FEHB Open Season 2019

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Topic Author
motorcyclesarecool
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FEHB Open Season 2019

Post by motorcyclesarecool » Tue Oct 08, 2019 1:44 am

I noticed yesterday that GEHA has published their 2020 HDHP brochure, as well as the long-anticipated brochure for their two tiers of indemnity plan.

Health Savings Advantage, my current plan, is seeing a modest premium increase. It appears the pass through to my HSA will remain unchanged from 2019.

Wanting to be thorough, I started reviewing the GEHA Elevate and Elevate Plus plan brochure. https://www.geha.com/docs/default-sour ... ochure.pdf I don’t understand what I’m reading, and feel there must be a misprint. Elevate Plus has a higher premium and lower deductible than Elevate, but the difference in premium between the two is greater than the deductible, and in multiple instances, the copays are higher under the Plus plan. Can anyone decipher this?
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.

Topic Author
motorcyclesarecool
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Re: FEHB Open Season 2019

Post by motorcyclesarecool » Tue Oct 08, 2019 1:46 am

OPM has posted some documents indicating 2020 premiums for FEHB plans, but doesn’t appear to have fully rolled out Open Season info as of yet.
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.

nps
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Re: FEHB Open Season 2019

Post by nps » Tue Oct 08, 2019 6:01 am

motorcyclesarecool wrote:
Tue Oct 08, 2019 1:44 am
Wanting to be thorough, I started reviewing the GEHA Elevate and Elevate Plus plan brochure. https://www.geha.com/docs/default-sour ... ochure.pdf I don’t understand what I’m reading, and feel there must be a misprint. Elevate Plus has a higher premium and lower deductible than Elevate, but the difference in premium between the two is greater than the deductible, and in multiple instances, the copays are higher under the Plus plan. Can anyone decipher this?
They're called indemnity plans, but they just look like additional flavors of FFS plans similar to existing GEHA standard and high options.

The biggest difference I see between the new plans is Elevate Plus has fixed copays across the range of medical services. The cheaper Elevate plan has some lower copays for certain services but has a 25% coinsurance on emergency, hospital and surgical services for in-network. That's pretty high.

delamer
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Re: FEHB Open Season 2019

Post by delamer » Tue Oct 08, 2019 11:00 am

This is a case where paying for the Consumer Checkbook report on 2020 FEHB coverage is a good idea.

Hopefully, it will explain the pros and cons of the new GEHA plans.

Kaufmanrider
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Re: FEHB Open Season 2019

Post by Kaufmanrider » Tue Oct 08, 2019 11:37 am

My take, it appears Elevate has a $500 individual and $1000 family deductible that must be paid before plan payment/copays kick in and they offer the ability to earn 500 in incentives (per person max $1000 family). Elevate Plus has no deductible. Copays kick in from day one. Not sure about incentives with Plus. I'm still reading the brochure.

chalet
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Re: FEHB Open Season 2019

Post by chalet » Tue Oct 08, 2019 7:09 pm

I will get around to looking at the new geha plans. I will be interested to know if how it differs from geha standard (what I have now)

MillennialFinance19
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Re: FEHB Open Season 2019

Post by MillennialFinance19 » Tue Oct 08, 2019 7:28 pm

I’m also awaiting info. I plan on switching from BCBS Basic to GEHA HDHP. I’m nervous, but have back-tested the last two years’ health expenses and I would have come out ahead in both. Time to make the leap in order to utilize the HSA!

Tdubs
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Re: FEHB Open Season 2019

Post by Tdubs » Tue Oct 08, 2019 7:45 pm

MillennialFinance19 wrote:
Tue Oct 08, 2019 7:28 pm
I’m also awaiting info. I plan on switching from BCBS Basic to GEHA HDHP. I’m nervous, but have back-tested the last two years’ health expenses and I would have come out ahead in both. Time to make the leap in order to utilize the HSA!
Checkbook indicates CareFirst HDHP was a better deal than GEHA HDHP in 2019. Will be interested to see the 2020 information.

Cash
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Re: FEHB Open Season 2019

Post by Cash » Tue Oct 08, 2019 8:20 pm

FYI for those in Florida who use GEHA, I received notice that GEHA is changing their provider network in Florida from Aetna Signature Administrators to UnitedHealthcare Choice Plus. Supposedly their website will update this month to reflect providers for the new network.

MillennialFinance19
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Re: FEHB Open Season 2019

Post by MillennialFinance19 » Tue Oct 08, 2019 8:41 pm

Tdubs wrote:
Tue Oct 08, 2019 7:45 pm
MillennialFinance19 wrote:
Tue Oct 08, 2019 7:28 pm
I’m also awaiting info. I plan on switching from BCBS Basic to GEHA HDHP. I’m nervous, but have back-tested the last two years’ health expenses and I would have come out ahead in both. Time to make the leap in order to utilize the HSA!
Checkbook indicates CareFirst HDHP was a better deal than GEHA HDHP in 2019. Will be interested to see the 2020 information.
Unfortunately, it doesn’t serve my area.

AnonJohn
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Re: FEHB Open Season 2019

Post by AnonJohn » Thu Oct 10, 2019 6:51 am

MillennialFinance19 wrote:
Tue Oct 08, 2019 7:28 pm
I’m also awaiting info. I plan on switching from BCBS Basic to GEHA HDHP. I’m nervous, but have back-tested the last two years’ health expenses and I would have come out ahead in both. Time to make the leap in order to utilize the HSA!
I made that switch two years ago and have only one regret: that I didn't do it 10 years earlier. If I had I'd have saved tens of thousands. :oops:

On top of that, in one of the years we had some major health care expenses and easily cleared the deductible. It worked fine, and I had net savings compared with BCBS in several ways, including that the Basic plan has some chunky hospital stay co-pays.

My only caution: this depends on math. What is your marginal tax rate (bearing in mind that CA and NJ don't play nice with HSAs), and how much can you afford to put into the HSA? If capping it at a medium or higher tax rate I think it's slam dunk, as Grabiner has persuasively documented several times.

Good luck!

AnonJohn
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Re: FEHB Open Season 2019

Post by AnonJohn » Thu Oct 10, 2019 7:04 am

Tdubs wrote:
Tue Oct 08, 2019 7:45 pm
MillennialFinance19 wrote:
Tue Oct 08, 2019 7:28 pm
I’m also awaiting info. I plan on switching from BCBS Basic to GEHA HDHP. I’m nervous, but have back-tested the last two years’ health expenses and I would have come out ahead in both. Time to make the leap in order to utilize the HSA!
Checkbook indicates CareFirst HDHP was a better deal than GEHA HDHP in 2019. Will be interested to see the 2020 information.
I did this analysis in 2018, including studying checkbook. While I concluded that CF HDHP was a better deal, I stayed with GEHA since it was of order ~$100 on the year and I've been happy with GEHA. I think I also looked up my physicians and found a couple missing in CF HDHP. It's a technical comparison depending on your own health care needs. For instance: I note that the CF lower OOP max's are only for in-network services. CF bills itself as an HMO and GEHA as a PPO.

