WSJ: HSAs Offer Tax Benefits Beyond 401(k)s
WSJ: HSAs Offer Tax Benefits Beyond 401(k)s
Interesting perspective that depends on your 401k match and your tax rate
"Due to this combination of tax advantages, HSAs—which are paired with the HSA-qualified health plans available on health-care exchanges and offered by 43% of employers—can even be a better deal than a 401(k) with an employer matching contribution. That is most likely to be the case if you are in a high tax bracket and the 401(k) match is less than dollar for dollar, says Greg Geisler, an associate professor of accounting at the University of Missouri-St. Louis."
https://www.google.com/search?q=HSAs+Of ... nd+401(k)s
"Due to this combination of tax advantages, HSAs—which are paired with the HSA-qualified health plans available on health-care exchanges and offered by 43% of employers—can even be a better deal than a 401(k) with an employer matching contribution. That is most likely to be the case if you are in a high tax bracket and the 401(k) match is less than dollar for dollar, says Greg Geisler, an associate professor of accounting at the University of Missouri-St. Louis."
https://www.google.com/search?q=HSAs+Of ... nd+401(k)s
Re: WSJ: HSAs Offer Tax Benefits Beyond 401(k)s
One should not look only to the tax benefits of the HSA. There are drawbacks to HDHPs.
The tax benefits of the HSA may be there, but the HDHP one needs to have to open and contribute to an HSA often has much higher out of pocket costs than traditional plans. Unless you never see a doctor and don't take any regular prescription drugs, an HDHP may not be the best idea.
The tax benefits of the HSA may be there, but the HDHP one needs to have to open and contribute to an HSA often has much higher out of pocket costs than traditional plans. Unless you never see a doctor and don't take any regular prescription drugs, an HDHP may not be the best idea.
Re: WSJ: HSAs Offer Tax Benefits Beyond 401(k)s
This is a great point, but as someone who is in the industry, I can tell you that in the majority of cases, the HDHP is the best plan. A few years ago, they were a lot less common, but now, the entire industry is shifting to heavily promoting HDHPs. My last two employers strongly pushed in favor of the HDHP. Had I wanted a lower deductible plan, the bidding started at 4 times the cost of my HDHP, and that was just for a lower HDHP ($1500 vs. $3000 deductible). Had I wanted an $800 deductible plan, it was roughly 6-7 times as much as what I was paying. You get the picture. The story has been much the same with my current employer, but this one offers an HSA contribution for selecting the HDHP on top of the much cheaper cost. I am very happy to oblige by picking that plan every time and throwing pre-tax money into my HSA.madbrain wrote:One should not look only to the tax benefits of the HSA. There are drawbacks to HDHPs.
The tax benefits of the HSA may be there, but the HDHP one needs to have to open and contribute to an HSA often has much higher out of pocket costs than traditional plans. Unless you never see a doctor and don't take any regular prescription drugs, an HDHP may not be the best idea.
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Re: WSJ: HSAs Offer Tax Benefits Beyond 401(k)s
madbrain wrote:One should not look only to the tax benefits of the HSA. There are drawbacks to HDHPs.
The tax benefits of the HSA may be there, but the HDHP one needs to have to open and contribute to an HSA often has much higher out of pocket costs than traditional plans. Unless you never see a doctor and don't take any regular prescription drugs, an HDHP may not be the best idea.
That has not been my experience in the four HDHPs that I have participated in.
HSHPs generally have a lower premium and a lower out-of-pocket maximums when compared to the traditional plans.
Time and time again, people who never see a doctor do better with a HDHP. Also, people with chronic conditions who use a lot of healthcare ALSO benefit as their out-of-pockets are less than the traditional plans.
The people in the middle generally do better with the traditional plan.
Re: WSJ: HSAs Offer Tax Benefits Beyond 401(k)s
I have a HDHP (and an HSA of course).
Financially, the HDHP makes sense, but what I don't like is how every time I get sick, I ask myself, am I $150 sick? A few years back I had some chest pains. I'm young and healthy, it turned out to be indigestion. If something were to happen today where I needed to go to the emergency room to get it checked out, I'd ask myself, am I 5k sick?
Logically, I know if you're sick, you should spend the money, go to the doctor, and let *them* advise you on the best course of action. Your health is not worth sacrificing to save money.
And yet, realistically? I didn't fill that scrip I got for heartburn medication. Not worth it, I'll just take some tums and deal with it. Doc wrote a perscription for an ear infection? Better check walmart's $4 perscription list and argue that he should change to another generic. See a dermatologist about plaque psoriasis? Not spending that kinda money on a skin condition! (even though I know it's often comorbid with psoriatic arthritis)
I don't know anyone who enjoys 'consuming' healthcare. Even when I had good insurance, I went to the Dr only when I absolutely needed it. The unspoken truth about making all of us 'smart healthcare consumers' is there's a lot of folks that will wind up forgoing healthcare they technically need, but irrationally see price as yet another excuse not to do what needs to be done.
Financially, the HDHP makes sense, but what I don't like is how every time I get sick, I ask myself, am I $150 sick? A few years back I had some chest pains. I'm young and healthy, it turned out to be indigestion. If something were to happen today where I needed to go to the emergency room to get it checked out, I'd ask myself, am I 5k sick?
Logically, I know if you're sick, you should spend the money, go to the doctor, and let *them* advise you on the best course of action. Your health is not worth sacrificing to save money.
And yet, realistically? I didn't fill that scrip I got for heartburn medication. Not worth it, I'll just take some tums and deal with it. Doc wrote a perscription for an ear infection? Better check walmart's $4 perscription list and argue that he should change to another generic. See a dermatologist about plaque psoriasis? Not spending that kinda money on a skin condition! (even though I know it's often comorbid with psoriatic arthritis)
I don't know anyone who enjoys 'consuming' healthcare. Even when I had good insurance, I went to the Dr only when I absolutely needed it. The unspoken truth about making all of us 'smart healthcare consumers' is there's a lot of folks that will wind up forgoing healthcare they technically need, but irrationally see price as yet another excuse not to do what needs to be done.
Re: WSJ: HSAs Offer Tax Benefits Beyond 401(k)s
We have many chronic conditions include HIV, which are very expensive. The meds alone cost $60k billed to my insurance every year.jlawrence01 wrote: Time and time again, people who never see a doctor do better with a HDHP. Also, people with chronic conditions who use a lot of healthcare ALSO benefit as their out-of-pockets are less than the traditional plans.
My employer's Kaiser HMO is far cheaper than the HDHP, even when factoring the tax benefits of the HSA.
