HDHP over BCBS Basic for Feds?

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Topic Author
RJC
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HDHP over BCBS Basic for Feds?

Post by RJC » Mon Nov 11, 2019 2:08 pm

Dear friends,

Open Season is here. Is it worth switching from BCBS Basic to a HDHP if you are a Fed w/ a family (2 toddlers)? We are fairly healthy with no chronic illnesses.

If so, are there specific HDHP plans that you would recommend? We live in the Wash DC area.

Thanks!

Tdubs
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Re: HDHP over BCBS Basic for Feds?

Post by Tdubs » Mon Nov 11, 2019 2:59 pm

Yes, HDHP will benefit you, especially if you maximize contributions to the HSA.

The favorite HDHP seems to be GEHA. Checkbook's analysis for 2020 plan indicates that GEHA is a better buy than the other FEHB HDHPs regardless of high or low spend years.

Topic Author
RJC
Posts: 389
Joined: Fri Dec 14, 2018 1:40 pm

Re: HDHP over BCBS Basic for Feds?

Post by RJC » Mon Nov 11, 2019 8:27 pm

Tdubs wrote:
Mon Nov 11, 2019 2:59 pm
Yes, HDHP will benefit you, especially if you maximize contributions to the HSA.

The favorite HDHP seems to be GEHA. Checkbook's analysis for 2020 plan indicates that GEHA is a better buy than the other FEHB HDHPs regardless of high or low spend years.
Thank you. I will look into GEHA.

motorcyclesarecool
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Re: HDHP over BCBS Basic for Feds?

Post by motorcyclesarecool » Mon Nov 11, 2019 8:38 pm

Got GEHA HDHP and two littles. Works great! Not switching. One has severe food allergies and we hit the deductible every year between that and the usual ear infections. We’ve also used Limited Expense (LEX) FSA in FSAFEDS for when we’ve been able to anticipate major dental work (crowns, etc.) FSAFEDS app for iPhone is the best government related IT system I’ve ever seen. I can submit the optical or dental receipt prior to leaving the establishment, and the reimbursement is in my checking account in under a week.
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
RJC
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Re: HDHP over BCBS Basic for Feds?

Post by RJC » Mon Nov 11, 2019 8:48 pm

motorcyclesarecool wrote:
Mon Nov 11, 2019 8:38 pm
Got GEHA HDHP and two littles. Works great! Not switching. One has severe food allergies and we hit the deductible every year between that and the usual ear infections. We’ve also used Limited Expense (LEX) FSA in FSAFEDS for when we’ve been able to anticipate major dental work (crowns, etc.) FSAFEDS app for iPhone is the best government related IT system I’ve ever seen. I can submit the optical or dental receipt prior to leaving the establishment, and the reimbursement is in my checking account in under a week.
Good to hear! So the gov't puts in $1,800 into your HSA account each year? How does that work?

Tdubs
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Re: HDHP over BCBS Basic for Feds?

Post by Tdubs » Mon Nov 11, 2019 8:54 pm

RJC wrote:
Mon Nov 11, 2019 8:48 pm
motorcyclesarecool wrote:
Mon Nov 11, 2019 8:38 pm
Got GEHA HDHP and two littles. Works great! Not switching. One has severe food allergies and we hit the deductible every year between that and the usual ear infections. We’ve also used Limited Expense (LEX) FSA in FSAFEDS for when we’ve been able to anticipate major dental work (crowns, etc.) FSAFEDS app for iPhone is the best government related IT system I’ve ever seen. I can submit the optical or dental receipt prior to leaving the establishment, and the reimbursement is in my checking account in under a week.
Good to hear! So the gov't puts in $1,800 into your HSA account each year? How does that work?
They will deposit $150/month to your HSA. In your first year, the first deposit won't start until February.

tj
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Re: HDHP over BCBS Basic for Feds?

Post by tj » Mon Nov 11, 2019 9:12 pm

Tdubs wrote:
Mon Nov 11, 2019 2:59 pm
Yes, HDHP will benefit you, especially if you maximize contributions to the HSA.

The favorite HDHP seems to be GEHA. Checkbook's analysis for 2020 plan indicates that GEHA is a better buy than the other FEHB HDHPs regardless of high or low spend years.

OP lives in DC. CareFirst has an HDHP which is allegedly better.

motorcyclesarecool
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Re: HDHP over BCBS Basic for Feds?

Post by motorcyclesarecool » Mon Nov 11, 2019 9:13 pm

Tdubs wrote:
Mon Nov 11, 2019 8:54 pm
RJC wrote:
Mon Nov 11, 2019 8:48 pm
motorcyclesarecool wrote:
Mon Nov 11, 2019 8:38 pm
Got GEHA HDHP and two littles. Works great! Not switching. One has severe food allergies and we hit the deductible every year between that and the usual ear infections. We’ve also used Limited Expense (LEX) FSA in FSAFEDS for when we’ve been able to anticipate major dental work (crowns, etc.) FSAFEDS app for iPhone is the best government related IT system I’ve ever seen. I can submit the optical or dental receipt prior to leaving the establishment, and the reimbursement is in my checking account in under a week.
Good to hear! So the gov't puts in $1,800 into your HSA account each year? How does that work?
They will deposit $150/month to your HSA. In your first year, the first deposit won't start until February.
What s/he said. You’ll still get $1800, but the last $150 premium pass-through won’t arrive in your account until January 2021. But it still counts as a contribution for 2020. Don’t accidentally over contribute.
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.

6Pack
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Re: HDHP over BCBS Basic for Feds?

Post by 6Pack » Mon Nov 11, 2019 9:24 pm

Of course the first day of open season would be on a federal holiday...

I have a family of 5 (including me) and we will stick with BCBS Basic. With kids, it’s amazing the stuff that can just come up (like my youngest needing minor surgery last year). However, if you’re comfortable with a HDHP, go for it.

Tdubs
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Re: HDHP over BCBS Basic for Feds?

