HDHP vs Kaiser HMO

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seed4great
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HDHP vs Kaiser HMO

Post by seed4great » Tue May 07, 2019 1:26 pm

For employer sponsored health insurance, I always had a traditional PPO plan from UHC or BCBS through my career. Currently, I'm preparing to move to new job and they do not offer traditional PPO. Instead, they offer a few HDHP plans from UHC and no deductible plan from Kaiser California. I'm not that familiar with high deductible plans, but according to others they has very little benefits over high cost when paying out of pocket before deductible. There is HSA attached to it and some match from my prospective employer, which may be good to store pre-tax money. But account doesn't have much investment options and has high fees. From other side, Kaiser system is known for its reasonable cost for customers. But it is also evident that doctors employed by Kaiser may not be as good as private practitioners, and there might be problem if some special (not main stream) knowledge required. I understand there are pros and contras between these plans. I'd appreciate if someone can share an experience or opinion, especially those who live in SF Bay Area where Kaiser system is advanced. I'm a bit over 50, single, no kids and so far went to doctor for routine checks only. But of course anything can happen at this age.
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southerndoc
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Re: HDHP vs Kaiser HMO

Post by southerndoc » Tue May 07, 2019 1:31 pm

If you're in California, Kaiser is a pretty good system. Outside of that, they usually have narrow in-network facilities/physicians.

mega317
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Re: HDHP vs Kaiser HMO

Post by mega317 » Tue May 07, 2019 1:35 pm

It would be helpful if you posted the specifics of the plans available to you--premiums, out of pocket max, etc.
seed4great wrote:
Tue May 07, 2019 1:26 pm
But it is also evident that doctors employed by Kaiser may not be as good as private practitioners, and there might be problem if some special (not main stream) knowledge required.
Why would you say that? First of all Kaiser is private, but how can you determine that a large group of physicians is on the whole not as good as another group? And if specialization is required you get referred to a specialist. I don't have a dog in this fight but I don't think you should make your decision based on perceived abilities of the docs without supporting evidence. Or if you can't be convinced otherwise, then IMO your decision is made.

xenochrony
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Re: HDHP vs Kaiser HMO

Post by xenochrony » Tue May 07, 2019 1:41 pm

I'm in CA and the same age as you and this is my first year with Kaiser HMO. Thus far, I have been impressed with physician quality, its actually been far superior than the extremely poor quality of physicians I had access to with another CA health insurance company. While the other poster said Kaisers physician networks were thin, my experience thus far (< 1 year) has been the opposite as my prior insurance company, while they had a long list of in-network doctors, many of them were either not taking new patients, were far away, or appeared to be bottom of the barrel.

Kaiser does a lot of things differently and may take some time getting used to. Different as in better for some things and worse for others.

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Re: HDHP vs Kaiser HMO

Post by SevenBridgesRoad » Tue May 07, 2019 1:45 pm

There's no reason to believe Kaiser Permanente systematically hires inferior physicians. In fact, it may be the opposite. More and more docs are looking for straight employment over traditional private practice. Choosing employment with a large, well-run health system isn't a sign of inferiority. I'd suggest there are plenty of private practices with problematic physicians.
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Re: HDHP vs Kaiser HMO

Post by Scrapr » Tue May 07, 2019 1:52 pm

We are in Oregon and love our Kaiser docs. I have had some issues a few years ago w/Crohns. I had 1 GI doc that wasn't a good fit. Another GI doc that was the best I had ever seen. Mrs Scrapr is going through C treatment so lots & lots of appointments through different levels. She has not had one bad or even average interaction. Everything very positive. Kaiser will refer out of system if needed. We have had excellent communication. Today we were meeting with the oncologist. We talked about several ancillary things. While we were in the room 2 different specialties came in and discussed options. No prior communications on the docs.