The math goes like this - excerpt from my spreadsheet from the previous year. The costs barely changed this year, under 1% :
HMO :
annual premium : $7416
employer premium subsidy : $4992
deductible : $0
max family OOP : $3000
current annual out-of-pocket (all copays we actually spend on all drugs/visits/lab), about the same for 4 years : $600 . All paid pre-tax in an FSA . All the copays are fixed and very low, no coinsurance. Zero lab copay, $10 doctor visit, $10 for brand-name drug for 100 days.
Those $600 in out of pocket costs include 7 generic maintenance drugs, 3 brand name maintenance drugs, an estimate of 8 primary physician visits, 4 specialist visits, 8 urgent care visits, 8 one-off generic prescriptions, 12 lab visits include 80 different lab tests.
net annual healthcare costs : $3024, all pre-tax costs
HSA/HDHP :
annual premium : $6192
employer premium subsidy : $4992
employer HSA contribution : $450 . This is low because of my income - the employer is more generous at lower income levels with this plan. Whereas there is no income-based cost difference for the HMO .
employee HSA contribution : $3300
deductible : $2600
max family OOP : $3750
annual out-of-pocket costs we would actually owe on all drugs/visits/lab : $3750 . This is primarily due to drug coinsurance. $60k of HIV drugs at 10% coinsurance means we will reach this every year. There is thus no need to calculate the cost of any other services.
net annual healthcare costs : $4,500, all pre-tax costs
Ie. for us, with chronic conditions, and expensive drugs, the HDHP would cost 50% more than the HMO every year. And the out-of-pocket costs with the HDHP are about 6x the OOP what they are with the HMO. In theory, the HMO could go higher if we hit the HMO's max OOP, but this is extremely unlikely and has never happened.
Whereas the HDHP's plan design means we automatically hit the max OOP every year because of the 10% coinsurance on drugs.
I realize not all HDHPs and not HMOs are created equal, but the devil is in the details. HDHPs are rarely the best deal for people with chronic conditions. The premium savings have to come from somewhere, and it's usually in the form of higher OOP costs.
I think the fallacy is to think that everyone who consumes a lot of healthcare will hit the max OOP on a traditional plan - which is just not true on many plans. However, almost everyone consumes a lot of healthcare is going to hit the max OOP on an HDHP.
Again, this depends on plan design, and the individual items you consumes - whether it's prescription drugs, lab visits, hospital, imaging, ER, etc . But it's fair to say that you need a much smaller number of those items in general to hit the max OOP on an HDHP, than you do on a traditional plan.
FYI, the costs for the 2 above plans are with a US mega-corp.
Re: WSJ: HSAs Offer Tax Benefits Beyond 401(k)s
From my experience, its either an HSA or a PPO. I haven't heard of many HMOs in recent years. I wish my company still had the HMO. Bad stories of not a lot of good doctors available with it, but mine accepted it and I was happy.
I chose the HSA HDHP. I agree with the previous poster, hsa is best in our plan for no expenses or high expenses. The middle of the road, not so much. Had a child and it cost 5k deductible. PPO would have been 7k due to the 10% after deductible ppo vs 0% after deductible for hsa.
Lower premiums, company contribution make mine better in many situations.
I chose the HSA HDHP. I agree with the previous poster, hsa is best in our plan for no expenses or high expenses. The middle of the road, not so much. Had a child and it cost 5k deductible. PPO would have been 7k due to the 10% after deductible ppo vs 0% after deductible for hsa.
Lower premiums, company contribution make mine better in many situations.
Re: WSJ: HSAs Offer Tax Benefits Beyond 401(k)s
I think you mean HDHP or PPO. HSA is entirely optional - you could have an HDHP without an HSA, though it may not be the best idea.ne2ca28 wrote:From my experience, its either an HSA or a PPO.
I don't know what you call middle of the road, but I don't consider our $60k in prescription drugs every year to be "middle of the road", and still the HMO plans comes far, far cheaper. FYI, the HMO is regulated by the CA department of managed care, while the HDHP is administered by UHC but self-insured by my large employer.I haven't heard of many HMOs in recent years. I wish my company still had the HMO. Bad stories of not a lot of good doctors available with it, but mine accepted it and I was happy.
I chose the HSA HDHP. I agree with the previous poster, hsa is best in our plan for no expenses or high expenses. The middle of the road, not so much. Had a child and it cost 5k deductible. PPO would have been 7k due to the 10% after deductible ppo vs 0% after deductible for hsa.
Lower premiums, company contribution make mine better in many situations.
I would love to hear from people who have other expensive chronic conditions what their out-of-pocket costs are like with HDHP, especially those who have switched from a traditional plan, or have done the math to compare it.
IMO, when it comes to one's health, the tax savings should not be the primary concern.
There is mounting evidence that HDHPs are hazardous to one's health. People are foregoing necessary care because of the deductibles and out-of-pocket costs. Frankly, I think combining insurance with investment components is a bad idea, and that's as true with health insurance as it is with life insurance.
I would normally not cite the RAND corporation, but this is what came in google about high deductible plans :
http://www.rand.org/pubs/technical_repo ... plans.html
Several analyses suggest that consumers with few health care needs will see savings if they switch from a standard plan to an HDHP, whereas those with chronic diseases and moderate health care needs will likely face higher out-of-pocket costs for health care.
Lower spending observed in HDHPs may be the result of favorable selection, that is, may attract a higher proportion of healthier enrollees.
If HDHPs are offered as a choice among several different types of health plans, they may tend to attract younger and healthier individuals, who have low health care needs, or high income employees, who can afford greater out-of-pocket costs in exchange for lower premiums.
FYI, here is another study about HDHP for those with chronic conditions:Barry et al. (2008), in analyzing Alcoa's decision to introduce a CDHP as a health plan choice to its employees, found that families that had a member with diabetes, asthma, or heart disease were less likely to enroll in the CDHP than families without a member with a chronic condition.
http://theincidentaleconomist.com/wordp ... onditions/
Another issue is foregoing or delaying care, which is especially serious for people with chronic conditions :
https://www.researchgate.net/publicatio ... alth_Plans
The foregone/delayed can actually result in worse health down the line for the employee, and higher medical costs for the employer HDHP plan down the line, especially self-insured plans.
Here is another good article that my company's HDHP 10% cost sharing on prescription drugs actually exemplifies :
http://healthaffairs.org/blog/2015/10/0 ... lth-plans/
I don't think there is really much of a debate that for the same set of medical services, the out-of-pocket costs will in general be higher with an HDHP plan than a traditional plan (especially an HMO). This is the compromise you make in exchange for a lower premium. If you have an expensive chronic medical condition, it's likely to cost you more to treat with the HDHP than traditional plan overall, when considering both the premium and out-of-pocket costs. If it happens to cost you less, you might not be treating it to the same degree.In some plans, including those consumer-directed health plans with a health savings account, out-of-pocket expenses apply to prescription drugs as well, which may result in patients not filling prescribed medications. This phenomenon is especially troubling among the chronically ill, for whom following through with necessary medications and tests is vital for disease maintenance. Indeed, a recent Deloitte white paper suggests that provider-initiated disease management programs and the improvement in quality ratings may suffer, when patient compliance is challenged by high cost-sharing.