A lot of the tradeoffs are fixed copay vs 5%. Good luck figuring out what that means in dollars. I did it for several years worth of EOBs. The conclusion was that if I need physical therapy, the 5% saves a lot of money; if I need to see a doctor for antibiotics, the fixed copay saves a little money.

Finally: GEHA has preventative dental very nicely covered. CF does not. I've found this valuable.

A comparison here

I'd welcome any insights from those who have studied this more deeply!

gtd98765
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Re: FEHB Open Season 2019

Post by gtd98765 » Thu Oct 10, 2019 7:17 am

This is a case where paying for the Consumer Checkbook report on 2020 FEHB coverage is a good idea.

Hopefully, it will explain the pros and cons of the new GEHA plans.
Agree. The Checkbook report is a bargain at $15. https://www.checkbook.org/newhig2/hig.cfm?

daheld
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Re: FEHB Open Season 2019

Post by daheld » Thu Oct 10, 2019 8:26 am

Curious if anyone else here uses APWU. I've been very pleased over the last four years but rarely hear anyone who uses this plan.

MillennialFinance19
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Re: FEHB Open Season 2019

Post by MillennialFinance19 » Thu Oct 10, 2019 8:35 am

AnonJohn wrote:
Thu Oct 10, 2019 6:51 am
MillennialFinance19 wrote:
Tue Oct 08, 2019 7:28 pm
I’m also awaiting info. I plan on switching from BCBS Basic to GEHA HDHP. I’m nervous, but have back-tested the last two years’ health expenses and I would have come out ahead in both. Time to make the leap in order to utilize the HSA!
I made that switch two years ago and have only one regret: that I didn't do it 10 years earlier. If I had I'd have saved tens of thousands. :oops:

On top of that, in one of the years we had some major health care expenses and easily cleared the deductible. It worked fine, and I had net savings compared with BCBS in several ways, including that the Basic plan has some chunky hospital stay co-pays.

My only caution: this depends on math. What is your marginal tax rate (bearing in mind that CA and NJ don't play nice with HSAs), and how much can you afford to put into the HSA? If capping it at a medium or higher tax rate I think it's slam dunk, as Grabiner has persuasively documented several times.

Good luck!
Marginal tax rate will be 24% from next year into the foreseeable future. So just off the top, we we'll be saving $1100 in premiums and $1500 in FSA contributions. This savings alone will allow us to make an HSA contribution of $2600 in addition to the $1800 the GEHA plan passes through. Once we're done paying $1500/month in daycare, we'll easily be able to hit the HSA limit.

Tdubs
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Re: FEHB Open Season 2019

Post by Tdubs » Thu Oct 10, 2019 11:42 am

AnonJohn wrote:
Thu Oct 10, 2019 7:04 am
Tdubs wrote:
Tue Oct 08, 2019 7:45 pm
MillennialFinance19 wrote:
Tue Oct 08, 2019 7:28 pm
I’m also awaiting info. I plan on switching from BCBS Basic to GEHA HDHP. I’m nervous, but have back-tested the last two years’ health expenses and I would have come out ahead in both. Time to make the leap in order to utilize the HSA!
Checkbook indicates CareFirst HDHP was a better deal than GEHA HDHP in 2019. Will be interested to see the 2020 information.
I did this analysis in 2018, including studying checkbook. While I concluded that CF HDHP was a better deal, I stayed with GEHA since it was of order ~$100 on the year and I've been happy with GEHA. I think I also looked up my physicians and found a couple missing in CF HDHP. It's a technical comparison depending on your own health care needs. For instance: I note that the CF lower OOP max's are only for in-network services. CF bills itself as an HMO and GEHA as a PPO.

A lot of the tradeoffs are fixed copay vs 5%. Good luck figuring out what that means in dollars. I did it for several years worth of EOBs. The conclusion was that if I need physical therapy, the 5% saves a lot of money; if I need to see a doctor for antibiotics, the fixed copay saves a little money.

Finally: GEHA has preventative dental very nicely covered. CF does not. I've found this valuable.

A comparison here

I'd welcome any insights from those who have studied this more deeply!
Agree. The differences in the two plans make comparisons exasperating. On dental, Checkbook indicates CareFirst is better (2019 comparison). Image

So not sure why the two comparisons differ. I like my GEHA plan, but the advantages for CareFirst make me wonder. So far my providers all seem to be within the plan.

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BogleFanGal
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Re: FEHB Open Season 2019

Post by BogleFanGal » Thu Oct 10, 2019 12:43 pm

OP: thank you for thread - hoping people keep adding as more info comes to opm site. Does anyone know if GEHA HDHP members gain access to GEHA's discounted dental network rates through its HDHP plan? I'm not talking about the HDHP plan actually paying for any dental work other than preventive cleanings/exam benefit.

I'm just asking whether it gives you access to their negotiated dental rates if/when you need dental work and are paying out of pocket for it. (vs paying full walk-in rate.)

Or do you have to buy the separate GEHA Dental Plan for that?
I've had the dental plan for years but may drop it, given some problems I've experienced.
"Life would be infinitely happier if we could only be born at the age of eighty and gradually approach eighteen." Mark Twain

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Drain
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Re: FEHB Open Season 2019

Post by Drain » Thu Oct 10, 2019 1:27 pm

I'd like to comment on the comparison of the CareFirst HDHP to the GEHA HDHP. I am far from an expert, but I've done these comparisons many times over the years, and I think I've learned some things. Be aware that, due to the onset of blindness, I cannot read the brochures anymore, so I have been getting my information from plan reps and from others I consider knowledgeable...or who at least have interesting things to say. :)

First off, there is the matter of CF being an HMO-based plan and GEHA being a PPO. Now, I don't have an inside pipeline to the underwriters and the others in the back rooms, but I do believe that HMOs have a long history of being less generous on approving claims than PPOs do. I'd be unable to predict when that might matter and when it might not, but I'd prefer not to find out when someone in my family needs care. The fact that the CF plan is so much less expensive (per Checkbook 2019) than the GEHA plan makes me all the more confident in my suspicions. This is not to suggest that the CF plan would be inadequate, or even sub-standard. I don't know. I just think the odds are in my favor going with the pricier PPO than with the cheaper HMO. Also, My impression from two years in the GEHA plan is that GEHA is pretty good about not hassling the patient in this regard.