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seed4great
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Re: HDHP vs Kaiser HMO

Post by seed4great » Tue May 07, 2019 1:59 pm

Thanks a lot for the responses! It appear after all Kaiser may not be as bad as I initially thought. These are more specifics about plans:
PREMIUMS
HS Basic Plan $18.17
HS Standard Plan $37.53
HS Premium Plan $48.91
Kaiser CA $54.09
COVERAGE
HS Basic Plan Deductible $2,500, OOP $3,250, plan pays 80% in-network including office visits/ER (preventive care 100%), no match HSA
HS Standard Plan Deductible $1,750, OOP $3,250, plan pays 90% in-network including office visits/ER (preventive care 100%), $500 match HSA
HS Premium Plan Deductible $1,500, OOP $3,000, plan pays 90% in-network including office visits/ER (preventive care 100%), $750 match HSA
Kaiser CA No deductible, OOP $1500, copay for Kaiser doctors and $125 for ER (preventive care 100%), $30 primary care/40 special care for visit

HS plans has cheaper premiums, but Kaiser plan premium pretty much in line with what I pay for BCBS PPO at my current job.
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decapod10
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Re: HDHP vs Kaiser HMO

Post by decapod10 » Tue May 07, 2019 4:20 pm

One thing to know about Kaiser is that the hospitals and specialists tend to be concentrated in a few areas. If you need to see a particular specialist, it's probably worth checking to see if they have one near you . Probably not a big issue in the SF Bay Area though.

Financially speaking, I don't really know about your other plans. Kaiser tends to have few surprises though (at least big surprises). You don't get these situations where your ER visit wasn't preapproved and your insurance refuses to cover it, so you get a $20,000 bill from the hospital. Or you get a blood test and the insurance company decides it wasn't a necessary test, so you get a bill for it. Same with CT scans and MRIs and such. There's no preapproval required, if your doctor orders it, you just go get it and pay whatever the copay is. The Kaiser insurance plan doesn't have to review the request. There are some insurance plans that are very restrictive about that sort of thing, just all depends on the individual insurance plan.

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Re: HDHP vs Kaiser HMO

Post by seed4great » Tue May 07, 2019 4:39 pm

decapod10 wrote:
Tue May 07, 2019 4:20 pm
One thing to know about Kaiser is that the hospitals and specialists tend to be concentrated in a few areas. If you need to see a particular specialist, it's probably worth checking to see if they have one near you . Probably not a big issue in the SF Bay Area though.

Financially speaking, I don't really know about your other plans. Kaiser tends to have few surprises though (at least big surprises). You don't get these situations where your ER visit wasn't preapproved and your insurance refuses to cover it, so you get a $20,000 bill from the hospital. Or you get a blood test and the insurance company decides it wasn't a necessary test, so you get a bill for it. Same with CT scans and MRIs and such. There's no preapproval required, if your doctor orders it, you just go get it and pay whatever the copay is. The Kaiser insurance plan doesn't have to review the request. There are some insurance plans that are very restrictive about that sort of thing, just all depends on the individual insurance plan.
Thanks for the info, I really appreciate it. I don't know all details about high deductible plans at this time as well, I'd expect some of the problems you described might exist. I asked about Kaiser because I did hear some good (and some not so good) opinions about this system. But it looks like it definitely has its benefits.
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decapod10
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Re: HDHP vs Kaiser HMO

Post by decapod10 » Tue May 07, 2019 5:09 pm

seed4great wrote:
Tue May 07, 2019 4:39 pm
decapod10 wrote:
Tue May 07, 2019 4:20 pm
One thing to know about Kaiser is that the hospitals and specialists tend to be concentrated in a few areas. If you need to see a particular specialist, it's probably worth checking to see if they have one near you . Probably not a big issue in the SF Bay Area though.

Financially speaking, I don't really know about your other plans. Kaiser tends to have few surprises though (at least big surprises). You don't get these situations where your ER visit wasn't preapproved and your insurance refuses to cover it, so you get a $20,000 bill from the hospital. Or you get a blood test and the insurance company decides it wasn't a necessary test, so you get a bill for it. Same with CT scans and MRIs and such. There's no preapproval required, if your doctor orders it, you just go get it and pay whatever the copay is. The Kaiser insurance plan doesn't have to review the request. There are some insurance plans that are very restrictive about that sort of thing, just all depends on the individual insurance plan.
Thanks for the info, I really appreciate it. I don't know all details about high deductible plans at this time as well, I'd expect some of the problems you described might exist. I asked about Kaiser because I did hear some good (and some not so good) opinions about this system. But it looks like it definitely has its benefits.
Yeah, it's tough because I think it really depends a lot on what your medical conditions and needs are, and also what your personality is too. The Kaiser system is excellent in some ways, not so excellent in other ways, just like most insurance/systems out there, and what your neighbor likes/dislikes may be different that what you like/dislike.