Post by Tdubs » Mon Nov 11, 2019 9:26 pm

tj wrote:
Mon Nov 11, 2019 9:12 pm
Tdubs wrote:
Mon Nov 11, 2019 2:59 pm
Yes, HDHP will benefit you, especially if you maximize contributions to the HSA.

The favorite HDHP seems to be GEHA. Checkbook's analysis for 2020 plan indicates that GEHA is a better buy than the other FEHB HDHPs regardless of high or low spend years.

OP lives in DC. CareFirst has an HDHP which is allegedly better.
Not according to Checkbook 2020. It has flipped since the 2019 analysis.
Last edited by Tdubs on Mon Nov 11, 2019 9:28 pm, edited 1 time in total.

Topic Author
RJC
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Re: HDHP over BCBS Basic for Feds?

Post by RJC » Mon Nov 11, 2019 9:28 pm

Tdubs wrote:
Mon Nov 11, 2019 9:26 pm
tj wrote:
Mon Nov 11, 2019 9:12 pm
Tdubs wrote:
Mon Nov 11, 2019 2:59 pm
Yes, HDHP will benefit you, especially if you maximize contributions to the HSA.

The favorite HDHP seems to be GEHA. Checkbook's analysis for 2020 plan indicates that GEHA is a better buy than the other FEHB HDHPs regardless of high or low spend years.

OP lives in DC. CareFirst has an HDHP which is allegedly better.
Not according to Checkbook 2020.
CareFirst appears to be a HMO (vs FFS for GEHA). Does that matter?

Topic Author
RJC
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Re: HDHP over BCBS Basic for Feds?

Post by RJC » Mon Nov 11, 2019 9:31 pm

6Pack wrote:
Mon Nov 11, 2019 9:24 pm
Of course the first day of open season would be on a federal holiday...

I have a family of 5 (including me) and we will stick with BCBS Basic. With kids, it’s amazing the stuff that can just come up (like my youngest needing minor surgery last year). However, if you’re comfortable with a HDHP, go for it.
I have my doubts as well but the more I'm learning about HDHPs, it seems like a good deal even for a family (as long as there are no chronic illnesses). Off the bat, you have about 3k in premium savings and credits with GEHA HDHP vs BCBS Basic which will cover the difference in deductibles.
Last edited by RJC on Mon Nov 11, 2019 9:32 pm, edited 1 time in total.

Tdubs
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Re: HDHP over BCBS Basic for Feds?

Post by Tdubs » Mon Nov 11, 2019 9:32 pm

RJC wrote:
Mon Nov 11, 2019 9:28 pm
Tdubs wrote:
Mon Nov 11, 2019 9:26 pm
tj wrote:
Mon Nov 11, 2019 9:12 pm
Tdubs wrote:
Mon Nov 11, 2019 2:59 pm
Yes, HDHP will benefit you, especially if you maximize contributions to the HSA.

The favorite HDHP seems to be GEHA. Checkbook's analysis for 2020 plan indicates that GEHA is a better buy than the other FEHB HDHPs regardless of high or low spend years.

OP lives in DC. CareFirst has an HDHP which is allegedly better.
Not according to Checkbook 2020.
CareFirst appears to be a HMO (vs FFS for GEHA). Does that matter?
When I put in all of my family's doctors into the comparison tool for Checkbook (a fair number), I couldn't find any that were in my GEHA plan but not Carefirst. So, on that score, at least, it doesn't seem to matter.

Tdubs
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Re: HDHP over BCBS Basic for Feds?

Post by Tdubs » Mon Nov 11, 2019 9:35 pm

RJC wrote:
Mon Nov 11, 2019 9:31 pm
6Pack wrote:
Mon Nov 11, 2019 9:24 pm
Of course the first day of open season would be on a federal holiday...

I have a family of 5 (including me) and we will stick with BCBS Basic. With kids, it’s amazing the stuff that can just come up (like my youngest needing minor surgery last year). However, if you’re comfortable with a HDHP, go for it.
I have my doubts as well but the more I'm learning about HDHPs, it seems like a good deal even for a family (as long as there are no chronic illnesses). Off the bat, you have about 3k in premium savings and credits with GEHA HDHP vs BCBS Basic which will cover the difference in deductibles.
Whether you make light or heavy use of medical, HDHPs are superior, as far as cost goes.

Topic Author
RJC
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Re: HDHP over BCBS Basic for Feds?

Post by RJC » Mon Nov 11, 2019 10:03 pm

motorcyclesarecool wrote:
Mon Nov 11, 2019 9:13 pm
Tdubs wrote:
Mon Nov 11, 2019 8:54 pm
RJC wrote:
Mon Nov 11, 2019 8:48 pm
motorcyclesarecool wrote:
Mon Nov 11, 2019 8:38 pm
Got GEHA HDHP and two littles. Works great! Not switching. One has severe food allergies and we hit the deductible every year between that and the usual ear infections. We’ve also used Limited Expense (LEX) FSA in FSAFEDS for when we’ve been able to anticipate major dental work (crowns, etc.) FSAFEDS app for iPhone is the best government related IT system I’ve ever seen. I can submit the optical or dental receipt prior to leaving the establishment, and the reimbursement is in my checking account in under a week.
Good to hear! So the gov't puts in $1,800 into your HSA account each year? How does that work?
They will deposit $150/month to your HSA. In your first year, the first deposit won't start until February.
What s/he said. You’ll still get $1800, but the last $150 premium pass-through won’t arrive in your account until January 2021. But it still counts as a contribution for 2020. Don’t accidentally over contribute.
Would you be able to invest that $1,800 if you don't need to use it that year?

Tdubs
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Re: HDHP over BCBS Basic for Feds?