Second, the price differential in Checkbook might not be as wide as it appears. From my own experience, Checkbook has a history of getting dental estimates wrong. I have discovered multiple errors over the years in that category of costs. From memory...I think Checkbook had the estimate of CF's costs from preventive dental at $0, or something else unreasonably low. CF's dental plan is a discount plan, and that's all. CF does not pay anything for dental themselves. There is just a fee schedule covering all the possible procedures and products, and dentists in the network agree to abide by that schedule. So add about $200-$300 (again, from memory, so don't totally trust me) to your estimate of dental expenses under the CF plan.

Third, I had a CF plan in 2013 that used the same network, and my perception--based primarily on Checkbook's separate ratings of local (DC area) dentists--was that the CF dental network did not include any of the well rated practitioners. Just my own attitude, but that makes me uncomfortable. I want to feel confident in my healthcare providers, and the sense that the dentists in the CF network are the ones who kinda need to be in the network to attract more business doesn't help with that.

Finally...when I was with CF before, it always seemed like a low-budget operation to me. I called their customer support fairly often (not all their fault), and I got the same rep close to half the time. Made me wonder how many were on their staff. And...it just didn't strike me as being as professional as a GEHA, or an Aetna, for that matter.

Speaking of Aetna...I was with them for years prior to switching to GEHA. I switched primarily because they stopped being competitive on cost (per Checkbook, as always). But there was an aspect of their plans that never gets mentioned, and that is the protection from balance billing. I don't know if any other insurer in the FEHB has that. I know GEHA doesn't. Here's how it works. If you get treatment at an in-network facility, all your charges will be treated as in-network by Aetna, even if one of your providers is not in the network. You know what I mean. You go in for surgery at an in-network hospital, and when you receive the bill, you discover that one of the providers--the anesthesiologist, say--was out of network and is balance-billing you. Aetna will always pay 90 percent of the charge after the deductible is met as long as the facility is in-network. If the usual and customary fee is $2000 and you are charged $5000, Aetna will try to negotiate it down. Even if unsuccessful, Aetna will pay 90 percent, so if the charge remains $5000, you pay $500 and Aetna pays $4500. So Aetna is not quite as non-competitive price-wise as it appears.

Anyway...in the end, you have to decide for yourself how much of a cost break you get with CF is worth the potential negatives. The difference wasn't enough for me last year. My incumbent bias (I was already with GEHA) also contributed to my rejection of the CF plan.
Darin

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Drain
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Re: FEHB Open Season 2019

Post by Drain » Thu Oct 10, 2019 1:31 pm

BogleFanGal wrote:
Thu Oct 10, 2019 12:43 pm
OP: thank you for thread - hoping people keep adding as more info comes to opm site. Does anyone know if GEHA HDHP members gain access to GEHA's discounted dental network rates through its HDHP plan? I'm not talking about the HDHP plan actually paying for any dental work other than preventive cleanings/exam benefit.

I'm just asking whether it gives you access to their negotiated dental rates if/when you need dental work and are paying out of pocket for it. (vs paying full walk-in rate.)

Or do you have to buy the separate GEHA Dental Plan for that?
I've had the dental plan for years but may drop it, given some problems I've experienced.
You have to buy the separate dental coverage to get its rates. The HDHP covers preventive and not much more. What the brochure states is all there is.
Darin

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BogleFanGal
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Re: FEHB Open Season 2019

Post by BogleFanGal » Thu Oct 10, 2019 3:32 pm

Drain wrote:
Thu Oct 10, 2019 1:31 pm
BogleFanGal wrote:
Thu Oct 10, 2019 12:43 pm
OP: thank you for thread - hoping people keep adding as more info comes to opm site. Does anyone know if GEHA HDHP members gain access to GEHA's discounted dental network rates through its HDHP plan? I'm not talking about the HDHP plan actually paying for any dental work other than preventive cleanings/exam benefit.

I'm just asking whether it gives you access to their negotiated dental rates if/when you need dental work and are paying out of pocket for it. (vs paying full walk-in rate.)

Or do you have to buy the separate GEHA Dental Plan for that?
I've had the dental plan for years but may drop it, given some problems I've experienced.
You have to buy the separate dental coverage to get its rates. The HDHP covers preventive and not much more. What the brochure states is all there is.
Thanks! Very helpful.
"Life would be infinitely happier if we could only be born at the age of eighty and gradually approach eighteen." Mark Twain

Tdubs
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Re: FEHB Open Season 2019

Post by Tdubs » Thu Oct 10, 2019 4:02 pm

Drain wrote:
Thu Oct 10, 2019 1:27 pm
I'd like to comment on the comparison of the CareFirst HDHP to the GEHA HDHP. I am far from an expert, but I've done these comparisons many times over the years, and I think I've learned some things. Be aware that, due to the onset of blindness, I cannot read the brochures anymore, so I have been getting my information from plan reps and from others I consider knowledgeable...or who at least have interesting things to say. :)

First off, there is the matter of CF being an HMO-based plan and GEHA being a PPO. Now, I don't have an inside pipeline to the underwriters and the others in the back rooms, but I do believe that HMOs have a long history of being less generous on approving claims than PPOs do. I'd be unable to predict when that might matter and when it might not, but I'd prefer not to find out when someone in my family needs care. The fact that the CF plan is so much less expensive (per Checkbook 2019) than the GEHA plan makes me all the more confident in my suspicions. This is not to suggest that the CF plan would be inadequate, or even sub-standard. I don't know. I just think the odds are in my favor going with the pricier PPO than with the cheaper HMO. Also, My impression from two years in the GEHA plan is that GEHA is pretty good about not hassling the patient in this regard.

Second, the price differential in Checkbook might not be as wide as it appears. From my own experience, Checkbook has a history of getting dental estimates wrong. I have discovered multiple errors over the years in that category of costs. From memory...I think Checkbook had the estimate of CF's costs from preventive dental at $0, or something else unreasonably low. CF's dental plan is a discount plan, and that's all. CF does not pay anything for dental themselves. There is just a fee schedule covering all the possible procedures and products, and dentists in the network agree to abide by that schedule. So add about $200-$300 (again, from memory, so don't totally trust me) to your estimate of dental expenses under the CF plan.

Third, I had a CF plan in 2013 that used the same network, and my perception--based primarily on Checkbook's separate ratings of local (DC area) dentists--was that the CF dental network did not include any of the well rated practitioners. Just my own attitude, but that makes me uncomfortable. I want to feel confident in my healthcare providers, and the sense that the dentists in the CF network are the ones who kinda need to be in the network to attract more business doesn't help with that.

Finally...when I was with CF before, it always seemed like a low-budget operation to me. I called their customer support fairly often (not all their fault), and I got the same rep close to half the time. Made me wonder how many were on their staff. And...it just didn't strike me as being as professional as a GEHA, or an Aetna, for that matter.