The RAND study cited before also articulated a potentially hazardous vicious circle: individuals in poorer health tend to be ordered more medical services that can result in comparatively greater financial burden, leading to noncompliance, which in turn sustains adverse health.
In our case, with $60k in prescription drugs and $600 in copays on the HMO, that works out to 1% cost sharing.
The very same drugs cost $3750 in out of pocket costs on the HDHP - or 6.25% cost sharing.
And of course, it would be 10% if the max OOP on the HDHP was not reached - but OOP is likely to go up.
Additionally, the drugs are not all our costs - there are doctor visits and lab tests, for which I have absolutely no idea of the real cost, because I never see a bill from my HMO, with the exception of prescription drugs, where the bill states "your insurance saved you $XXX", where $XXX is the difference between my copay and the retail price of the drugs.
As I said, I would love to see someone else with an actual chronic condition - not a one-time event - and what their costs are on an HDHP, especially if there is a comparison available with HMO or PPO. The experts seem to all think that it's incorrect to say that chronic conditions will cost less with HDHPs.
On the other hand, if you are never sick, and/or young and invincible, then, yes, the HDHPs may be the best plan for you. Until you are not in that group anymore. Then you'll likely want to do the math again and switch - if your employer still offers a traditional plan.
Re: WSJ: HSAs Offer Tax Benefits Beyond 401(k)s
Employers are increasingly offering only an HDHP plan, so when that decision has already been made for you, I think it's a no-brainer to set up and max out an HSA.
Our company added an HDHP to our other two options about five years ago, and then at open enrollment in late 2014 told us that starting in 2015 there would be only one healthcare plan, an HDHP. As a carrot, the company contributed $500 for anyone who opened an HSA; it was a one-time only contribution.
Our company added an HDHP to our other two options about five years ago, and then at open enrollment in late 2014 told us that starting in 2015 there would be only one healthcare plan, an HDHP. As a carrot, the company contributed $500 for anyone who opened an HSA; it was a one-time only contribution.
Re: WSJ: HSAs Offer Tax Benefits Beyond 401(k)s
The difference isn't always this large. At my employer the PPO plan with $300/person deductible only costs the employee 20% more than the HDHP. An HMO plan with zero deductible actually costs the employee less than the HDHP.BeneIRA wrote:This is a great point, but as someone who is in the industry, I can tell you that in the majority of cases, the HDHP is the best plan. A few years ago, they were a lot less common, but now, the entire industry is shifting to heavily promoting HDHPs. My last two employers strongly pushed in favor of the HDHP. Had I wanted a lower deductible plan, the bidding started at 4 times the cost of my HDHP, and that was just for a lower HDHP ($1500 vs. $3000 deductible). Had I wanted an $800 deductible plan, it was roughly 6-7 times as much as what I was paying.madbrain wrote:One should not look only to the tax benefits of the HSA. There are drawbacks to HDHPs.
The tax benefits of the HSA may be there, but the HDHP one needs to have to open and contribute to an HSA often has much higher out of pocket costs than traditional plans. Unless you never see a doctor and don't take any regular prescription drugs, an HDHP may not be the best idea.
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Re: WSJ: HSAs Offer Tax Benefits Beyond 401(k)s
If you are in the 25% federal bracket or higher and sometimes, states allows a deduction for HSA contributions, those tax savings coupled with the savings on the premiums that the employee pay would be higher than the amounts you'd be saving by having a PPO or HRA.
I am a CPA and trust me, I ran the calculation a billion times. It is better to have an HSA than any other plan. Employers essentially pushed the cost of care on the federal government by having the employee pay less taxes.
I am a CPA and trust me, I ran the calculation a billion times. It is better to have an HSA than any other plan. Employers essentially pushed the cost of care on the federal government by having the employee pay less taxes.
Re: WSJ: HSAs Offer Tax Benefits Beyond 401(k)s
Madbrain, agree in your case it looks like the HSA is not the way to go. What would the math look like if you assumed you don't need the HSA money to pay for your medical expenses every year, I.e. have more money for investing?
For us the HSA is a complete no brainer. We are in the highest tax bracket, the premium difference is much higher than in your example and our medical expenses are relatively low. I don't touch the money in my HSA and let it grow. Or at least in theory it would grow if it wasn't invested in international / emerging market stocks
For us the HSA is a complete no brainer. We are in the highest tax bracket, the premium difference is much higher than in your example and our medical expenses are relatively low. I don't touch the money in my HSA and let it grow. Or at least in theory it would grow if it wasn't invested in international / emerging market stocks
Re: WSJ: HSAs Offer Tax Benefits Beyond 401(k)s
Well, then you may want to consider that your math doesn't apply to everyone or every HDHP plan.ahmadcpa wrote:If you are in the 25% federal bracket or higher and sometimes, states allows a deduction for HSA contributions, those tax savings coupled with the savings on the premiums that the employee pay would be higher than the amounts you'd be saving by having a PPO or HRA.
I am a CPA and trust me, I ran the calculation a billion times. It is better to have an HSA than any other plan. Employers essentially pushed the cost of care on the federal government by having the employee pay less taxes.
The biggest problem, IMO, is that $X in out-of-pocket in a traditional plan buys more healthcare than $X in out-of-pocket costs in an HDHP.
If you are comparing identical out-of-pocket amounts, you are usually comparing the same price for a very different set of services. The tax aspect becomes irrelevant at this point.
As I have shown, even for $60k+ in healthcare, I only have $600 of OOP costs on my HMO. But I would max out the $3750 OOP costs on my employer's HDHP. It would take us 30 $100 surgeries to max my HMO plan (or more, I once paid a single $100 copay for 3 operations during one visit), or 300 brand-name prescription for 100 days each, 300 physician visits, an infinite number of lab visits (there is no copay), or 40 ER visits. It's actually really difficult to imagine how I would max those $3000 OOP on my HMO, one has to get creative. It could easily take one million dollar + of healthcare to do that.
But it's not hard at all to max the $3750 OOP on the HDHP, which has 10% coinsurance on many things. $37,500 in drugs is enough to reach the max OOP, and we have more than that every year.
I'm not a CPA, but I'm actually in the 25%+ federal tax bracket . The tax benefit of the HSA absolutely does not make up for the much higher cost of the HDHP in my case, which disagrees with your billion previous calculations. It's really hard to make up for a 50% higher healthcare cost through tax breaks, which is what the HDHP premium + OOP costs vs my HMO premium + OOP , for the same services.