Post by Tdubs » Mon Nov 11, 2019 10:16 pm

RJC wrote:
Mon Nov 11, 2019 10:03 pm
motorcyclesarecool wrote:
Mon Nov 11, 2019 9:13 pm
Tdubs wrote:
Mon Nov 11, 2019 8:54 pm
RJC wrote:
Mon Nov 11, 2019 8:48 pm
motorcyclesarecool wrote:
Mon Nov 11, 2019 8:38 pm
Got GEHA HDHP and two littles. Works great! Not switching. One has severe food allergies and we hit the deductible every year between that and the usual ear infections. We’ve also used Limited Expense (LEX) FSA in FSAFEDS for when we’ve been able to anticipate major dental work (crowns, etc.) FSAFEDS app for iPhone is the best government related IT system I’ve ever seen. I can submit the optical or dental receipt prior to leaving the establishment, and the reimbursement is in my checking account in under a week.
Good to hear! So the gov't puts in $1,800 into your HSA account each year? How does that work?
They will deposit $150/month to your HSA. In your first year, the first deposit won't start until February.
What s/he said. You’ll still get $1800, but the last $150 premium pass-through won’t arrive in your account until January 2021. But it still counts as a contribution for 2020. Don’t accidentally over contribute.
Would you be able to invest that $1,800 if you don't need to use it that year?
Yes, sometimes HSA's require you reach a balance of $1000 before you can move money out to a linked brokerage account. For GEHA, you work with HSA Bank for your cash account that can pay bills. Once you have enough to invest, you will move money to TD Ameritrade.

FedLawyerandBaller
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Re: HDHP over BCBS Basic for Feds?

Post by FedLawyerandBaller » Mon Nov 11, 2019 10:48 pm

OP,

I will tell you a lot of folks on this forum love HSAs, and that is understandable, but I disagree with the posts or recommendations that you should blindly assume that an HDHP with and HSA will be better. I have put a lot of time and effort into these considerations and for BCBS Basic last year, I was out of pocket 4760 pretax. In the last year, my wife (a runner) had X-Rays and an MRI ($5,000 alone) and I had a sonogram and an endoscopy when I felt a lump in my throat and doctors wanted to make sure I was okay (I was). Although this year the BCBS Basic made more financial sense, I think the bigger question is are you going to avoid care - now that it will come out of pocket - for you and your family if you sign up for an HDHP? Personally, I don’t want to be in that situation where there is something wrong and it’s “probably okay” and I don’t want to spend down a large chunk of my HSA. All this is to say, I think the question is more personal than many of those on this forum that immediately say it is always right.

motorcyclesarecool
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Re: HDHP over BCBS Basic for Feds?

Post by motorcyclesarecool » Tue Nov 12, 2019 5:35 am

RJC wrote:
Mon Nov 11, 2019 10:03 pm
Would you be able to invest that $1,800 if you don't need to use it that year?
I’ve forgotten how much cash HSABank makes you keep on hand before you can push money to TD Ameritrade. Currently, I’m setup to have my “cafeteria plan” payroll contributions made to my Fidelity HSA, which has better investment options. Only the $1800 premium pass-through goes to HSABank. My agency does its payroll through USDA NFC. I don’t know how feasible that would be if your agency uses a different payroll processor. Currently, I do not max my TSP contributions, so we use my HSA money to pay our medical expenses. Generally, we use our HSA Bank debit cards to pay for prescriptions, and I pay medical bills using Fidelity’s Online Bill Pay function. Works great.
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.

stormswami
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Re: HDHP over BCBS Basic for Feds?

Post by stormswami » Tue Nov 12, 2019 6:13 am

We (family of four) were longtime Fed users of BCBS Basic, but switched last year to go to the HDHP with GEHA. My only regret is not doing so before. I finally got out of my BCBS comfort zone after seeing the circumstances of a couple of coworkers/friends that have had serious medical issues such as Kidney transplants and advanced stages of cancer while under a HDHP (GEHA in particular). Catastrophic limits were easily reached in those cases, but even under the worst case circumstances, GEHA HDHP was cheaper for them than BCBS Basic. Mileage in terms of providers/networks/circumstances will vary, but my general take, backed by real-life circumstances and detailed calculations of scenarios, is that a HDHP plan such as GEHA comes out ahead the majority of the time compared to a very good BCBS Basic plan (which we were very satisfied with). We even picked up some fringe benefits as far as dental, with the GEHA HDHP being more generous than BCBS Basic for routine cleanings/Xray.

Our pass-through HSA contributions go to HSABank, but we direct our elective portion to Fidelity for investment.

Topic Author
RJC
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Re: HDHP over BCBS Basic for Feds?

Post by RJC » Tue Nov 12, 2019 8:33 am

FedLawyerandBaller wrote:
Mon Nov 11, 2019 10:48 pm
OP,

I will tell you a lot of folks on this forum love HSAs, and that is understandable, but I disagree with the posts or recommendations that you should blindly assume that an HDHP with and HSA will be better. I have put a lot of time and effort into these considerations and for BCBS Basic last year, I was out of pocket 4760 pretax. In the last year, my wife (a runner) had X-Rays and an MRI ($5,000 alone) and I had a sonogram and an endoscopy when I felt a lump in my throat and doctors wanted to make sure I was okay (I was). Although this year the BCBS Basic made more financial sense, I think the bigger question is are you going to avoid care - now that it will come out of pocket - for you and your family if you sign up for an HDHP? Personally, I don’t want to be in that situation where there is something wrong and it’s “probably okay” and I don’t want to spend down a large chunk of my HSA. All this is to say, I think the question is more personal than many of those on this forum that immediately say it is always right.
This is a very good point. Thank you. But wouldn't the costs still be similar after reaching the 3k in deductibles? I'm also assuming the 3k is a gift since it's the total of premium savings and employee contributions.

Topic Author
RJC
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Re: HDHP over BCBS Basic for Feds?

Post by RJC » Tue Nov 12, 2019 9:29 am

Are there any situations where BCBS Basic is better than GEHA HDHP? Car accident? Chronic medications?

mw1739
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Re: HDHP over BCBS Basic for Feds?

Post by mw1739 » Tue Nov 12, 2019 9:47 am

RJC wrote:
Tue Nov 12, 2019 9:29 am
Are there any situations where BCBS Basic is better than GEHA HDHP? Car accident? Chronic medications?
I don't have the exact figures in front of me, but the cost of almost every prescription is higher on GEHA. Once I factored that in, the cost differential was < $1,000 for my situation.