Like with Kaiser, you and the doctors have the ability to communicate through messages through the website or a smartphone app. If you have a rash or something, you can take a picture and send it to them rather than scheduling a visit. I think some people find that too impersonal, other people like the convenience of it. Different strokes and all.

nervouscorps
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Re: HDHP vs Kaiser HMO

Post by nervouscorps » Tue May 07, 2019 5:13 pm

I've had Kaiser for over 10 years and for the most part I can't complain. My only problem has been finding great internists who are on the younger side who stay for a year or two then leave. My guess is Kaiser is a better place to be a patient than an employee.

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Re: HDHP vs Kaiser HMO

Post by peseta » Tue May 07, 2019 5:53 pm

For what it's worth, Kaiser is the only thing preventing our family from going the HDHP route. We love Kaiser (DC area) too much to leave. I would throw a parade if they offered an HDHP option.

peseta

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Re: HDHP vs Kaiser HMO

Post by Shallowpockets » Tue May 07, 2019 6:09 pm

Recent Kaiser visit for aspiration per U/S. Doctor in room while US tech does her thing. Doc says I don't see anything to aspirate. No sense in possibly creating a problem. I agreed.
Doc says, did you pay a copay today?"
I say, "yes, I did."
Doc says, "I'll get that back for you".
Gives me a form signed by him. I take it out to the front desk and they reverse the charge on my credit card right then.
Another time I contested a $25 copay per phone saying I thought it was included as a post op follow up. Woman on phine agrees, nullifies the bill.

Try any of that with a regular plan. This is what you get with integration of payer and medical, all in one.

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Watty
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Re: HDHP vs Kaiser HMO

Post by Watty » Tue May 07, 2019 6:16 pm

Nothing is perfect but Kaiser has a huge incentive to not have bad doctors work for them since Kaiser would be paying the costs for any malpractice lawsuits.

A traditional insurance company would be less concerned about that since they would not be paying for malpractice claims against the doctor. They may be willing to have bad doctor be in-network as long as they are will to take the low payments the insurance company would pay.
seed4great wrote:
Tue May 07, 2019 1:26 pm
Instead, they offer a few HDHP plans from UHC.....
One thing you may be missing is that UHC likely has their own network of doctors which will have some strengths and weaknesses that you you would also need to evaluate.

Kaiser may not have the top doctors in some fields but they may not be in the UHC network either since they are mainly concerned with getting the least expensive doctors possible.

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Re: HDHP vs Kaiser HMO

Post by Bill Bernstein » Tue May 07, 2019 6:59 pm

One more vote for Kaiser; great service, short waiting room times, and doctors and nurses who seem to have all the time in the world to spend with you.

A little industrial in the public areas, but once you're inside the clinic rooms that changes. Their web interface is a revelation: make appointments, order meds, email your MD at your fingertips.

Portland, OR is a very over-doctored city, and in a lot of specialties Kaiser docs actually make higher pay than "private" docs, so at least in this city they get the cream of the crop.

This retired MD is impressed.

Bill

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Re: HDHP vs Kaiser HMO

Post by Sunflower » Tue May 07, 2019 7:43 pm

In SF and been with Kaiser for two years. Still have some adjustment issues -- probably because I don't go that often and the system is so different to me. I like it quite a bit. They keep tabs on you and remind you it's time for certain appointments and if you're new they will "hound" you until you make appointments/take tests and get you updated.

One issue I've had recently: trying to get the shingles shot (I know there's a nationwide shortage). I emailed my doctor and she ordered it, no problem; however, I had to check for availability. While I was hoping to call the Injection Clinic to see if they had a supply or be put on a waiting list I found out there really wasn't a number to call and had to go in person. I went first thing only to be told they didn't have it, but they did put me on a list and gave me a phone number to call. It really wasn't a wasted trip because I timed it to pick up prescriptions.