Speaking of Aetna...I was with them for years prior to switching to GEHA. I switched primarily because they stopped being competitive on cost (per Checkbook, as always). But there was an aspect of their plans that never gets mentioned, and that is the protection from balance billing. I don't know if any other insurer in the FEHB has that. I know GEHA doesn't. Here's how it works. If you get treatment at an in-network facility, all your charges will be treated as in-network by Aetna, even if one of your providers is not in the network. You know what I mean. You go in for surgery at an in-network hospital, and when you receive the bill, you discover that one of the providers--the anesthesiologist, say--was out of network and is balance-billing you. Aetna will always pay 90 percent of the charge after the deductible is met as long as the facility is in-network. If the usual and customary fee is $2000 and you are charged $5000, Aetna will try to negotiate it down. Even if unsuccessful, Aetna will pay 90 percent, so if the charge remains $5000, you pay $500 and Aetna pays $4500. So Aetna is not quite as non-competitive price-wise as it appears.

Anyway...in the end, you have to decide for yourself how much of a cost break you get with CF is worth the potential negatives. The difference wasn't enough for me last year. My incumbent bias (I was already with GEHA) also contributed to my rejection of the CF plan.
Very helpful, thanks. Not the kinds of details you can find on Checkbook.

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grabiner
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Re: FEHB Open Season 2019

Post by grabiner » Sat Oct 12, 2019 7:54 pm

MillennialFinance19 wrote:
Thu Oct 10, 2019 8:35 am
Marginal tax rate will be 24% from next year into the foreseeable future. So just off the top, we we'll be saving $1100 in premiums and $1500 in FSA contributions. This savings alone will allow us to make an HSA contribution of $2600 in addition to the $1800 the GEHA plan passes through. Once we're done paying $1500/month in daycare, we'll easily be able to hit the HSA limit.
Because of the tax advantages, you should max out the HSA in preference to any other investment except a matched contribution to the TSP/401(k). You posted earlier that you have a taxable account; it would be worth selling stock there, even for a taxable capital gain, to max out the HSA.
Wiki David Grabiner

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Re: FEHB Open Season 2019

Post by MillennialFinance19 » Mon Oct 14, 2019 11:43 am

grabiner wrote:
Sat Oct 12, 2019 7:54 pm
MillennialFinance19 wrote:
Thu Oct 10, 2019 8:35 am
Marginal tax rate will be 24% from next year into the foreseeable future. So just off the top, we we'll be saving $1100 in premiums and $1500 in FSA contributions. This savings alone will allow us to make an HSA contribution of $2600 in addition to the $1800 the GEHA plan passes through. Once we're done paying $1500/month in daycare, we'll easily be able to hit the HSA limit.
Because of the tax advantages, you should max out the HSA in preference to any other investment except a matched contribution to the TSP/401(k). You posted earlier that you have a taxable account; it would be worth selling stock there, even for a taxable capital gain, to max out the HSA.
Got it, aim to fund HSA prior to taxable.

Side question - I'll be using HSA bank per my plan. Can I open a Fidelity HSA to house my personal contributions, provided I don't go over the $7000 limit between the two?

tj
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Re: FEHB Open Season 2019

Post by tj » Mon Oct 14, 2019 11:56 am

Drain wrote:
Thu Oct 10, 2019 1:31 pm
BogleFanGal wrote:
Thu Oct 10, 2019 12:43 pm
OP: thank you for thread - hoping people keep adding as more info comes to opm site. Does anyone know if GEHA HDHP members gain access to GEHA's discounted dental network rates through its HDHP plan? I'm not talking about the HDHP plan actually paying for any dental work other than preventive cleanings/exam benefit.

I'm just asking whether it gives you access to their negotiated dental rates if/when you need dental work and are paying out of pocket for it. (vs paying full walk-in rate.)

Or do you have to buy the separate GEHA Dental Plan for that?
I've had the dental plan for years but may drop it, given some problems I've experienced.
You have to buy the separate dental coverage to get its rates. The HDHP covers preventive and not much more. What the brochure states is all there is.
The seperate dental coverage has a completely different network with different reimbursement rates. Geha dental has a much more comprehensive network too.

tj
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Re: FEHB Open Season 2019

Post by tj » Mon Oct 14, 2019 11:56 am

MillennialFinance19 wrote:
Mon Oct 14, 2019 11:43 am
grabiner wrote:
Sat Oct 12, 2019 7:54 pm
MillennialFinance19 wrote:
Thu Oct 10, 2019 8:35 am
Marginal tax rate will be 24% from next year into the foreseeable future. So just off the top, we we'll be saving $1100 in premiums and $1500 in FSA contributions. This savings alone will allow us to make an HSA contribution of $2600 in addition to the $1800 the GEHA plan passes through. Once we're done paying $1500/month in daycare, we'll easily be able to hit the HSA limit.
Because of the tax advantages, you should max out the HSA in preference to any other investment except a matched contribution to the TSP/401(k). You posted earlier that you have a taxable account; it would be worth selling stock there, even for a taxable capital gain, to max out the HSA.
Got it, aim to fund HSA prior to taxable.

Side question - I'll be using HSA bank per my plan. Can I open a Fidelity HSA to house my personal contributions, provided I don't go over the $7000 limit between the two?
Yes.

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Re: FEHB Open Season 2019

Post by grabiner » Mon Oct 14, 2019 12:28 pm

MillennialFinance19 wrote:
Mon Oct 14, 2019 11:43 am
Side question - I'll be using HSA bank per my plan. Can I open a Fidelity HSA to house my personal contributions, provided I don't go over the $7000 limit between the two?
You can, but it may be an unnecessary complication. While you have GEHA HDHP insurance, fees are waived in the HSA Bank account, so you can just put all your cash in HSA Bank, and transfer to TD Ameritrade when you are ready to make an investment. If you leave GEHA later, you can roll your entire HSA Bank HSA to whatever provider is best then.
Wiki David Grabiner

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Re: FEHB Open Season 2019

Post by Cash » Mon Oct 14, 2019 1:45 pm

Yeah I opened a Fidelity HSA for my personal contributions, but probably would have just left everything at HSA Bank/TDA if TDA had been offering $0 commissions at the time.

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Re: FEHB Open Season 2019

Post by VictoriaF » Mon Oct 14, 2019 3:19 pm

grabiner wrote:
Mon Oct 14, 2019 12:28 pm
While you have GEHA HDHP insurance, fees are waived in the HSA Bank account, so you can just put all your cash in HSA Bank, and transfer to TD Ameritrade when you are ready to make an investment. If you leave GEHA later, you can roll your entire HSA Bank HSA to whatever provider is best then.
I have recently left GEHA, and now HSA Bank charges me $2/month. What are good options for holding a ~$40k HSA account used as savings (not investments) for ~$3k-$4k annual withdrawals?

