiculous. In order to fill up your deductible/out of pocket maximum, you are almost forced to pay the inflated prices quoted by your drug plan.

For example, DW takes one generic med which cost $10 a month. It cost about $55 a month at local pharmacy with a GoodRx coupon without using insurance. If we buy though our insurance plan, the drug price quoted is $480!

SimonJester
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Re: Help! yet aother PPO vs HDHP plan

Post by SimonJester » Mon Nov 12, 2018 2:37 pm

hmw wrote:
Mon Nov 12, 2018 11:11 am
I have thought about this. Sometimes the medication cost quoted by our drug plan cost way more than what you can get yourself with a
GoodRx coupon. It is ridiculous. In order to fill up your deductible/out of pocket maximum, you are almost forced to pay the inflated prices quoted by your drug plan.

For example, DW takes one generic med which cost $10 a month. It cost about $55 a month at local pharmacy with a GoodRx coupon without using insurance. If we buy though our insurance plan, the drug price quoted is $480!
I am in the same boat with my HDHP. I would just opt for the lowest yearly costs and not really pay attention to the deductible. So in your case take the $55 good rx price...
"They who can give up essential liberty to obtain a little temporary safety, deserve neither liberty nor safety." - Benjamin Franklin

hmw
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Re: Help! yet aother PPO vs HDHP plan

Post by hmw » Mon Nov 12, 2018 11:16 pm

chazas wrote:
Mon Nov 12, 2018 12:07 pm
Seems to me the less you pay overall the better, even if you hit the deductible later in the year. I use the coupon price and then, later in the year once I've hit the deductible because of other expenses, submit the receipts for reimbursement.
hmw wrote:
Mon Nov 12, 2018 11:11 am
I have thought about this. Sometimes the medication cost quoted by our drug plan cost way more than what you can get yourself with a
GoodRx coupon. It is ridiculous. In order to fill up your deductible/out of pocket maximum, you are almost forced to pay the inflated prices quoted by your drug plan.

For example, DW takes one generic med which cost $10 a month. It cost about $55 a month at local pharmacy with a GoodRx coupon without using insurance. If we buy though our insurance plan, the drug price quoted is $480!
I went over the fine print. The meds DW takes are considered maintence meds and therefore it is not subject to the deductible. We pay 10% of the inflated rack price which will be $48 a month. It is slightly cheaper than the cash price with GoodRx.


If I pay cash using the GoodRx coupon, I don't think I can have it counted towards the annual out of pocket maximum.

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