Even if my state allowed a deduction for HSA contributions (it doesn't), the tax break still wouldn't make up for the 50% higher cost.
While it would be possible to contribute a higher amount to the HSA than the annual out-of-pocket expenses, and thus the possibility of some tax-free growth, it would take a very long time - certainly many years, if not decades - just to make up the cost difference. And you also have to consider that you could invest some of the money in a taxable account as well if you have the HMO.
In fact, let's do the math, since it's saturday night and I'm in the mood. Let's forget the state tax issue and assume there isn't any (ie neutral).
HSA/HDHP case :
employee pretax premium : $1200 ($6192 - $4992)
employee pretax HSA contribution : $3300 . This covers the $3750 max OOP minus $450 employer HSA contribution, which is what we would actually owe for using the same services as with the HMO.
total spent by employee on healthcare, pretax : $4500
HMO :
employee pretax premium : $2442 ($7416 - $4992)
employee pretax FSA contribution : $600 (this covers the $600 we owe in actual costs, not the $3000 max OOP)
total spent by employee on healthcare, pretax : $3024
This means I have $4500 - $3024 = $1476 more gross dollars available for things other than healthcare by using the HMO instead of the HDHP/HSA.
Unless the tax rate on those $1476 is 100%, that means I will have more money to invest or spend by using the HMO.
Assuming 25% federal tax bracket, that means $1107 extra available every year for investing in a taxable account.
Of course, the HSA allows a family contribution higher than the max out of pocket costs of my HDHP. Let's run the scenario this way, assuming one has extra amount left over to invest in the HSA beyond the actual out-of-pocket costs of the HDHP every year :
HSA/HDHP case :
employee pretax premium : $1200 ($6192 - $4992)
employee pretax HSA contribution : $6200 . This is the maximum possible employee contribution, which leaves $2900 available for investing, after deducting the $3750 max OOP we would owe, and adding the $450 employer HSA contribution.
total gross dollars spent on healthcare + investing : $7400
leftover in HSA for investing each year : $2900
HMO :
employee pretax premium : $2442 ($7416 - $4992)
employee pretax FSA contribution : $600 (this covers the $600 we owe in actual costs, not the $3000 max OOP)
total spent by employee on healthcare, pretax : $3024
Amount available for after tax investing, assuming $7400 gross dollars spent on healthcare + investing, and 25% tax bracket.
(7400 - 3024) *.75 = $3282
So, if I decide to spend the same amount of gross dollars, I start with much more money available to invest by using the HMO, $3282 vs $2900, or 13.1% more contributions every year in fact. The tax advantage of the HSA may mean that the balance will grow faster, however. But it has to overcome that 13.1% more contributions in the after-tax account ! I believe that's going to be extremely difficult, and the tax breaks aren't going to do it.
Here is the math based on investing these amounts over 40 years in a fund with an 8% total return and 2% taxable dividend yield.
This is assuming the tax rate on dividends is 15%.
As you can see, the balance in the HSA never exceeds the balance in the taxable account !
After 40 years, the balance difference between the 2 accounts is only 3.79% or $32,090, in favor of the HMO/taxable account
There is also one big issue : flexibility . In the taxable account case, you can use the funds for anything you want.
With the HSA, you are restricted to paying for qualified medical expenses, or LTCI, or COBRA (there may be other exceptions). If you use the funds for any other reason, you will pay regular income tax on it, not to mention an extra 20% penalty, if withdrawing before age 65.
Assuming one is still in the 25% tax bracket - and makes partial withdrawals every year - the balance after 40 years will be significantly lower with the HSA than with the taxable account - $846,355.16 for the taxable account, $610,698.76 for the HSA.
And of course, if taking larger withdrawals (say, all at once), one could end up in a higher tax bracket than 25%, which would reduce it further.
To me, this shows the HSA is a bad bet. And I'm not even accounting for the fact that I'm in CA which would make the taxes look worse for the HSA - by reducing the $6200 contribution amount by 9.3%, since California doesn't have a deduction for contributions. The same 9.3% would also be added to dividend taxes for the taxable account. The 9.3% also reduces the amount left to contribute every year in the taxable account.
Here is what it looks like with CA adjustments . CA makes the HSA/HDHP case worse, but only a little bit, since the CA taxes on the taxable account too.
Re: WSJ: HSAs Offer Tax Benefits Beyond 401(k)s
Great question.ge1 wrote:Madbrain, agree in your case it looks like the HSA is not the way to go. What would the math look like if you assumed you don't need the HSA money to pay for your medical expenses every year, I.e. have more money for investing?
If assuming $0 out-of-pocket costs for both plans, the math would be overwhelmingly in favor of the HSA/HDHP - the final investment balance is about double in the HSA vs taxable account, in the 25% tax bracket, even with CA taxes figured in.
However, I think doing that comparison is very misleading. The only way to get to $0 out-of-pocket costs is if you are skipping things like lab tests ordered by your doctor during the free annual checkup - or skipping the free checkup altogether. If you did those tests, you probably would have non-zero OOP costs with your HDHP. Since the plan has a high deductible, those costs would be significant. Multiply that by every family member as well.
On the other hand, you might have very low costs on a traditional plan. For example, in my HMO, all lab tests are free with no copay, and the plan has no deductible.
Even if we were very healthy and did just the annual checkups, the lab tests for the 2 of us might cost $1000 on the HDHP, which would be below the deductible and thus owed, vs $0 on the HMO. But $1,000 is just a guess, I really have no idea, since I have never seen a lab bill from my HMO - there is no copay and thus no E.O.B. for lab tests, and never has been for 15 years on my various Kaiser plans.
If one isn't even doing their checkup and associated tests, then maybe the better comparison would be for someone who declines coverage altogether and just invests all the money after-tax that would have been spent on healthcare premium + HSA.
IMO, if one wants to make valid comparisons, one needs to know the list of services that one will be using, and have a reasonable estimate of the OOP costs of those services for both plans.
For example, my cost estimate for my HMO OOP costs is based on 12 lab visits, 80 annual lab tests, 0.5 xray, 0.5 ER visits, 7 generic maintenance drugs, 4 brand name maintenance drugs, 8 one-off generic drugs. The OOP estimated amount is $597.50 .
Quicken shows me that our actual copays last year were $400 exactly , so that was an overestimate for the year.
But we do know that just because of drugs, the same services we used last year would have cost the full $3750 OOP on the company's HDHP - that's a very simple calculation.
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Re: WSJ: HSAs Offer Tax Benefits Beyond 401(k)s
Answer is: It depends. FSA have tax savings as well, right?ahmadcpa wrote:If you are in the 25% federal bracket or higher and sometimes, states allows a deduction for HSA contributions, those tax savings coupled with the savings on the premiums that the employee pay would be higher than the amounts you'd be saving by having a PPO or HRA.