Victoria
WINNER of the 2015 Boglehead Contest. | Every joke has a bit of a joke. ... The rest is the truth. (Marat F)

MillennialFinance19
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Re: FEHB Open Season 2019

Post by MillennialFinance19 » Mon Oct 14, 2019 5:41 pm

grabiner wrote:
Mon Oct 14, 2019 12:28 pm
MillennialFinance19 wrote:
Mon Oct 14, 2019 11:43 am
Side question - I'll be using HSA bank per my plan. Can I open a Fidelity HSA to house my personal contributions, provided I don't go over the $7000 limit between the two?
You can, but it may be an unnecessary complication. While you have GEHA HDHP insurance, fees are waived in the HSA Bank account, so you can just put all your cash in HSA Bank, and transfer to TD Ameritrade when you are ready to make an investment. If you leave GEHA later, you can roll your entire HSA Bank HSA to whatever provider is best then.
Okay, so when my HSA bank account gets opened I’ll have the option of utilizing TDA as well?

Tdubs
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Re: FEHB Open Season 2019

Post by Tdubs » Mon Oct 14, 2019 6:01 pm

MillennialFinance19 wrote:
Mon Oct 14, 2019 5:41 pm
grabiner wrote:
Mon Oct 14, 2019 12:28 pm
MillennialFinance19 wrote:
Mon Oct 14, 2019 11:43 am
Side question - I'll be using HSA bank per my plan. Can I open a Fidelity HSA to house my personal contributions, provided I don't go over the $7000 limit between the two?
You can, but it may be an unnecessary complication. While you have GEHA HDHP insurance, fees are waived in the HSA Bank account, so you can just put all your cash in HSA Bank, and transfer to TD Ameritrade when you are ready to make an investment. If you leave GEHA later, you can roll your entire HSA Bank HSA to whatever provider is best then.
Okay, so when my HSA bank account gets opened I’ll have the option of utilizing TDA as well?
Yes.

MillennialFinance19
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Re: FEHB Open Season 2019

Post by MillennialFinance19 » Mon Oct 14, 2019 6:23 pm

Tdubs wrote:
Mon Oct 14, 2019 6:01 pm

Yes.
Follow-on question. Is TD Ameritrade or Devenir preferred? It appears they're both highly rated in terms of HSAs.

Tdubs
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Re: FEHB Open Season 2019

Post by Tdubs » Mon Oct 14, 2019 6:53 pm

MillennialFinance19 wrote:
Mon Oct 14, 2019 6:23 pm
Tdubs wrote:
Mon Oct 14, 2019 6:01 pm

Yes.
Follow-on question. Is TD Ameritrade or Devenir preferred? It appears they're both highly rated in terms of HSAs.
I chose TDA for the no-commission ETFs. The low ER options with State Street and iShares were enough for me.

tbone555
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Re: FEHB Open Season 2019

Post by tbone555 » Mon Oct 14, 2019 7:04 pm

Cash wrote:
Mon Oct 14, 2019 1:45 pm
Yeah I opened a Fidelity HSA for my personal contributions, but probably would have just left everything at HSA Bank/TDA if TDA had been offering $0 commissions at the time.
I think you have to pay FICA taxes if you don't use the employer plan?

"There’s a major benefit to sticking with your employer’s plan: If your employer offers an HSA through a Section 125 Cafeteria Plan, your contributions will avoid FICA (Social Security and Medicare) taxes of 7.65%—a big benefit. According to Mark Luscombe, principal analyst with Wolters Kluwer Tax & Accounting U.S., in Riverwoods, Ill., the relevant language can be found in IRS Publication 15: “Employee contributions to their HSAs or MSAs through a payroll deduction plan must be included in wages and are subject to Social Security, Medicare, and FUTA taxes and income tax withholding. However, HSA contributions made under a salary reduction arrangement in a Section 125 Cafeteria Plan aren’t wages and aren’t subject to employment taxes or withholding.”


Now, if you really don’t like your employer’s offering, you can set up your own account elsewhere, fund it with after-tax money, and take the above-the-line deduction for those contributions on your tax return. But that tax break is limited to income taxes; you won’t get a deduction for FICA taxes."

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Re: FEHB Open Season 2019

Post by Cash » Mon Oct 14, 2019 8:03 pm

If your payroll is processed by the USDA, then you can direct pre-tax HSA contributions to the HSA of your choice. The pass-through contributions will still go to HSA Bank. I don’t know about other payroll processors.

Tdubs
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Re: FEHB Open Season 2019

Post by Tdubs » Mon Oct 14, 2019 8:23 pm

Cash wrote:
Mon Oct 14, 2019 8:03 pm
If your payroll is processed by the USDA, then you can direct pre-tax HSA contributions to the HSA of your choice. The pass-through contributions will still go to HSA Bank. I don’t know about other payroll processors.
I think this is true for all feds regardless of which agency processes their check.

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motorcyclesarecool
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Re: FEHB Open Season 2019

Post by motorcyclesarecool » Mon Oct 14, 2019 8:44 pm

VictoriaF wrote:
Mon Oct 14, 2019 3:19 pm

I have recently left GEHA, and now HSA Bank charges me $2/month. What are good options for holding a ~$40k HSA account used as savings (not investments) for ~$3k-$4k annual withdrawals?

Victoria
Fidelity HSA charges no fees and has online bill pay on the website. (The app doesn’t do online bill pay from my HSA). I haven’t tried to do a debit card for my Fidelity HSA. Perhaps someone knows the answer. You can choose FDIC insured options for your cash, or a range of brokered CDs and mutual funds.
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.

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Re: FEHB Open Season 2019

Post by nps » Mon Oct 14, 2019 9:01 pm

MillennialFinance19 wrote:
Mon Oct 14, 2019 6:23 pm
Tdubs wrote:
Mon Oct 14, 2019 6:01 pm

Yes.
Follow-on question. Is TD Ameritrade or Devenir preferred? It appears they're both highly rated in terms of HSAs.
TDA is a brokerage with zero commission fees and ETF access as low as .03 percent ER. As far as I last knew, Devenir under HSA Bank sold mutual funds with high fees. Not sure if that has changed.

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grabiner
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Re: FEHB Open Season 2019

Post by grabiner » Mon Oct 14, 2019 10:14 pm

tbone555 wrote:
Mon Oct 14, 2019 7:04 pm
I think you have to pay FICA taxes if you don't use the employer plan?