ChrisC
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Re: HDHP over BCBS Basic for Feds?

Post by ChrisC » Tue Nov 12, 2019 9:58 am

RJC wrote:
Tue Nov 12, 2019 9:29 am
Are there any situations where BCBS Basic is better than GEHA HDHP? Car accident? Chronic medications?
Hmmmm, I had BCBS Basic for many years until I switched over to Aetna HDHP in 2008, and then later GEHA HDHP in retirement in 2016; when we went on Medicare (Part A) in 2018 we switched over to GEHA Standard. The only case in which BCBS Basic would have been better one year is when I had very low medical expenses and had lots of acupunture treatments that BCBS Basic would have covered. I switched over from Aetna HDHP to GEHA HDHP because Aetna would not cover a treatment that it considered experimental but GEHA didn't.

We've had multiple surgeries during coverage by HDHPs and once the deductible was met the HDHP insurance coverage and cost was superior to BCBS-Basic. Having said that, it's a whole different situation in retirement and if Medicare coverage applies.

Tdubs
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Re: HDHP over BCBS Basic for Feds?

Post by Tdubs » Tue Nov 12, 2019 10:06 am

RJC wrote:
Tue Nov 12, 2019 8:33 am
FedLawyerandBaller wrote:
Mon Nov 11, 2019 10:48 pm
OP,

I will tell you a lot of folks on this forum love HSAs, and that is understandable, but I disagree with the posts or recommendations that you should blindly assume that an HDHP with and HSA will be better. I have put a lot of time and effort into these considerations and for BCBS Basic last year, I was out of pocket 4760 pretax. In the last year, my wife (a runner) had X-Rays and an MRI ($5,000 alone) and I had a sonogram and an endoscopy when I felt a lump in my throat and doctors wanted to make sure I was okay (I was). Although this year the BCBS Basic made more financial sense, I think the bigger question is are you going to avoid care - now that it will come out of pocket - for you and your family if you sign up for an HDHP? Personally, I don’t want to be in that situation where there is something wrong and it’s “probably okay” and I don’t want to spend down a large chunk of my HSA. All this is to say, I think the question is more personal than many of those on this forum that immediately say it is always right.
This is a very good point. Thank you. But wouldn't the costs still be similar after reaching the 3k in deductibles? I'm also assuming the 3k is a gift since it's the total of premium savings and employee contributions.
Certainly there will be a temptation to avoid spending on medical when it is your money, but probably only one family member--you--will have this problem. My family thinks not at all about the HDHP deductible when going in for care. There is also an odd incentive to seek care in an HDHP. It is the end of the year, and I've been harassing my young-adult kids to go in for care and refill prescriptions before the end of the year while we are still only paying 5% on office visits, allergy shots and the like.

The implication from the discussion above is that if you have a lot of medical expenses, a basic plan is better. It usually isn't, though there are some cases where the calculation gets iffy particularly if your expenses are very close to the deductible. High expense, low expense years are almost always best in an HDHP.

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VictoriaF
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Re: HDHP over BCBS Basic for Feds?

Post by VictoriaF » Tue Nov 12, 2019 11:52 am

I am in the DC area and trying to choose between BC/BS-Basic and BC/BS-Standard. Another option is GEHA-High.

How likely is one to need an out-of-network doctor that's not covered by BC/BS-Basic? All my current doctors are in the network, but I am thinking about unknown unknowns.

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

Tdubs
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Re: HDHP over BCBS Basic for Feds?

Post by Tdubs » Tue Nov 12, 2019 1:09 pm

VictoriaF wrote:
Tue Nov 12, 2019 11:52 am
I am in the DC area and trying to choose between BC/BS-Basic and BC/BS-Standard. Another option is GEHA-High.

How likely is one to need an out-of-network doctor that's not covered by BC/BS-Basic? All my current doctors are in the network, but I am thinking about unknown unknowns.

Victoria
Was in GEHA high and I'm now in GEHA HDHP. I don't recommend the high option. Just expensive. I have the same access to doctors in the HDHP and pay less.

I have no experience with BC, but I never had a problem with access to good care in GEHA. A family member recently had an unusual situation with her vision that required an ophthalmologist with special skills. The one nearby was not in the GEHA network. All that meant is that we wound up at the Wilmer Eye Institute at Hopkins and got a doctor with a great reputation.

ChrisC
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Re: HDHP over BCBS Basic for Feds?

Post by ChrisC » Tue Nov 12, 2019 2:52 pm

One thing I've observed the last few years in GEHA, whether its HDHP or Standard, is that the customer service is horrible, relative to the superior service I received from Aetna and BCBS in the past. Frequently, the information I received from GEHA representatives is wrong or subject to correction from another representative or official. I had to hassle with them over Medicare coverage -- for my wife and me. They messed up my HSA contributions the last month I was in the HDHP, when I went over to Medicare Part A in December. They gave me inconsistent information about the mail order drug program.

The other day, I get a notice from GEHA asking about my retiree dental insurance coverage from the Federal agency I retired from, not FedVip insurance coverage. In speaking to the customer representative, she tells me that all medical insurance claims will be in a hold pattern until I provide GEHA with the required information about my dental insurance coverage -- who would have thought that! I tell her that my dental insurance is primary and covers a lot more than the meager, sliver of dental coverage provided by GEHA. I think they paid only a few dollars this year for my wife -- after my dentist processed claims through my primary dental insurer.

I'm now carefully looking at BCBS-Basic, which has covered my BIL with MS for the last 2 years along with Medicare. We've managed his health care and we've had no issues with BCBS-Basic for him, despite extraordinarily expensive drug treatments for him. I'm carefully looking at BCBS-Basic now as all our providers are in network, and I'm sure we would get better customer service and Basic is probably a shade cheaper than GEHA standard and might even have better coverage for hearing aids, which I might need.

tj
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Re: HDHP over BCBS Basic for Feds?