I am a CPA and trust me, I ran the calculation a billion times. It is better to have an HSA than any other plan. Employers essentially pushed the cost of care on the federal government by having the employee pay less taxes.
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Re: WSJ: HSAs Offer Tax Benefits Beyond 401(k)s
It would be interesting to see the actual data on that. These HDHPs are not just falling randomly from the sky. They are part of an aggressive search to reduce benefit costs. I suspect my situation is not that unusual -- the net cost to the employee is cheaper under almost all the most plausible scenarios than the traditional plans also offered.madbrain wrote:One should not look only to the tax benefits of the HSA. There are drawbacks to HDHPs.
The tax benefits of the HSA may be there, but the HDHP one needs to have to open and contribute to an HSA often has much higher out of pocket costs than traditional plans. Unless you never see a doctor and don't take any regular prescription drugs, an HDHP may not be the best idea.
Re: WSJ: HSAs Offer Tax Benefits Beyond 401(k)s
As I stated earlier, I don't think the data if you never see a doctor is all that relevant - if you aren't even bothering to do a checkup and annual tests, why do you even have health insurance ? Why not invest the entire cost of the healthcare premium ? That would come out ahead of both the traditional plan + after-tax investing ; or HDHP + HSA investing .Aptenodytes wrote:It would be interesting to see the actual data on that. These HDHPs are not just falling randomly from the sky. They are part of an aggressive search to reduce benefit costs. I suspect my situation is not that unusual -- the net cost to the employee is cheaper under almost all the most plausible scenarios than the traditional plans also offered.madbrain wrote:One should not look only to the tax benefits of the HSA. There are drawbacks to HDHPs.
The tax benefits of the HSA may be there, but the HDHP one needs to have to open and contribute to an HSA often has much higher out of pocket costs than traditional plans. Unless you never see a doctor and don't take any regular prescription drugs, an HDHP may not be the best idea.
IMO, when doing a price comparison, one needs to compare the price for the same set of services rendered. Otherwise, the comparison is not meaningful. That means estimating your OOP costs for the various plans available. Not just calculating the worst case.
$0 of OOP costs with my HMO buys an unlimited amount of lab tests that could max the OOP cost of the HDHP.
I have run the calculations with those numbers below for this case - $200 of OOP costs on HMO for the few services that have copays (imaging) vs $1200 of OOP costs with HDHP, both to pay for regular tests. I think it is optimistic to think that anybody's OOP costs will remain this low for 40 years. There may be less than $1200 in lab tests at a young age, and more than $1000 when older - but more likely, it won't just be tests when older. It's just the way life is - people get sicker when they are older - and even if healthy, there is more screening in older age - more Xrays, ultrasound, MRI, CT scans, mammograms, colonoscopies, vaccines, hearing exams, etc.
Here is what that calculation shows, with $200 of OOP for HMO, $1200 OOP for HDHP - ie. OOP for screening only, and 25% tax bracket, no state tax :
In this case, the final HSA balance is 50.73% higher than the taxable account.
However, if you withdraw the HSA funds for non-qualified expenses, then what's left is only 13.05%.
Here is the same thing with the highest 39.6% federal tax bracket, and 13.3% California state tax bracket, and 20% federal dividend tax rate.
In this case, the final HSA balance is 125.90% higher than the taxable account - more than double.
However, if you withdraw the HSA funds for non-qualified expenses, then what's left is only 6.40%.
If you are really that healthy for 40 years and only require screening and no treatments, then I think it's fair to say that you won't be able to use most of the HSA balance for qualified expenses. Thus, IMO, it's valid to count the taxes on non-qualified withdrawals. Note that these calculations are all assuming the same tax brackets for every year.
If your spouse inherits your HSA, and the spouse does a non-qualified withdrawal of the balance, the less favorable single tax brackets may mean that the withdrawal taxes will be higher.
If the HSA is inherited by a non-spouse, then it will become taxable in full that year, in the beneficiary's tax brackets, which are unknown, but can't be higher for the last illustration since it assumes the highest tax brackets, but they could very well be higher for the previous illustration.
The amount of tax in the taxable account might be reduced by TLH also, which I didn't try to account for. This would skew things a little bit in favor of the taxable account, more so if you are in the highest tax bracket, possibly enough to make up the difference in the case where the HSA balance is used for non-qualified expenses. I didn't attempt to calculate the impact of TLH. Of course, TLH won't be available every year, so it's hard to estimate.
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Re: WSJ: HSAs Offer Tax Benefits Beyond 401(k)s
madbrain wrote:I think you mean HDHP or PPO. HSA is entirely optional - you could have an HDHP without an HSA, though it may not be the best idea.ne2ca28 wrote:From my experience, its either an HSA or a PPO.
I don't know what you call middle of the road, but I don't consider our $60k in prescription drugs every year to be "middle of the road", and still the HMO plans comes far, far cheaper. FYI, the HMO is regulated by the CA department of managed care, while the HDHP is administered by UHC but self-insured by my large employer.I haven't heard of many HMOs in recent years. I wish my company still had the HMO. Bad stories of not a lot of good doctors available with it, but mine accepted it and I was happy.
I chose the HSA HDHP. I agree with the previous poster, hsa is best in our plan for no expenses or high expenses. The middle of the road, not so much. Had a child and it cost 5k deductible. PPO would have been 7k due to the 10% after deductible ppo vs 0% after deductible for hsa.
Lower premiums, company contribution make mine better in many situations.
I would love to hear from people who have other expensive chronic conditions what their out-of-pocket costs are like with HDHP, especially those who have switched from a traditional plan, or have done the math to compare it.
IMO, when it comes to one's health, the tax savings should not be the primary concern.
There is mounting evidence that HDHPs are hazardous to one's health. People are foregoing necessary care because of the deductibles and out-of-pocket costs. Frankly, I think combining insurance with investment components is a bad idea, and that's as true with health insurance as it is with life insurance.
I would normally not cite the RAND corporation, but this is what came in google about high deductible plans :
http://www.rand.org/pubs/technical_repo ... plans.html
Several analyses suggest that consumers with few health care needs will see savings if they switch from a standard plan to an HDHP, whereas those with chronic diseases and moderate health care needs will likely face higher out-of-pocket costs for health care.Lower spending observed in HDHPs may be the result of favorable selection, that is, may attract a higher proportion of healthier enrollees.If HDHPs are offered as a choice among several different types of health plans, they may tend to attract younger and healthier individuals, who have low health care needs, or high income employees, who can afford greater out-of-pocket costs in exchange for lower premiums.FYI, here is another study about HDHP for those with chronic conditions:Barry et al. (2008), in analyzing Alcoa's decision to introduce a CDHP as a health plan choice to its employees, found that families that had a member with diabetes, asthma, or heart disease were less likely to enroll in the CDHP than families without a member with a chronic condition.
http://theincidentaleconomist.com/wordp ... onditions/
Another issue is foregoing or delaying care, which is especially serious for people with chronic conditions :
https://www.researchgate.net/publicatio ... alth_Plans
The foregone/delayed can actually result in worse health down the line for the employee, and higher medical costs for the employer HDHP plan down the line, especially self-insured plans.