"There’s a major benefit to sticking with your employer’s plan: If your employer offers an HSA through a Section 125 Cafeteria Plan, your contributions will avoid FICA (Social Security and Medicare) taxes of 7.65%—a big benefit. According to Mark Luscombe, principal analyst with Wolters Kluwer Tax & Accounting U.S., in Riverwoods, Ill., the relevant language can be found in IRS Publication 15: “Employee contributions to their HSAs or MSAs through a payroll deduction plan must be included in wages and are subject to Social Security, Medicare, and FUTA taxes and income tax withholding. However, HSA contributions made under a salary reduction arrangement in a Section 125 Cafeteria Plan aren’t wages and aren’t subject to employment taxes or withholding.”
While this is true, it is not a major benefit. You avoid paying Social Security tax now, but you earn less Social Security as a result. The net effect is close to break-even, and may even be a net loss if you have low income; see Payroll Deduction: Health Savings Account on the wiki. It is a clear benefit, but only 1.45%, if you are over the SS limit and pay only Medicare.
Wiki David Grabiner

tj
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Re: FEHB Open Season 2019

Post by tj » Mon Oct 14, 2019 10:23 pm

motorcyclesarecool wrote:
Mon Oct 14, 2019 8:44 pm
VictoriaF wrote:
Mon Oct 14, 2019 3:19 pm

I have recently left GEHA, and now HSA Bank charges me $2/month. What are good options for holding a ~$40k HSA account used as savings (not investments) for ~$3k-$4k annual withdrawals?

Victoria
Fidelity HSA charges no fees and has online bill pay on the website. (The app doesn’t do online bill pay from my HSA). I haven’t tried to do a debit card for my Fidelity HSA. Perhaps someone knows the answer. You can choose FDIC insured options for your cash, or a range of brokered CDs and mutual funds.

I have the Fidelity HSA Debit card but I've never used it.

tj
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Re: FEHB Open Season 2019

Post by tj » Mon Oct 14, 2019 10:24 pm

VictoriaF wrote:
Mon Oct 14, 2019 3:19 pm
grabiner wrote:
Mon Oct 14, 2019 12:28 pm
While you have GEHA HDHP insurance, fees are waived in the HSA Bank account, so you can just put all your cash in HSA Bank, and transfer to TD Ameritrade when you are ready to make an investment. If you leave GEHA later, you can roll your entire HSA Bank HSA to whatever provider is best then.
I have recently left GEHA, and now HSA Bank charges me $2/month. What are good options for holding a ~$40k HSA account used as savings (not investments) for ~$3k-$4k annual withdrawals?

Victoria

Is there a reason you left GEHA?

Trapper
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Re: FEHB Open Season 2019

Post by Trapper » Tue Oct 15, 2019 7:11 am

Good question Victoria. I will be following thread for an answer. I expect to remain with GEHA, but always like to explore options.

UALflyer
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Re: FEHB Open Season 2019

Post by UALflyer » Tue Oct 15, 2019 9:19 am

AnonJohn wrote:
Thu Oct 10, 2019 6:51 am
MillennialFinance19 wrote:
Tue Oct 08, 2019 7:28 pm
I’m also awaiting info. I plan on switching from BCBS Basic to GEHA HDHP. I’m nervous, but have back-tested the last two years’ health expenses and I would have come out ahead in both. Time to make the leap in order to utilize the HSA!
I made that switch two years ago and have only one regret: that I didn't do it 10 years earlier. If I had I'd have saved tens of thousands. :oops:

On top of that, in one of the years we had some major health care expenses and easily cleared the deductible. It worked fine, and I had net savings compared with BCBS in several ways, including that the Basic plan has some chunky hospital stay co-pays.

My only caution: this depends on math. What is your marginal tax rate (bearing in mind that CA and NJ don't play nice with HSAs), and how much can you afford to put into the HSA?
Good luck!
Just keep in mind that comparing BCBS Basic to GEHA HDHP is a comparison of two very different health plans with very different benefits, which is skewing the calculations. If you compare BCBS's Basic plan to GEHA's Standard plan (not HDHP) or to the FEP Blue Focus, you'll also see substantial differences in their annual premiums.
If capping it at a medium or higher tax rate I think it's slam dunk, as Grabiner has persuasively documented several times.
It's actually not a slam dunk at all. With all due respect to grabiner, he does not run the calculations correctly. There are actually quite a few scenarios under which on a net basis something like the GEHA HDHP would end up costing you more than its Standard plan (there are also plenty of scenarios where the opposite is true).

Please take a look at the exchange here: viewtopic.php?t=232140

Keep in mind that the differences in monthly premiums are also amplified for various types of employees, such as part time employees.
grabiner wrote:
Mon Oct 14, 2019 10:14 pm
While this is true, it is not a major benefit. You avoid paying Social Security tax now, but you earn less Social Security as a result. The net effect is close to break-even, and may even be a net loss if you have low income; see Payroll Deduction: Health Savings Account on the wiki. It is a clear benefit, but only 1.45%, if you are over the SS limit and pay only Medicare.
If you are under the Social Security wage cutoff, the net effect is not necessarily close to break-even. For lower income folks, it is true that it can be a net loss, but it also tends to be a net gain for higher income folks, as well as for those whose spousal Social Security benefits would end up being higher than their own individual Social Security benefits, etc...

Please also remember that once you are over the Social Security wage cutoff, in addition to the 1.45% regular Medicare tax, there is a supplemental 0.9% Medicare surcharge (so, the grand total ends up being 2.35%) imposed on those with incomes (well, actually, MAGI rather than gross income) over $200K/single and $250K/married filing jointly. In addition, for those whose MAGI exceeds the above thresholds, there is an additional 3.8% tax on their net investment income.

Here's a Fidelity explanation: https://www.fidelity.com/viewpoints/per ... care-taxes

Tdubs
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Re: FEHB Open Season 2019

Post by Tdubs » Tue Oct 15, 2019 1:22 pm

UALflyer wrote:
Tue Oct 15, 2019 9:19 am
If capping it at a medium or higher tax rate I think it's slam dunk, as Grabiner has persuasively documented several times.
It's actually not a slam dunk at all. With all due respect to grabiner, he does not run the calculations correctly. There are actually quite a few scenarios under which on a net basis something like the GEHA HDHP would end up costing you more than its Standard plan (there are also plenty of scenarios where the opposite is true).

Please take a look at the exchange here: viewtopic.php?t=232140

Keep in mind that the differences in monthly premiums are also amplified for various types of employees, such as part time employees.
Though it is worth noting that Checkbook runs three scenarios where GEHA HDHP bests BCBS or GEHA basic plans. None where basic plans come out on top. And the max out of pocket on GEHA HDHP is lower. So Grabiner's calculations aren't the problem.

It is more that there are plausible, if unlikely, scenarios where a standard plan comes out on top, such as a year where your only medical expense is a gigantic accident-induced ER-only visit. Not an outcome you should bet your insurance plan on. If you are making full use of the HSA, the probabilities seem to favor an HDHP/HSA.