I also like that they have lots of classes. Admittedly, I've only taken a couple. I need to sign up for some cooking classes. Hmmm...

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Re: HDHP vs Kaiser HMO

Post by tooluser » Tue May 07, 2019 9:46 pm

I've been in Los Angeles for 30 years and have heard nothing bad about Kaiser the whole time, in fact always positive comments. If I were starting over I would go with them, especially if they are cheaper and/or located more conveniently.

For the past two decades I have chosen the PPO route because I had a non-Kaiser HMO for a few years when I was younger, and they made me wait two weeks with a potentially broken foot bone before I could get it fixed (and it did require fixing). Never again.

Also, in the PPO when my physician abandoned me on an issue ("you'll just have to live with it"), and his company stalled on recommending any referrals, the free choices of the PPO provided the opportunity to fire him and move on to someone much better, who had all sorts of ideas for further tests and treatment, which worked out well. I presume Kaiser has a way to change physicians if it's not working out, but sometimes the issue is more systemic to an organization.

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Re: HDHP vs Kaiser HMO

Post by WoodSpinner » Tue May 07, 2019 11:31 pm

Another happy Kaiser family here. I really like their seamless integration for managing all of our health needs. No complaints about the quality of the doctors, nurses or staff. Very process centric though — which can be a bit annoying. You just get used to it.

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SocalLiving
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Re: HDHP vs Kaiser HMO

Post by SocalLiving » Wed May 08, 2019 11:21 am

I had a lot of the same concerns as the OP when we had to switch from PPO to Kaiser HMO last year (Los Angeles area). We had always been on a PPO plan and had heard negative things about Kaiser.

Within a month of being on Kaiser, my husband had a serious and completely unexpected medical condition. Kaiser was amazing! They were so fast to respond. All the tests, MRI's, nerve testing, blood tests etc were done immediately. My husband saw specialists the same day and treatments were started. There was no stress of figuring out who was in-network, what was covered. Everything was in one place. The specialists and doctors were very pro-active.

Because of the incredible and fast care my husband received, his recovery has been so much faster than is typical. We renewed our Kaiser insurance this year with no hesitation.

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Re: HDHP vs Kaiser HMO

Post by azianbob » Wed May 08, 2019 11:59 am

If you are healthy, the HDHP Premium sounds like a good deal based on numbers. With a $750 match it pretty much covers your premium plus any investment fees plus a bit more so as long as you just need annual physicals I think you come out on top. You can squirrel away $3500 a year in pretax money, and as long as you save your receipts you can make tax free distributions anytime in the future.

You would probably have to do the research on who would provide better care in the event you come down with something.

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Re: HDHP vs Kaiser HMO

Post by carruthers209 » Wed May 08, 2019 12:15 pm

We've had Kaiser's for over 50 years here in California. Consumer Report gives them five stars-their highest rating consistently. Kaiser's has a "patient centered" philosophy which means it is not profit driven the way some insurance/medical choices are. I've know of horror stories where the insurance company has to approve cancer treatments for patients-my friend-and by the time the profit driven insurance company approved the cancer therapy, several months later, my friend's cancer had advanced to a terminal condition. That's unforgiveable, but profit driven insurance company put profits above patients. Kaiser's is so popular and esteemed here that people who live out of the zip code area of coverage fraudulently use their family's addresses in order to qualify for Kaiser's medical services. My husband had deep brain stimulation surgery for his Parkinson's and it was a wonderful success. We don't need to worry about "out-of-network" financial nightmares when using Kaiser's hospitals.

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Re: HDHP vs Kaiser HMO

Post by Minot » Wed May 08, 2019 1:01 pm

I've been with Kaiser for at least 30 years (I can't remember exactly when the company I worked for started offering it). For the last 17 years (I'm 82) I've been on their Medicare Advantage program, which seems pretty comparable to the Kaiser CA plan. I agree with the other recommendations in this thread; I've been very satisfied with Kaiser from the beginning.

