HSA option only has in-network benefits, open enrollment dilemma

[blackcat allie]

Hi, wondering if people sacrifice the actual quality/offerings of health insurance plan for the option of the HSA account?
Normally I would take the health plan with in and out of network benefits, but at my job that only comes with FSA feature.

Since becoming active on this board, I’ve been watering my mouth with the idea of extra HSA triple-advantaged space. I suppose I could also be asking this question in Investing-Help with Personal Investments. One side point is that I'm a low earner, with tax bracket between 12/22% so perhaps HSA should not be as motivating.

I realize no one knows the future, and I don’t expect easy answers about which health insurance to to get, but wondering if anyone else has been in this boat? Thanks in advance for any reflections, experiences, input.

[DarkHelmetII]

Hi, wondering if people sacrifice the actual quality/offerings of health insurance plan for the option of the HSA account?
Normally I would take the health plan with in and out of network benefits, but at my job that only comes with FSA feature.

Since becoming active on this board, I’ve been watering my mouth with the idea of extra HSA triple-advantaged space. I suppose I could also be asking this question in Investing-Help with Personal Investments. One side point is that I'm a low earner, with tax bracket between 12/22% so perhaps HSA should not be as motivating.

I realize no one knows the future, and I don’t expect easy answers about which health insurance to to get, but wondering if anyone else has been in this boat? Thanks in advance for any reflections, experiences, input.

Some thoughts:

1) On the HSA / in-network only plan - some questions to think through:
How strong is the network?
How does out-of-network work for out of town / emergencies / out of country?
How healthy are you, what is the likelihood you need to see a doctor?

2) On the health plan option with in-network and out-of-network benefits, is it HSA eligible aside from the FSA? Perhaps unlikely, but if the plan is otherwise HSA-compliant, perhaps you can decline the FSA and fund an HSA.

3) Employer-sponsored insurance usually saves you money relative to the exchanges ... but if a) you are young, and b) employer's contribution to premiums is weak, maybe you can get an attractive HSA compatible plan on the exchanges.

All-in-all, the triple tax savings is certainly a nice little bonus (I am a huge fan!) but it's not THAT much money ... so don't overly jeopardize your access to the doctors you want and / or need.

[BL]

All-in-all, the triple tax savings is certainly a nice little bonus (I am a huge fan!) but it's not THAT much money ... so don't overly jeopardize your access to the doctors you want and / or need.

+1
Will you be mostly dependent on SS in retirement? Both FSA and HSA, AFAIK, don't add to SS. This could affect low earners.

[Edie]

Please clarify only in-network benefits. Is there no deductible (and then coinsurance) or out of pocket max for out-of-network expenses?

If there isn't even an OOP max for out-of-network, I would forego the HSA, because I am risk averse, and we often travel outside of our geographical area, where we might encounter out-of-network hospitals in the event of an emergency.

It is possible that emergency care could be charged at the in-network rate (according to what I read on https://www.healthcare.gov/using-market ... ency-care/), but that still wouldn't make the emergency care in-network and thus subject to deductibles and OOP maxes.

[blackcat allie]

Please clarify only in-network benefits. Is there no deductible (and then coinsurance) or out of pocket max for out-of-network expenses?

If there isn't even an OOP max for out-of-network, I would forego the HSA, because I am risk averse, and we often travel outside of our geographical area, where we might encounter out-of-network hospitals in the event of an emergency.

It is possible that emergency care could be charged at the in-network rate (according to what I read on https://www.healthcare.gov/using-market ... ency-care/), but that still wouldn't make the emergency care in-network and thus subject to deductibles and OOP maxes.

Thanks for your reply -- sadly there is no deductible or coinsurance for out-of-network.
There's an emergency medical plan that I need to find out more about. (I stayed on webinar for two hours at home on my day off, then when I tried to ask question the benefits presenter cut off the call. )

I'm risk averse too, and travel is something I'm hoping to do more. It would be interesting to research more what happens with unexpected travel medical expenses, and how easily those are reimbursed from domestic insurance plans with "out of network" benefits.

[toofache32]

OON benefits are becoming a thing of the past. I am a surgeon that is completely OON with all insurance, and I have seen OON benefits quickly disappear over the past 5-6 years. It used to be that all plans had some form of OON benefits. Now I see more and more plans with zero OON benefits. With all the "gotchas" of OON clauses, I'm not sure if they are worth it anyway. They rarely pay anything and look for ways to dump the responsibility on you. Since they wrote the contracts, they usually win in this regard.

[MP123]

In theory, ACA compliant plans have to cover you at in network rates for emergency care even if you are OON. But you're still open to balance billing from the providers for amounts that exceed that in many states. How that all works out is anyone's guess depending on the situation, emergency, and so on.

This doesn't apply to non-emergency care though.

[Chris K Jones]

The health insurance marketplace in my area is terrible. My job does not provide health insurance so I am left to the Obamacare policies that sell to individuals. There are NO companies that provide out of network benefits in my area. You are basically left with either Blue Cross' network or Kaiser's network. Both have HSA policies available. I chose Blue Cross because Kaiser is inconvenient for my family. In my experience in recent years, health insurance has paid virtually nothing. The HSA plan with Blue Cross is one of the cheaper ones ($1200 per month for one adult and two kids). I figure that I will at least get the HSA deduction.