If you had a three-sided coin and two are heads, why would you call tails?

bene1
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Re: FEHB Open Season 2019

Post by bene1 » Tue Oct 15, 2019 2:30 pm

nps wrote:
Mon Oct 14, 2019 9:01 pm
MillennialFinance19 wrote:
Mon Oct 14, 2019 6:23 pm
Follow-on question. Is TD Ameritrade or Devenir preferred? It appears they're both highly rated in terms of HSAs.
TDA is a brokerage with zero commission fees and ETF access as low as .03 percent ER. As far as I last knew, Devenir under HSA Bank sold mutual funds with high fees. Not sure if that has changed.
http://www.hsabank.com/hsabank/members/ ... nt-program

The Devenir platform has access to cheap Vanguard Admiral funds, however read the fine print at the bottom of the page:
"The Devenir Mutual Fund Investment Account includes a 0.30% annual fee which is invoiced quarterly..."

UALflyer
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Re: FEHB Open Season 2019

Post by UALflyer » Tue Oct 15, 2019 2:54 pm

Tdubs wrote:
Tue Oct 15, 2019 1:22 pm
It is more that there are plausible, if unlikely, scenarios where a standard plan comes out on top, such as a year where your only medical expense is a gigantic accident-induced ER-only visit. Not an outcome you should bet your insurance plan on. If you are making full use of the HSA, the probabilities seem to favor an HDHP/HSA.
If you take a look at the thread that I linked above, you'll see a very common example that does not include any ER visits whatsoever.

There are plenty of other examples like it out there. In general, if your medical spending consists primarily of office visits, labs and prescription drugs, non-HDHP's will in a lot of cases save you money, all without forcing you to make very consequential healthcare decisions that all HDHP participants are frequently forced to make to forego medical attention for health issues that could prove to be very serious but that don't manifest themselves in an obvious way. As you've also correctly mentioned, if your healthcare spending tends to involve at least some ER visits in connection with accidental injuries (this is pretty common for people who enjoy certain very popular sports -- basketball, soccer, tennis, skiing/snowboarding, etc...), GEHA's Basic Plan, FEP Blue Focus and many other ones would provide 100% coverage without a deductible for the first 72 hours, which tends to represent a rather significant advantage.

As I've previously mentioned, there is absolutely nothing wrong with HDHP's, and they can certainly save their participants money. In close cases, however, people should very seriously consider erring on the side of caution and choosing non-HDHP plans, so that when the symptoms that they experience aren't totally clear, they do not have a financial incentive to forego seeking medical attention.

In general, it is exceptionally common for people to run their HDHP vs. non-HDHP calculations incorrectly, by, for instance, ignoring the identical tax benefits afforded to healthcare FSA's and HSA's (although the HSA's are obviously more flexible), the fact that with non-HDHP's certain types of healthcare spending results in a very small or even no out of pocket impact to the participants, etc...

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VictoriaF
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Re: FEHB Open Season 2019

Post by VictoriaF » Tue Oct 15, 2019 3:56 pm

motorcyclesarecool wrote:
Mon Oct 14, 2019 8:44 pm
VictoriaF wrote:
Mon Oct 14, 2019 3:19 pm

I have recently left GEHA, and now HSA Bank charges me $2/month. What are good options for holding a ~$40k HSA account used as savings (not investments) for ~$3k-$4k annual withdrawals?

Victoria
Fidelity HSA charges no fees and has online bill pay on the website. (The app doesn’t do online bill pay from my HSA). I haven’t tried to do a debit card for my Fidelity HSA. Perhaps someone knows the answer. You can choose FDIC insured options for your cash, or a range of brokered CDs and mutual funds.
I am not interested in an HSA debit card or online bill pay. I prefer to pay my bills using credit cards, claim my expenses online, and get reimbursed as a transfer from the HSA custodian to my bank account. Can I do that with Fidelity?

Victoria
WINNER of the 2015 Boglehead Contest. | Every joke has a bit of a joke. ... The rest is the truth. (Marat F)

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Re: FEHB Open Season 2019

Post by Tdubs » Tue Oct 15, 2019 8:13 pm

UALflyer wrote:
Tue Oct 15, 2019 2:54 pm
Tdubs wrote:
Tue Oct 15, 2019 1:22 pm
It is more that there are plausible, if unlikely, scenarios where a standard plan comes out on top, such as a year where your only medical expense is a gigantic accident-induced ER-only visit. Not an outcome you should bet your insurance plan on. If you are making full use of the HSA, the probabilities seem to favor an HDHP/HSA.
If you take a look at the thread that I linked above, you'll see a very common example that does not include any ER visits whatsoever.

There are plenty of other examples like it out there. In general, if your medical spending consists primarily of office visits, labs and prescription drugs, non-HDHP's will in a lot of cases save you money, all without forcing you to make very consequential healthcare decisions that all HDHP participants are frequently forced to make to forego medical attention for health issues that could prove to be very serious but that don't manifest themselves in an obvious way. As you've also correctly mentioned, if your healthcare spending tends to involve at least some ER visits in connection with accidental injuries (this is pretty common for people who enjoy certain very popular sports -- basketball, soccer, tennis, skiing/snowboarding, etc...), GEHA's Basic Plan, FEP Blue Focus and many other ones would provide 100% coverage without a deductible for the first 72 hours, which tends to represent a rather significant advantage.

As I've previously mentioned, there is absolutely nothing wrong with HDHP's, and they can certainly save their participants money. In close cases, however, people should very seriously consider erring on the side of caution and choosing non-HDHP plans, so that when the symptoms that they experience aren't totally clear, they do not have a financial incentive to forego seeking medical attention.

In general, it is exceptionally common for people to run their HDHP vs. non-HDHP calculations incorrectly, by, for instance, ignoring the identical tax benefits afforded to healthcare FSA's and HSA's (although the HSA's are obviously more flexible), the fact that with non-HDHP's certain types of healthcare spending results in a very small or even no out of pocket impact to the participants, etc...
Yes, I did read it, and we had a similar discussion previously viewtopic.php?f=2&t=284039. There I noted that a standard plan with FSAs loses in low-spend and high spend years--an FSA has no advantage if you spend little or nothing on medical, which was one of your examples in the original thread ($400 in copays paid from an FSA). In high spend years, the superior coverage of GEHA HDHP above the deductible tips the scales.

For the basic plans to come out ahead, you have to nail a max spend of your FSA and nothing more in the examples you provide, such as the one where you get free labs, have copays but spend nothing in areas advantaged by a GEHA HDHP. Not much more, not much less. You can carry over $500, but that isn't going to gain you much over an HSA across many years of coverage. I have two co-workers who had to figure out how to spend down to the $500. They got messages they didn't need, bought extra pairs of reading glasses they didn't need and the like. This is wasted money. In an HSA, you don't have that problem.

I don't think most sports injuries would be enough of an ER visit to tip the scales. Even someone who is a sports enthusiast isn't likely to visit an ER often enough that they should skip an HDHP.

There are scenarios where the basic plan + FSA wins, but it seems like drawing an inside straight from year to year.

I'd agree that if someone is inclined to avoid seeking care to save money in an HDHP, then a basic plan is best--certainly some insurers are betting people will do exactly that.