Post by tj » Tue Nov 12, 2019 3:39 pm

RJC wrote:
Mon Nov 11, 2019 9:28 pm
Tdubs wrote:
Mon Nov 11, 2019 9:26 pm
tj wrote:
Mon Nov 11, 2019 9:12 pm
Tdubs wrote:
Mon Nov 11, 2019 2:59 pm
Yes, HDHP will benefit you, especially if you maximize contributions to the HSA.

The favorite HDHP seems to be GEHA. Checkbook's analysis for 2020 plan indicates that GEHA is a better buy than the other FEHB HDHPs regardless of high or low spend years.

OP lives in DC. CareFirst has an HDHP which is allegedly better.
Not according to Checkbook 2020.
CareFirst appears to be a HMO (vs FFS for GEHA). Does that matter?
All of the regional plans seem to show up as hmo.

Topic Author
RJC
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Re: HDHP over BCBS Basic for Feds?

Post by RJC » Wed Nov 13, 2019 8:50 am

Thank you everyone for your comments. I will look into GEHA HDHP and compare line-by-line with my current BCBS Basic plan.

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VictoriaF
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Re: HDHP over BCBS Basic for Feds?

Post by VictoriaF » Wed Nov 13, 2019 6:27 pm

Tdubs wrote:
Tue Nov 12, 2019 1:09 pm
VictoriaF wrote:
Tue Nov 12, 2019 11:52 am
I am in the DC area and trying to choose between BC/BS-Basic and BC/BS-Standard. Another option is GEHA-High.

How likely is one to need an out-of-network doctor that's not covered by BC/BS-Basic? All my current doctors are in the network, but I am thinking about unknown unknowns.

Victoria
Was in GEHA high and I'm now in GEHA HDHP. I don't recommend the high option. Just expensive. I have the same access to doctors in the HDHP and pay less.

I have no experience with BC, but I never had a problem with access to good care in GEHA. A family member recently had an unusual situation with her vision that required an ophthalmologist with special skills. The one nearby was not in the GEHA network. All that meant is that we wound up at the Wilmer Eye Institute at Hopkins and got a doctor with a great reputation.
Thank you for your comments. FYI, BCBS-Basic does not cover out-of-network providers but BCBS-Standard and GEHA do. I don't have an existing need for out-of-network care but wonder if I need to cover a potential need. For now, I signed for GEHA-High, but may change my mind in the next couple weeks, while the enrollment is on.

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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VictoriaF
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Re: HDHP over BCBS Basic for Feds?

Post by VictoriaF » Wed Nov 13, 2019 6:30 pm

ChrisC wrote:
Tue Nov 12, 2019 2:52 pm
One thing I've observed the last few years in GEHA, whether its HDHP or Standard, is that the customer service is horrible, relative to the superior service I received from Aetna and BCBS in the past. Frequently, the information I received from GEHA representatives is wrong or subject to correction from another representative or official. I had to hassle with them over Medicare coverage -- for my wife and me. They messed up my HSA contributions the last month I was in the HDHP, when I went over to Medicare Part A in December. They gave me inconsistent information about the mail order drug program.

The other day, I get a notice from GEHA asking about my retiree dental insurance coverage from the Federal agency I retired from, not FedVip insurance coverage. In speaking to the customer representative, she tells me that all medical insurance claims will be in a hold pattern until I provide GEHA with the required information about my dental insurance coverage -- who would have thought that! I tell her that my dental insurance is primary and covers a lot more than the meager, sliver of dental coverage provided by GEHA. I think they paid only a few dollars this year for my wife -- after my dentist processed claims through my primary dental insurer.

I'm now carefully looking at BCBS-Basic, which has covered my BIL with MS for the last 2 years along with Medicare. We've managed his health care and we've had no issues with BCBS-Basic for him, despite extraordinarily expensive drug treatments for him. I'm carefully looking at BCBS-Basic now as all our providers are in network, and I'm sure we would get better customer service and Basic is probably a shade cheaper than GEHA standard and might even have better coverage for hearing aids, which I might need.
Hi Chris,

Thank you for your insights. Note that BCBS-Basic does not provide out-of-network coverage. Also, this year, GEHA-High will start reimbursing $600 per year of Medicare Part B costs.

Victoria
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Re: HDHP over BCBS Basic for Feds?

Post by Tdubs » Wed Nov 13, 2019 10:17 pm

VictoriaF wrote:
Wed Nov 13, 2019 6:27 pm
Tdubs wrote:
Tue Nov 12, 2019 1:09 pm
VictoriaF wrote:
Tue Nov 12, 2019 11:52 am
I am in the DC area and trying to choose between BC/BS-Basic and BC/BS-Standard. Another option is GEHA-High.

How likely is one to need an out-of-network doctor that's not covered by BC/BS-Basic? All my current doctors are in the network, but I am thinking about unknown unknowns.

Victoria
Was in GEHA high and I'm now in GEHA HDHP. I don't recommend the high option. Just expensive. I have the same access to doctors in the HDHP and pay less.

I have no experience with BC, but I never had a problem with access to good care in GEHA. A family member recently had an unusual situation with her vision that required an ophthalmologist with special skills. The one nearby was not in the GEHA network. All that meant is that we wound up at the Wilmer Eye Institute at Hopkins and got a doctor with a great reputation.
Thank you for your comments. FYI, BCBS-Basic does not cover out-of-network providers but BCBS-Standard and GEHA do. I don't have an existing need for out-of-network care but wonder if I need to cover a potential need. For now, I signed for GEHA-High, but may change my mind in the next couple weeks, while the enrollment is on.

Victoria
Good luck. GEHA High option is certainly safe, and I used it. Perhaps in a year or two, after you are comfortable with GEHA, consider the other GEHA options. They all have the same network of providers, and it is large enough that I never go outside the network even though my family has seen a lot of specialists including those with expertise in rare conditions. So the choice among the three is really just cost.