Here is another good article that my company's HDHP 10% cost sharing on prescription drugs actually exemplifies :
http://healthaffairs.org/blog/2015/10/0 ... lth-plans/
I don't think there is really much of a debate that for the same set of medical services, the out-of-pocket costs will in general be higher with an HDHP plan than a traditional plan (especially an HMO). This is the compromise you make in exchange for a lower premium. If you have an expensive chronic medical condition, it's likely to cost you more to treat with the HDHP than traditional plan overall, when considering both the premium and out-of-pocket costs. If it happens to cost you less, you might not be treating it to the same degree.In some plans, including those consumer-directed health plans with a health savings account, out-of-pocket expenses apply to prescription drugs as well, which may result in patients not filling prescribed medications. This phenomenon is especially troubling among the chronically ill, for whom following through with necessary medications and tests is vital for disease maintenance. Indeed, a recent Deloitte white paper suggests that provider-initiated disease management programs and the improvement in quality ratings may suffer, when patient compliance is challenged by high cost-sharing.
The RAND study cited before also articulated a potentially hazardous vicious circle: individuals in poorer health tend to be ordered more medical services that can result in comparatively greater financial burden, leading to noncompliance, which in turn sustains adverse health.
In our case, with $60k in prescription drugs and $600 in copays on the HMO, that works out to 1% cost sharing.
The very same drugs cost $3750 in out of pocket costs on the HDHP - or 6.25% cost sharing.
And of course, it would be 10% if the max OOP on the HDHP was not reached - but OOP is likely to go up.
Additionally, the drugs are not all our costs - there are doctor visits and lab tests, for which I have absolutely no idea of the real cost, because I never see a bill from my HMO, with the exception of prescription drugs, where the bill states "your insurance saved you $XXX", where $XXX is the difference between my copay and the retail price of the drugs.
As I said, I would love to see someone else with an actual chronic condition - not a one-time event - and what their costs are on an HDHP, especially if there is a comparison available with HMO or PPO. The experts seem to all think that it's incorrect to say that chronic conditions will cost less with HDHPs.
On the other hand, if you are never sick, and/or young and invincible, then, yes, the HDHPs may be the best plan for you. Until you are not in that group anymore. Then you'll likely want to do the math again and switch - if your employer still offers a traditional plan.
The devil is in the details.
If I went on a traditional plan, I would pay an additional $4k in premiums. And instead of a maximum family OOP of $4k with the HDHP, I would pay $8k with the traditional plan.
Under the traditional plan, my maximum exposure would equal CURRENT PREMIUM + $4k additional premium + $8k OOP. ( I might add that under the traditional plan, there are NO OOP maximums for medications. so there would probably be at least anouther $1k in medication expense.)
Under the HDHP, I would pay current premium + $4k OOP. In addition, I would get some tax benefits from the HSA.
And we decided long ago that HMOs were bad news and will avoid them as long as possible.
I only care about MAXIMUM exposures as I have already maxed out my OOP for 2016.
Re: WSJ: HSAs Offer Tax Benefits Beyond 401(k)s
I agree that the devil is in the details, and you may be missing the forest before the trees by looking only at maximum exposure.jlawrence01 wrote: The devil is in the details.
If I went on a traditional plan, I would pay an additional $4k in premiums. And instead of a maximum family OOP of $4k with the HDHP, I would pay $8k with the traditional plan.
Under the traditional plan, my maximum exposure would equal CURRENT PREMIUM + $4k additional premium + $8k OOP. ( I might add that under the traditional plan, there are NO OOP maximums for medications. so there would probably be at least anouther $1k in medication expense.)
Under the HDHP, I would pay current premium + $4k OOP. In addition, I would get some tax benefits from the HSA.
And we decided long ago that HMOs were bad news and will avoid them as long as possible.
I only care about MAXIMUM exposures as I have already maxed out my OOP for 2016.
Personally, I care about both maximum and actual exposure.
The traditional plan in my case has $2,424 in premium + $3,000 OOP - maximum exposure $5,424 .
The HDHP has a $1,200 premium + $3,750 max OOP, less the $450 employer HSA contribution - maximum exposure $4,500 .
If I only looked at the maximum exposure, I would choose the HDHP. But I'm savvier than that, so I look at what we actually would spend with either plan.
By looking at actual exposure, I see that our $60k+ of drugs + all other medical services (probably at least $10k more) only result in $600 OOP with the HMO, but they would result in the maximum exposure every year with the HDHP. And thus, the HMO is in reality a much better deal for me, since actual exposure with HMO is $2,424 + $600 = $3,024 , and actual exposure with HDHP is $1,200 + $3,300 = $4,500 .
I would strongly suggest you estimate your actual OOP costs when comparing plan options, and not just maximum costs.
In my case the OOP costs are 6x as high with the HDHP as with the HMO for the same services. I don't think it's uncommon at all. Higher OOP costs is a feature of HDHP plans, not a bug.
Re: WSJ: HSAs Offer Tax Benefits Beyond 401(k)s
madbrain,
Regarding your $60k in prescription drugs being based on the "sticker price," consider that those under HDHPs are paying far below sticker price as well in many cases since their insurers also likely negotiate rates. It's true that before the deductible in the HDHP you would pay 100 percent of that negotiated rate, but you wouldn't usually be paying the sticker price.
I'm thinking it's probably not enough to swing the analysis in your case but during your company's next open enrollment you might be able to ask the available HDHP providers to run the numbers for the drugs you take.
Regarding your $60k in prescription drugs being based on the "sticker price," consider that those under HDHPs are paying far below sticker price as well in many cases since their insurers also likely negotiate rates. It's true that before the deductible in the HDHP you would pay 100 percent of that negotiated rate, but you wouldn't usually be paying the sticker price.
I'm thinking it's probably not enough to swing the analysis in your case but during your company's next open enrollment you might be able to ask the available HDHP providers to run the numbers for the drugs you take.