At age 82, I'm consuming considerably more health care than I was when I started with Kaiser. I continue to be very positive about the care I'm getting. One thing I noticed a few years ago was an improvement in my experience of being cared for, across the board, starting with checking in for appointments, including not just my physicians but also the various technicians, therapists, etc. I'm guessing that Kaiser has taken seriously the research regarding improved patient outcomes with patients who feel cared for, and has found an effective way to train their staff to access and communicate their compassion.

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Re: HDHP vs Kaiser HMO

Post by lscntr51 » Wed May 08, 2019 2:03 pm

One more plus for Kaiser. I live in metro Atlanta and my wife and I (Age 40 & 33) switched from Blue Cross Blue Shield about 4 years ago, basically because it was a $250 co-pay to deliver our 1st child. Our mindset was, let's try it out and see how things go.

Things have been really wonderful. The doctors seem to care a little bit more and spend more time talking with you about your needs. In the past, some doctors that I went to seemed to get you in and out quickly, and the whole approach was to see as many patients as possible in one day.
We have 2 small children and the Pediatric Department has been great for the little ones. In the county we live in, they have one Comprehensive Medical Center (with 24 hour urgent care, etc.) and numerous satellite offices around town. They have agreements with Emory Healthcare, Northside Hospital, etc. and if something cannot be treated at their facility, you get a referral to Emory or one of the other hospitals. We pay a little bit more in premiums, but it's worth it in my opinion. My wife and I also get two $500 Visa gift cards per year for completing our bio-metric screenings, which helps offset the premium costs.

It seems like the big hang up with Kaiser, and reason people tend to not switch over to them, is the fact that people will lose access to their current doctors. If you have a great relationship with a doctor, it may not be for you, but if not, I would definitely give them a try. It's been great for my family and I plan to be with them for awhile.

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Re: HDHP vs Kaiser HMO

Post by Hayden » Wed May 08, 2019 2:21 pm

decapod10 wrote:
Tue May 07, 2019 4:20 pm
One thing to know about Kaiser is that the hospitals and specialists tend to be concentrated in a few areas. If you need to see a particular specialist, it's probably worth checking to see if they have one near you . Probably not a big issue in the SF Bay Area though.

Financially speaking, I don't really know about your other plans. Kaiser tends to have few surprises though (at least big surprises). You don't get these situations where your ER visit wasn't preapproved and your insurance refuses to cover it, so you get a $20,000 bill from the hospital. Or you get a blood test and the insurance company decides it wasn't a necessary test, so you get a bill for it. Same with CT scans and MRIs and such. There's no preapproval required, if your doctor orders it, you just go get it and pay whatever the copay is. The Kaiser insurance plan doesn't have to review the request. There are some insurance plans that are very restrictive about that sort of thing, just all depends on the individual insurance plan.
I have Kaiser and my experience has been different. Dr ordered a test. After the fact, Kaiser said it was not covered because I didn't obtain preapproval.

Another time I scheduled a contact lens exam, asking in advance how much it would be. They quoted a price, which they actually noted in the record. I had my appointment, they handed me a bill for the quoted price, and I paid it on the spot. Some time later, they mailed me a second bill for a much higher price. I tried to appeal. To no avail.

A third time, I went to their walk-in clinic for a twisted ankle, and got handed a several hundred dollar bill for a 5 minute meeting with a PA.

I'm not in CA. Maybe Kaiser in CA is different.

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Re: HDHP vs Kaiser HMO

Post by JMacDonald » Wed May 08, 2019 2:21 pm

I have had Kaiser in SoCal for over 15 years. I can tell you I have has better care with Kaiser than with the other plan I had. Kaiser sends out surveys to patients asking about the care they are receiving. The last one I got I said my doctor was the best doctor I have ever had. I am very happy with the care I have been receiving.
Best Wishes, | Joe

decapod10
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Re: HDHP vs Kaiser HMO

Post by decapod10 » Wed May 08, 2019 2:41 pm

Hayden wrote:
Wed May 08, 2019 2:21 pm
decapod10 wrote:
Tue May 07, 2019 4:20 pm
One thing to know about Kaiser is that the hospitals and specialists tend to be concentrated in a few areas. If you need to see a particular specialist, it's probably worth checking to see if they have one near you . Probably not a big issue in the SF Bay Area though.