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MillennialFinance19
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Re: HDHP over BCBS Basic for Feds?

Post by MillennialFinance19 » Wed Nov 13, 2019 10:32 pm

I just made my election today. We’re switching from BCBS Basic to GEHA HDHP. The math makes sense based on our last two years of claims, and each year had a child birth. Considering we now expect our needs to be primarily preventative, I think we’ll be okay.

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Re: HDHP over BCBS Basic for Feds?

Post by Tdubs » Wed Nov 13, 2019 10:45 pm

BTW, my agency had its benefits fair today. I asked the rep from Kaiser why they didn't offer an HDHP. He said hardly any feds use an HDHP (~3%). I was stunned.

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Re: HDHP over BCBS Basic for Feds?

Post by burnsh » Thu Nov 14, 2019 6:55 am

With all the recent changes of online brokers dropping their fees, does it make sense to still set up an account with Fidelity instead of using TDAmeritrade? With the elimination of fees I don't think it matters anymore. Am I missing something?
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Re: HDHP over BCBS Basic for Feds?

Post by AnonJohn » Thu Nov 14, 2019 8:04 am

@OP & MillenialFinance: After a long time with BCBS basic and in between the birth of my two kids, I switched to GEHA HDHP. We've been happy ever since, including in the birth year. We live in DC. Regret not doing it earlier.

OP, I think you have it right --- ignore the deductible since it's "gift" money (in the form of HSA pass through and reduced premiums). That said, the earlier warning not to avoid care to save money is a key psychological point.

Other bits: the Carefirst HDHP was suggested. In my view it's a competitive offering, but I've stuck with GEHA since it's close and I can't see how to break the tie and I'm happy with GEHA. GEHA does offer some preventative dental and some in-network dental pricing, which is nice.

For those long-term investors with GEHA, the HSA bank / TD Ameritrade approach is free (fees paid). The only "cost" is having to leave $100 in HSA bank. I recommend it. Nowadays you can seemingly do Vanguard ETFs free @ TD ameritrade, but I haven't moved from the SPDRs, which have lower ERs (that's another project!)

I have my voluntary HSA contributions deducted through payroll, saving medicare tax. I prefer this to using fidelity / doing it myself, but it maybe depends on your agency.

I'd caveat all this with: (a) there are a lot of good choices in FEHB; lucky to have them and (b) fully funding the HSA with a middling to high marginal rate is a factor. In the 15% bracket you should run the numbers, but GEHA probably still looks good.

Hope this helps ...

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Re: HDHP over BCBS Basic for Feds?

Post by RJC » Thu Nov 14, 2019 8:07 am

Tdubs wrote:
Wed Nov 13, 2019 10:45 pm
BTW, my agency had its benefits fair today. I asked the rep from Kaiser why they didn't offer an HDHP. He said hardly any feds use an HDHP (~3%). I was stunned.
It's probably because there are "safe" plans like BCBS Basic and GEHA standard that are available to Feds. Before learning about HDHPs, I thought it was more risky especially for families. I'm planning on making the switch.

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RJC
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Re: HDHP over BCBS Basic for Feds?

Post by RJC » Thu Nov 14, 2019 8:21 am

burnsh wrote:
Thu Nov 14, 2019 6:55 am
With all the recent changes of online brokers dropping their fees, does it make sense to still set up an account with Fidelity instead of using TDAmeritrade? With the elimination of fees I don't think it matters anymore. Am I missing something?
This is a good question. I am curious as well.

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RJC
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Re: HDHP over BCBS Basic for Feds?

Post by RJC » Thu Nov 14, 2019 8:22 am

AnonJohn wrote:
Thu Nov 14, 2019 8:04 am
@OP & MillenialFinance: After a long time with BCBS basic and in between the birth of my two kids, I switched to GEHA HDHP. We've been happy ever since, including in the birth year. We live in DC. Regret not doing it earlier.

OP, I think you have it right --- ignore the deductible since it's "gift" money (in the form of HSA pass through and reduced premiums). That said, the earlier warning not to avoid care to save money is a key psychological point.

Other bits: the Carefirst HDHP was suggested. In my view it's a competitive offering, but I've stuck with GEHA since it's close and I can't see how to break the tie and I'm happy with GEHA. GEHA does offer some preventative dental and some in-network dental pricing, which is nice.

For those long-term investors with GEHA, the HSA bank / TD Ameritrade approach is free (fees paid). The only "cost" is having to leave $100 in HSA bank. I recommend it. Nowadays you can seemingly do Vanguard ETFs free @ TD ameritrade, but I haven't moved from the SPDRs, which have lower ERs (that's another project!)

I have my voluntary HSA contributions deducted through payroll, saving medicare tax. I prefer this to using fidelity / doing it myself, but it maybe depends on your agency.

I'd caveat all this with: (a) there are a lot of good choices in FEHB; lucky to have them and (b) fully funding the HSA with a middling to high marginal rate is a factor. In the 15% bracket you should run the numbers, but GEHA probably still looks good.

Hope this helps ...
Thank you AnonJohn. What do you mean by "(b) fully funding the HSA with a middling to high marginal rate is a factor. In the 15% bracket you should run the numbers, but GEHA probably still looks good."? Does it matter what tax bracket you are in to get the most benefit?

Also, have you used GEHA-HDHP's vision benefit? Can I take out my current vision plan?

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Re: HDHP over BCBS Basic for Feds?

Post by Tdubs » Thu Nov 14, 2019 9:31 am

RJC wrote:
Thu Nov 14, 2019 8:07 am
Tdubs wrote:
Wed Nov 13, 2019 10:45 pm
BTW, my agency had its benefits fair today. I asked the rep from Kaiser why they didn't offer an HDHP. He said hardly any feds use an HDHP (~3%). I was stunned.
It's probably because there are "safe" plans like BCBS Basic and GEHA standard that are available to Feds. Before learning about HDHPs, I thought it was more risky especially for families. I'm planning on making the switch.
Me too. After doing the math, I wondered how I could have been so stupid for the 7 years I wasted on a standard plan. But I guess most people don't do the math, ever.