Re: WSJ: HSAs Offer Tax Benefits Beyond 401(k)s
I don't know how much pricing power the insurers actually have in terms of HIV drug costs. HIV drugs commonly costs between $15,000 to $30,000 per person per year. Almost all of the HIV drugs are still covered by patents and thus brand-name. And one must take a minimum of 3 of these drugs in combination. Sometimes they come in combination pills, sometimes not. I take one that is a combo of 2 drugs, and the 3rd is separate. My husband takes a single combo pill that's 3-in-one. And of course, these HIV drugs are not the only drugs we take. I have another brand name drug for another issue, which is the only effective treatment for that condition. All our other prescriptions are generics.nps wrote:madbrain,
Regarding your $60k in prescription drugs being based on the "sticker price," consider that those under HDHPs are paying far below sticker price as well in many cases since their insurers also likely negotiate rates. It's true that before the deductible in the HDHP you would pay 100 percent of that negotiated rate, but you wouldn't usually be paying the sticker price.
I'm thinking it's probably not enough to swing the analysis in your case but during your company's next open enrollment you might be able to ask the available HDHP providers to run the numbers for the drugs you take.
The EOB from Kaiser shows me the fix copay and then says "your insurance saved you $XXX". I am not sure if $XXX is the amount Kaiser actually paid for the drugs (less my copay). The EOB lists the Kaiser member price for the drugs. I don't know if that is the same as the "sticker price". It may be the negotiated Kaiser price already. In any case, I get all my prescription drugs 100-day supply in the mail, and usually the $XXX number is in the $9000 range. It's similar for my husband.
I think it's a given for us that the HDHP will have higher OOP costs. The plan has a $2600 family deductible, and 10% coinsurance for all drugs, and a $3750 maximum OOP. I can do the math.
With Kaiser, I have current exposure of $3024 (see above, $2424 premiums + $600 OOP).
With the HDHP, it's $1200 + OOP minus $450 in employer HSA contributions.
So the OOP must be a max of $3024 - $1200 = $1824 . Add back the $450 of employer HSA contributions. Thus, the OOP must be a max of $2274 for the HDHP to breakeven with the HMO in terms of medical costs.
But the HDHP plan has a $2600 family deductible. Thus, we know we won't be paying less than $2600 in OOP for sure.
Even if these drugs were covered 100% after deductible, our total costs with the HDHP would still be higher than with the HMO.
But in reality, they are covered at only 10% after deductible. The difference between the max OOP and the deductible is $3750 - $2600 = $1150 .
Thus, if the drugs cost more than $2600 + $1150 / 10% = $14,100 a year, we will hit the max OOP for the HDHP.
$14,100 out of $60,000 retail price would be an insurance discount of 76.5%. I don't think it's likely for these brand name drugs. And of course, we still have other medical costs - doctor visits, lab tests, etc, such that it's inconceivable that we would not hit the max OOP on the HDHP.
It is not close - the HDHP has higher total costs, and this is by design.
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Re: WSJ: HSAs Offer Tax Benefits Beyond 401(k)s
During the last open enrollment, I fired up a spreadsheet and entered all our EOBs for the past few years. A childbirth is theoretically one of those life events for which an HDHP is not well suited, however, after crunching the numbers, I determined that, thanks to my employer's $1500 contribution (in the form of a premium pass-through) to my HSA, the premium reduction compared to the PPO we were on would have made our overall outlay for health care lower. The big difference, and cause of much irrationality, is that instead of being paid as premiums and handled by the insurance company, those dollars are being contributed to my HSA and handled by me. An employer contribution to a plan's HSA can make all the difference in the world.
Understand that choosing an HDHP is very much a "red pill" approach. Most would rather pay higher premiums for a $20 copay per visit. They will think you weird for choosing an HSA.
Re: WSJ: HSAs Offer Tax Benefits Beyond 401(k)s
@madbrain. POZ here and single. I picked a HDHP instead of a PPO copay plan and here is why:
I take one pill a day and the drug manufacturer will cover out of pocket costs for its medication for me up $6,000 a year.
My medication is about $6800 every quarter for a 90 day supply.
My insurance has a $1300 deductible and a $3000 out of pocket max and 20% coinsurance.
If my medication is my first claim which it was this year, that first script required me to pay $2400. The pharmacy then processes the copay card, and the manufacturer pays that $2400 and the insurance company has no knowledge of that. So now I basically have $600 remaining in my out of pocket max.
My annual premium is $1548 and my employer contributes $750 to my HSA. If I max out my contribution I get another $728 in tax savings. So basically, my net cost would be $70. The only nuisance is that you have to be a bit on top of getting refills as soon as you can.
The copay plan that's available is $242 a month and I could probably get about 700 in tax savings with fsa contributions but since prescription and medical costs are separate. I may easily have $1300 in out pocket medical costs so the copay plan doesn't make any sense. A copay plan would cost me at least $3500 per year.
The insurance copay assistance from the manufacturer appears to not make ineligible to make HSA contributions because any paperwork I read with it says that it is not insurance.
There are also no income limits for the copay assistance.
http://www.aidsmeds.com/articles/PAPs_C ... 9740.shtml
I take one pill a day and the drug manufacturer will cover out of pocket costs for its medication for me up $6,000 a year.
My medication is about $6800 every quarter for a 90 day supply.
My insurance has a $1300 deductible and a $3000 out of pocket max and 20% coinsurance.
If my medication is my first claim which it was this year, that first script required me to pay $2400. The pharmacy then processes the copay card, and the manufacturer pays that $2400 and the insurance company has no knowledge of that. So now I basically have $600 remaining in my out of pocket max.
My annual premium is $1548 and my employer contributes $750 to my HSA. If I max out my contribution I get another $728 in tax savings. So basically, my net cost would be $70. The only nuisance is that you have to be a bit on top of getting refills as soon as you can.
The copay plan that's available is $242 a month and I could probably get about 700 in tax savings with fsa contributions but since prescription and medical costs are separate. I may easily have $1300 in out pocket medical costs so the copay plan doesn't make any sense. A copay plan would cost me at least $3500 per year.
The insurance copay assistance from the manufacturer appears to not make ineligible to make HSA contributions because any paperwork I read with it says that it is not insurance.
There are also no income limits for the copay assistance.
http://www.aidsmeds.com/articles/PAPs_C ... 9740.shtml
Re: WSJ: HSAs Offer Tax Benefits Beyond 401(k)s
Thanks. I wasn't aware that these copay assistance plans didn't have income limits. This is good to know. It could possibly change the math for us, indeed.bazz2424 wrote:@madbrain. POZ here and single. I picked a HDHP instead of a PPO copay plan and here is why:
I take one pill a day and the drug manufacturer will cover out of pocket costs for its medication for me up $6,000 a year.
My medication is about $6800 every quarter for a 90 day supply.
My insurance has a $1300 deductible and a $3000 out of pocket max and 20% coinsurance.