Financially speaking, I don't really know about your other plans. Kaiser tends to have few surprises though (at least big surprises). You don't get these situations where your ER visit wasn't preapproved and your insurance refuses to cover it, so you get a $20,000 bill from the hospital. Or you get a blood test and the insurance company decides it wasn't a necessary test, so you get a bill for it. Same with CT scans and MRIs and such. There's no preapproval required, if your doctor orders it, you just go get it and pay whatever the copay is. The Kaiser insurance plan doesn't have to review the request. There are some insurance plans that are very restrictive about that sort of thing, just all depends on the individual insurance plan.
I have Kaiser and my experience has been different. Dr ordered a test. After the fact, Kaiser said it was not covered because I didn't obtain preapproval.

Another time I scheduled a contact lens exam, asking in advance how much it would be. They quoted a price, which they actually noted in the record. I had my appointment, they handed me a bill for the quoted price, and I paid it on the spot. Some time later, they mailed me a second bill for a much higher price. I tried to appeal. To no avail.

A third time, I went to their walk-in clinic for a twisted ankle, and got handed a several hundred dollar bill for a 5 minute meeting with a PA.

I'm not in CA. Maybe Kaiser in CA is different.
That’s strange, yes it could be a regional difference. Technically, the Northern CA system is separate from the Southern CA system, which is separate from the system in other states.

In Northern CA, Kaiser mostly owns its own labs, clinic buildings, hospitals, etc (though not 100%). It’s not like that everywhere, wonder if that has something to do with it. Like if they have an agreement with a third party lab, maybe it gets more complicated.

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Re: HDHP vs Kaiser HMO

Post by random_walker » Wed Oct 30, 2019 4:17 am

My understanding is that once you enroll in HSA (Health Savings Account) based HDHP (High-Deductible Healthcare Plan), you can never leave.
That might be a consideration for those who have been with Kaiser Permanente or other HMO and like it already.

It seems that Kaiser is now participating in HSA-based plans in many locations.
That might be a way to stay with Kaiser and enjoy the financial benefits of a HSA.

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Re: HDHP vs Kaiser HMO

Post by grabiner » Wed Oct 30, 2019 8:23 pm

random_walker wrote:
Wed Oct 30, 2019 4:17 am
My understanding is that once you enroll in HSA (Health Savings Account) based HDHP (High-Deductible Healthcare Plan), you can never leave.
This is not correct. If you change to a non-HDHP, you can no longer contribute to the HSA, but you can keep the HSA, and either let it grow or spend it on medical expenses. (You may also need to switch doctors if your new insurance plan has a different network.)

The "you can never leave" situation applies to some plans with an HRA (Health Reimbursement Agreement). If you don't use up the HRA and stay with the same plan, the unused money rolls over to the next year. But if you leave the plan, unused HRA money is lost.
Wiki David Grabiner

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Re: HDHP vs Kaiser HMO

Post by csmath » Thu Oct 31, 2019 12:58 am

grabiner wrote:
Wed Oct 30, 2019 8:23 pm
random_walker wrote:
Wed Oct 30, 2019 4:17 am
My understanding is that once you enroll in HSA (Health Savings Account) based HDHP (High-Deductible Healthcare Plan), you can never leave.
This is not correct. If you change to a non-HDHP, you can no longer contribute to the HSA, but you can keep the HSA, and either let it grow or spend it on medical expenses. (You may also need to switch doctors if your new insurance plan has a different network.)

The "you can never leave" situation applies to some plans with an HRA (Health Reimbursement Agreement). If you don't use up the HRA and stay with the same plan, the unused money rolls over to the next year. But if you leave the plan, unused HRA money is lost.
I believe random walker is referring to someone who goes with the HDHP and then wants to switch back to a LDHP. I think mentioning the HSA muddies the water a bit and Grabiner is correct about his HSA points. As for switching from HDHP to LDHP... I know that there are employers who have written into contracts that changing from a LDHP to a HDHP is a one-way change. Whether or not they enforce it is another thing.

I'm pretty sure that going from HDHP to LDHP is not restricted by law, but I admit I'm no where even close to an insurance expert.

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