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Re: HDHP over BCBS Basic for Feds?

Post by RJC » Thu Nov 14, 2019 10:49 am

Tdubs wrote:
Thu Nov 14, 2019 9:31 am
RJC wrote:
Thu Nov 14, 2019 8:07 am
Tdubs wrote:
Wed Nov 13, 2019 10:45 pm
BTW, my agency had its benefits fair today. I asked the rep from Kaiser why they didn't offer an HDHP. He said hardly any feds use an HDHP (~3%). I was stunned.
It's probably because there are "safe" plans like BCBS Basic and GEHA standard that are available to Feds. Before learning about HDHPs, I thought it was more risky especially for families. I'm planning on making the switch.
Me too. After doing the math, I wondered how I could have been so stupid for the 7 years I wasted on a standard plan. But I guess most people don't do the math, ever.
Do you have any concerns about the Rx coverage? I'm used to a flat $10 copay vs 25%. Is 25% good? Not sure how much generic drugs cost these days.

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Re: HDHP over BCBS Basic for Feds?

Post by asif408 » Thu Nov 14, 2019 10:56 am

RJC wrote:
Thu Nov 14, 2019 8:21 am
burnsh wrote:
Thu Nov 14, 2019 6:55 am
With all the recent changes of online brokers dropping their fees, does it make sense to still set up an account with Fidelity instead of using TDAmeritrade? With the elimination of fees I don't think it matters anymore. Am I missing something?
This is a good question. I am curious as well.
I think as long as your HSA has no maintenance fees and no investing limits it doesn't matter if you use Fidelity or one from another provider that uses TD Ameritrade (e.g., Lively). If I was you, OP, I'd just use the work HSA for contributions to get the tax savings on FICA and match and if you want to or have the ability to invest move money over periodically using a trustee-to-trustee transfer to another HSA account for investing. It's just a matter of personal preference which provider you use once you pick one that doesn't charge fees and let's you invest commission free.

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Re: HDHP over BCBS Basic for Feds?

Post by drizzleray » Thu Nov 14, 2019 11:08 am

RJC wrote:
Thu Nov 14, 2019 10:49 am
Tdubs wrote:
Thu Nov 14, 2019 9:31 am
RJC wrote:
Thu Nov 14, 2019 8:07 am
Tdubs wrote:
Wed Nov 13, 2019 10:45 pm
BTW, my agency had its benefits fair today. I asked the rep from Kaiser why they didn't offer an HDHP. He said hardly any feds use an HDHP (~3%). I was stunned.
It's probably because there are "safe" plans like BCBS Basic and GEHA standard that are available to Feds. Before learning about HDHPs, I thought it was more risky especially for families. I'm planning on making the switch.
Me too. After doing the math, I wondered how I could have been so stupid for the 7 years I wasted on a standard plan. But I guess most people don't do the math, ever.
Do you have any concerns about the Rx coverage? I'm used to a flat $10 copay vs 25%. Is 25% good? Not sure how much generic drugs cost these days.
You can price out your medications here: https://info.caremark.com/GEHA

UALflyer
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Re: HDHP over BCBS Basic for Feds?

Post by UALflyer » Thu Nov 14, 2019 11:51 am

RJC wrote:
Mon Nov 11, 2019 9:31 pm
6Pack wrote:
Mon Nov 11, 2019 9:24 pm
Of course the first day of open season would be on a federal holiday...

I have a family of 5 (including me) and we will stick with BCBS Basic. With kids, it’s amazing the stuff that can just come up (like my youngest needing minor surgery last year). However, if you’re comfortable with a HDHP, go for it.
I have my doubts as well but the more I'm learning about HDHPs, it seems like a good deal even for a family (as long as there are no chronic illnesses). Off the bat, you have about 3k in premium savings and credits with GEHA HDHP vs BCBS Basic which will cover the difference in deductibles.
A substantial portion of the premium savings that you are looking at is attributable to the fact that the two plans that you are looking at are quite different, so it's not an apples to apples comparison. If you compare GEHA Standard to GEHA HDHP, it'll be a much more apples to apples comparison. Also note that there's a BCBS Blue Focus plan, a non-HDHP with monthly premiums lower than those of GEHA Standard, which can be very attractive for people with low healthcare utilization.

In general, the decision between HDHP and non-HDHP plans tends to be a lot more nuanced than a lot of posters who've given you advice here (without knowing anything about your situation) would have you believe. Here's a link to a recent thread in which some of the considerations on both sides were discussed: viewtopic.php?f=2&t=292105
Last edited by UALflyer on Thu Nov 14, 2019 11:58 am, edited 2 times in total.

Tdubs
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Re: HDHP over BCBS Basic for Feds?

Post by Tdubs » Thu Nov 14, 2019 11:56 am

RJC wrote:
Thu Nov 14, 2019 10:49 am
Tdubs wrote:
Thu Nov 14, 2019 9:31 am
RJC wrote:
Thu Nov 14, 2019 8:07 am
Tdubs wrote:
Wed Nov 13, 2019 10:45 pm
BTW, my agency had its benefits fair today. I asked the rep from Kaiser why they didn't offer an HDHP. He said hardly any feds use an HDHP (~3%). I was stunned.
It's probably because there are "safe" plans like BCBS Basic and GEHA standard that are available to Feds. Before learning about HDHPs, I thought it was more risky especially for families. I'm planning on making the switch.
Me too. After doing the math, I wondered how I could have been so stupid for the 7 years I wasted on a standard plan. But I guess most people don't do the math, ever.
Do you have any concerns about the Rx coverage? I'm used to a flat $10 copay vs 25%. Is 25% good? Not sure how much generic drugs cost these days.
For generics, which is all but one prescription we have, everything is cheaper at 25% than a $10 copay.

tj
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Re: HDHP over BCBS Basic for Feds?