If my medication is my first claim which it was this year, that first script required me to pay $2400. The pharmacy then processes the copay card, and the manufacturer pays that $2400 and the insurance company has no knowledge of that. So now I basically have $600 remaining in my out of pocket max.
My annual premium is $1548 and my employer contributes $750 to my HSA. If I max out my contribution I get another $728 in tax savings. So basically, my net cost would be $70. The only nuisance is that you have to be a bit on top of getting refills as soon as you can.
The copay plan that's available is $242 a month and I could probably get about 700 in tax savings with fsa contributions but since prescription and medical costs are separate. I may easily have $1300 in out pocket medical costs so the copay plan doesn't make any sense. A copay plan would cost me at least $3500 per year.
The insurance copay assistance from the manufacturer appears to not make ineligible to make HSA contributions because any paperwork I read with it says that it is not insurance.
There are also no income limits for the copay assistance.
http://www.aidsmeds.com/articles/PAPs_C ... 9740.shtml
But it's less predictable, as it depends on the order of claims. Also, my HMO plan allows getting 100 day drug refills, but I don't think the HDHP does. This is a major inconvenience, especially when traveling. And my doctor of more than 15 years is with the HMO, and I'm not sure if I could even see him without being a Kaiser member - but if so, it would be out of network expense subject to separate limits. It would make things more complicated in terms of medical records too - all of them being with Kaiser and integrated with the Kaiser doctor. That would get messy with tests being done at an outside lab. And having to do with different facilities for specialists, imaging, lab, etc. With Kaiser, almost everything is in one facility, which makes things easy. Except for the fact that I live in the hills and it's 15 miles away ...
From a strict number perspective, it may work out though. Will try to rerun things.
Last edited by madbrain on Thu Feb 11, 2016 5:22 pm, edited 2 times in total.
Re: WSJ: HSAs Offer Tax Benefits Beyond 401(k)s
I would probably be driving myself crazy trying to figure out the math on HDHP with HSA vs PPO or HMO if I still had those choices, but our company dropped all the options except the HDHP several years ago after a few years of aggressively pushing the HDHP but not being able to get most employees to switch to it while they still had other options. I suspect that as employers keep shifting more of the cost for benefits onto employees, that's going to become more common. So we may all end up with HSAs.
Re: WSJ: HSAs Offer Tax Benefits Beyond 401(k)s
My HSA (HealthEquity) adds on a ~.4% annual fee on top of mutual fund expense ratios (compared to my 401k, which has a .145% fee). I also think they charge my employer a fixed monthly account maintenance fee. Fortunately they offer "institutional plus" versions of a handful of Vanguard funds, which makes it a little easier to swallow. I know they do more work than your typical IRA in terms of processing claims and such, but the fees dampen my interest in it as an investment account.
Re: WSJ: HSAs Offer Tax Benefits Beyond 401(k)s
If you believe that you will not meet your deductible, I would seriously consider getting my labs via Life Extension. The male panel ($269) and the female panel of tests are the best buys. I believe they have a sale in March/April.madbrain wrote:Great question.ge1 wrote:Madbrain, agree in your case it looks like the HSA is not the way to go. What would the math look like if you assumed you don't need the HSA money to pay for your medical expenses every year, I.e. have more money for investing?
If assuming $0 out-of-pocket costs for both plans, the math would be overwhelmingly in favor of the HSA/HDHP - the final investment balance is about double in the HSA vs taxable account, in the 25% tax bracket, even with CA taxes figured in.
However, I think doing that comparison is very misleading. The only way to get to $0 out-of-pocket costs is if you are skipping things like lab tests ordered by your doctor during the free annual checkup - or skipping the free checkup altogether. If you did those tests, you probably would have non-zero OOP costs with your HDHP. Since the plan has a high deductible, those costs would be significant. Multiply that by every family member as well.
PS I am planning to get a blood test done prior to my first and hopefully last appointment of the year.
The male panel test includes the following:
http://www.lifeextension.com/vitamins-s ... blood-test
Chemistry Panel (metabolic panel with lipids) - The cornerstone of any complete physical, the chemistry panel provides an array of markers to help assess cardiovascular risk, metabolic function, electrolyte status, minerals important for bone health, plus liver and kidney function.
Complete Blood Count (CBC) - The CBC test evaluates three types of cells that circulate in the blood (red blood cells, white blood cells, and platelets). These markers can help to provide information regarding the immune system, possibility of an infection, blood disorder, nutritional deficiencies, your body’s ability to clot, and more.
Free & Total Testosterone - Known as the feel-good hormone, testosterone helps maintain a man’s bone density, fat distribution, muscle strength, sex drive, mood, energy, sperm production, and more.
Dehydroepiandrosterone sulfate (DHEA-S) - Produced primarily by the adrenal glands, DHEA is the most abundant steroid hormone in the human body. DHEA plays a fundamental role in hormone balance, as well as supporting one’s immune function, energy, mood, and maintenance of muscle and bone mass. Since orally administered DHEA is mostly converted to DHEA-S, coupled with the fact that DHEA-S levels are more stable in the blood than DHEA, measurement of DHEA-S is preferable to DHEA.
Prostate Specific Antigen (PSA) - PSA is produced exclusively by cells of the prostate gland. Used in conjunction with a digital rectal examination, PSA is a useful screening test for benign prostate hyperplasia (BPH) and prostate cancer development.
Estradiol (E2) - The primary female sex hormone, estradiol is a form of estrogen that is also present in males. In men, high levels of estradiol are associated with excessive abdominal fat, enlargement of the prostate, and increased cardiovascular risk. Conversely, levels that are too low are associated with osteoporosis.
Homocysteine - Identified by Life Extension as 1 of 17 independent risk factors for cardiovascular disease, high homocysteine levels can directly damage the delicate endothelial cells that line the inside of arteries, resulting in vascular inflammation, arterial plaque rupture, and blood clot formation.
C-reactive protein (High sensitivity) - CRP measures general levels of inflammation in your body, but cannot show where the inflammation is located or what is causing it. Uncontrolled, systemic inflammation places you at risk for many degenerative diseases like heart disease and stroke.
TSH (Thyroid stimulating hormone) - TSH is produced by the pituitary gland, and stimulates your thyroid to produce thyroid hormones T3 and T4. TSH can be used to screen for thyroid disease and other thyroid imbalances.
Vitamin D, 25-Hydroxy - Known as the sunshine vitamin, vitamin D is important to every cell and tissue throughout the body. From proper immune function and bone density to heart health and mood disorders, vitamin D is critical for optimal health.
Hemoglobin A1C (HbA1C) - HbA1C shows the average level of blood sugar (glucose) over the previous 3 months. HbA1C is a useful indicator of how well blood glucose is being controlled, and is also used to monitor the effects of diet, exercise, and drug therapy in diabetic patients.