UALflyer
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Re: FEHB Open Season 2019

Post by UALflyer » Wed Oct 16, 2019 8:07 am

Tdubs wrote:
Tue Oct 15, 2019 8:13 pm
an FSA has no advantage if you spend little or nothing on medical, which was one of your examples in the original thread ($400 in copays paid from an FSA).
A lot depends on your particular situation. An FSA, while less flexible than an HSA, is still quite flexible and allows you to use it towards various expenses that don't have anything to do with medical co-pays. We know quite a few people, for instance, who get massages on a monthly basis, which are reimbursable from their FSA without a letter of medical necessity. There are quite a few expenses like that, but if none of them work for you, then you just need to factor this into your calculations.
For the basic plans to come out ahead, you have to nail a max spend of your FSA and nothing more in the examples you provide, such as the one where you get free labs, have copays but spend nothing in areas advantaged by a GEHA HDHP. Not much more, not much less.
That's not true either. What is true, however, is that with a non-HDHP plan, the category of your expenses matters. For some people, these expense categories are very stable and predictable, which makes these types of decisions fairly easy. For others, their expense categories and their overall healthcare spend varies a ton year to year, which makes these decisions a lot more difficult.

What is absolutely critical, however, is for people to run the calculations correctly. As I mentioned above, what is very common is for people to run the numbers in a way that, for instance, completely omits the tax advantages of a healthcare FSA (this is what grabiner did in the thread that I linked above, which skewed the numbers in favor of the HDHP's), disregards the fact that with a non-HDHP, a lot of healthcare expenses have very little or no out of pocket impact, etc...
You can carry over $500, but that isn't going to gain you much over an HSA across many years of coverage.
You should never be running these types of calculations over a period that is longer than a year. When you sign up for a health plan, at most, you are signing up for a year. Health plans change as do individual situations, so a health plan that made sense this year may not make sense the following year. This is one of the big advantages that FEHB's have, as a wide selection of those means that people can pick and choose them strategically in a way that maximizes their advantages for each year.
I have two co-workers who had to figure out how to spend down to the $500. They got messages they didn't need, bought extra pairs of reading glasses they didn't need and the like. This is wasted money. In an HSA, you don't have that problem.
This, I completely agree with, as an HSA is significantly more flexible. Prior to the implementation of the $500 carryover, this used to be a much bigger problem. Now, it's not nearly as much of an issue, particularly for families.
I don't think most sports injuries would be enough of an ER visit to tip the scales. Even someone who is a sports enthusiast isn't likely to visit an ER often enough that they should skip an HDHP.
For whatever reason, you make these very broad statements with great conviction, but without really looking into them.

Once again, it all depends on your particular situation. One of our neighbors, for instance, is an avid basketball player (plays 4-5 times a week) and a downhill skier. He averages 1-2 ER visits per year for various sports related injuries, which has been consistent for well over a decade.

I realize that this isn't your situation, but people and their lifestyles are all different, which is the reason that it's so important to run these calculations in a way that factors in your specific situation.
There are scenarios where the basic plan + FSA wins, but it seems like drawing an inside straight from year to year.
You're trying to say that this is the case for you, which is perfectly fine. I think that it's safe to say that every other person in the country isn't you, so their healthcare needs are going to be different.

There are lots and lots of people out there with very stable healthcare needs, for whom practically all their healthcare spend consists of maintenance medications and office visits with labs. For people like that, a non-HDHP plan will frequently make way more financial sense... or not, as they need to run their specific numbers.
I'd agree that if someone is inclined to avoid seeking care to save money in an HDHP, then a basic plan is best--certainly some insurers are betting people will do exactly that.
The very reason that employers and insurance companies like HDHP's is because they create powerful financial incentives for their participants to delay and avoid incurring medical expenses, which is the way that all these insurance companies and employers save money.

As I've previously mentioned, there are lots and lots of medical conditions that do not manifest themselves in an obvious way. If you have an HDHP and you get a really, really, really bad headache, you have a very powerful financial incentive to delay or avoid going to the ER. No matter how you slice it, an ER visit like that will cost you $1k+ (and, if imaging tests are ordered, you're talking about thousands of dollars), so there aren't a lot of HDHP participants out there who will just go to the ER right away, costs be damned. Instead, they will delay and try to manage it at home (until at least their regular doctor's office opens) as, after all, it's probably nothing. Yet, if it a brain aneurysm or subarachnoid hemorrhage, that delay could cost you your life.

Most people running these financial calculations tend not to pay all that much attention to the above factor. Yet, in practical terms, a person with no medical training already has a lot of trouble differentiating between emergent and non-emergent conditions, and the powerful financial incentive that HDHP's create causes virtually all HDHP participants to delay seeking care in these types of situations. This is the reason that I emphasize the fact that in close cases, people should err on the side of caution and opt for a non-HDHP.
Last edited by UALflyer on Fri Oct 18, 2019 7:26 am, edited 1 time in total.

AnonJohn
Posts: 254
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Re: FEHB Open Season 2019

Post by AnonJohn » Wed Oct 16, 2019 11:21 am

Drain wrote:
Thu Oct 10, 2019 1:31 pm
BogleFanGal wrote:
Thu Oct 10, 2019 12:43 pm
OP: thank you for thread - hoping people keep adding as more info comes to opm site. Does anyone know if GEHA HDHP members gain access to GEHA's discounted dental network rates through its HDHP plan? I'm not talking about the HDHP plan actually paying for any dental work other than preventive cleanings/exam benefit.

I'm just asking whether it gives you access to their negotiated dental rates if/when you need dental work and are paying out of pocket for it. (vs paying full walk-in rate.)

Or do you have to buy the separate GEHA Dental Plan for that?
I've had the dental plan for years but may drop it, given some problems I've experienced.
You have to buy the separate dental coverage to get its rates. The HDHP covers preventive and not much more. What the brochure states is all there is.
That doesn't comport with my experience at the dentist. Preventative service was covered free under HDHP (as in the brochure), and I got the GEHA negotiated rates for fillings. May be an artifact of how they handle insurance / billing, and I note that I had GEHA dental before, so perhaps the practice didn't handle the transition right. Either way, it's a nice feature to have.

AnonJohn
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Re: FEHB Open Season 2019

Post by AnonJohn » Wed Oct 16, 2019 11:23 am

Drain wrote:
Thu Oct 10, 2019 1:27 pm
I'd like to comment on the comparison of the CareFirst HDHP to the GEHA HDHP. I am far from an expert, but I've done these comparisons many times over the years, and I think I've learned some things. Be aware that, due to the onset of blindness, I cannot read the brochures anymore, so I have been getting my information from plan reps and from others I consider knowledgeable...or who at least have interesting things to say. :)
...
+1 - well put, and jives with my assessments.

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