Post by tj » Thu Nov 14, 2019 9:00 pm

RJC wrote:
Thu Nov 14, 2019 10:49 am
Tdubs wrote:
Thu Nov 14, 2019 9:31 am
RJC wrote:
Thu Nov 14, 2019 8:07 am
Tdubs wrote:
Wed Nov 13, 2019 10:45 pm
BTW, my agency had its benefits fair today. I asked the rep from Kaiser why they didn't offer an HDHP. He said hardly any feds use an HDHP (~3%). I was stunned.
It's probably because there are "safe" plans like BCBS Basic and GEHA standard that are available to Feds. Before learning about HDHPs, I thought it was more risky especially for families. I'm planning on making the switch.
Me too. After doing the math, I wondered how I could have been so stupid for the 7 years I wasted on a standard plan. But I guess most people don't do the math, ever.
Do you have any concerns about the Rx coverage? I'm used to a flat $10 copay vs 25%. Is 25% good? Not sure how much generic drugs cost these days.
People say that's the worst part of the plan, but it really depends on what you take. The only med i've taken in recent years is the Z Pack. This is what the search engine says. Sounds like the co-pay is more expensive than the drug.

Drug: Azithromycin 250mg Tablet
Day Supply: 5
Total Quantity: 6.0
Your Cost $0.54
Plan Cost $1.63
Total Cost $2.17

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Re: HDHP over BCBS Basic for Feds?

Post by stan1 » Thu Nov 14, 2019 9:17 pm

RJC wrote:
Thu Nov 14, 2019 10:49 am

Do you have any concerns about the Rx coverage? I'm used to a flat $10 copay vs 25%. Is 25% good? Not sure how much generic drugs cost these days.
Many of the FEHB plans now have prescription cost calculators so you can put in what you use.

Prescription drug coverage for non-generic drugs has become a major cost differentiator between different FEHB plans. If you need a non-generic drug you need to be very careful. Some drug classes do not have a generic option. If you don't need a non-generic drug now you can manage your risk by being able to switch to a different plan next year that has a fixed co-pay for non-generic drugs rather than a co-insurance payment. BCBS Standard is one of the more expensive plans but it may still be a good choice for anyone who needs non-generic prescriptions because it has a low co pay for a 90 day mail order supply (have to run the numbers for your situation).

Also remember non-HDHP plans can be paired with an FSA up to $2700 exempt from federal and state income tax. So $900 savings if you are married in 33% tax bracket.

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Re: HDHP over BCBS Basic for Feds?

Post by grabiner » Thu Nov 14, 2019 11:09 pm

stan1 wrote:
Thu Nov 14, 2019 9:17 pm
Also remember non-HDHP plans can be paired with an FSA up to $2700 exempt from federal and state income tax. So $900 savings if you are married in 33% tax bracket.
And HDHP holders can use a limited-expense HSA for dental and vision coverage, so you can still get some of that benefit if you buy glasses or contacts, or know you will have dental work. (Many HDHPs cover dental checkups and cleanings, so you may not need an FSA for that part of your expenses; likewise, if you have partial vision care, reduce your FSA contribution accordingly.)
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Re: HDHP over BCBS Basic for Feds?

Post by HawkeyeJD » Fri Nov 15, 2019 12:50 am

stan1 wrote:
Thu Nov 14, 2019 9:17 pm
RJC wrote:
Thu Nov 14, 2019 10:49 am

Do you have any concerns about the Rx coverage? I'm used to a flat $10 copay vs 25%. Is 25% good? Not sure how much generic drugs cost these days.
Many of the FEHB plans now have prescription cost calculators so you can put in what you use.

Prescription drug coverage for non-generic drugs has become a major cost differentiator between different FEHB plans. If you need a non-generic drug you need to be very careful. Some drug classes do not have a generic option. If you don't need a non-generic drug now you can manage your risk by being able to switch to a different plan next year that has a fixed co-pay for non-generic drugs rather than a co-insurance payment. BCBS Standard is one of the more expensive plans but it may still be a good choice for anyone who needs non-generic prescriptions because it has a low co pay for a 90 day mail order supply (have to run the numbers for your situation).

Also remember non-HDHP plans can be paired with an FSA up to $2700 exempt from federal and state income tax. So $900 savings if you are married in 33% tax bracket.

I can highlight in my situation why the HDHP plan was a substantially worse choice and it relates to one of Stan1’s points:

My monthly prescription costs $2000. Under BCBS Basic my cost is a $70 copay. I then use the drug companies copay program, which reduces the copay to $5 a month.

Under Geha HDHP, the drug is also $2000 a month but I’m on the hook for $500 a month (25% preferred specialty copay). The drug company program actually covers up to $10k a year in copay assistance. However, on page 88 of the 2020 geha HDHP brochure, it says “Drug coupon/copay cards: We do not honor or coordinate benefits with drug coupon/copay cards. You are responsible for your copay or coinsurance as indicated in this brochure.” Based on this language I’d be unable to use the copay program and I’d hit the HDHP individual catastrophic cap of $5k in the early to middle of each year.

Note that BCBS Basic brochure has no stated restrictions about copay card coordination.

Running the scenario based on the above appears to be a clear win for BSBC Basic in my scenario as the higher premiums relative to geha HDHP are more than offset by the much lower costs for my particular medication.

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RJC
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Re: HDHP over BCBS Basic for Feds?

Post by RJC » Sat Nov 16, 2019 10:36 pm

grabiner wrote:
Thu Nov 14, 2019 11:09 pm
stan1 wrote:
Thu Nov 14, 2019 9:17 pm
Also remember non-HDHP plans can be paired with an FSA up to $2700 exempt from federal and state income tax. So $900 savings if you are married in 33% tax bracket.
And HDHP holders can use a limited-expense HSA for dental and vision coverage, so you can still get some of that benefit if you buy glasses or contacts, or know you will have dental work. (Many HDHPs cover dental checkups and cleanings, so you may not need an FSA for that part of your expenses; likewise, if you have partial vision care, reduce your FSA contribution accordingly.)
I thought GEHA HDHP has full vision coverage?

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