Risk analysis of having HSA vs. PPO Plan

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Risk analysis of having HSA vs. PPO Plan

Post by haranoth » Tue Nov 12, 2019 9:58 pm

My current workplace (a mid level reputed tech firm) offers both PPO and HSA plan.
From, what I have seen/told from multiple colleagues, our health benefit is top notch.. Something like 90th percentile.
However, a lot of people (including me) are not aware of 2 very important notes to the PPO vs HSA plan.
Both of these points are quite typical of companies that offer both plans and the BCBS / Aetna sites that compares the 2 plans, do not do justice to this 2 extremely important points while comparing.

The hdhp for my company charges (for family)
in-network 3k deductible with 6k out of pocket max
out of network 6k deductible with 12k out of pocket max

However, lets say you went to emergency care to a hospital/urgent care/ doctor both in and out of network throughout the year.
Your out of max can actually be 6k(in-network) + 12k(out of network) = 18k per year !
For ppo that total max (in+out of network) comes out to 8k for my company.

The ppo network atleast for my company and several other companies in my area covers emergency room visit, all associated diagnostic tests , but the hdhp plan does not cover the diagnostic tests (even for emergency visit, hospice).

While people routinely use the BCBS/Aetna sites for comparing HDHP vs. ppo, they routinely quote 6k max, stead of thinking of 18k max.
(If you/your family is in emergency , I guarantee you , you will not check for in/out network at that point of time.)

Secondly, people like me and my colleagues who have been used to ppo plan forever, sort of assume a majority of ER visit related diagnostics are covered. In fact, many medical professionals are also under the same impression(several nurses during my latest ER visit told me ... yes it is covered :( )

So, when the HDHP vs. PPO plans are discussed around here.. in BCBS sites people should be really be aware of the 18k max and not just the 6k/in-network max that gets quoted and be aware that other than preventive care, most other ER/Hospise etc. are not really covered until deductible is met. Emergencies do happen and while doing HSA vs PPO these 2 points should be thought out extensively before coming to a decision.

So, after all this rant, I wanted to ask is there a better comparison tool out there that can asses not just monetary (how much you pay in HDHP vs ppo), but also focusing on these kind of nitty details?
On another note, can the bogleheads wiki be updated to highlight these 2 important points?
https://www.bogleheads.org/wiki/High_de ... advantages

From talking to several colleagues that switched to HDHP plan from PPO , I am pretty sure no one thought to think about these or learned these the hard way.

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Re: Risk analysis of having HSA vs. PPO Plan

Post by grabiner » Tue Nov 12, 2019 10:56 pm

Check your plan documents. I would expect that in-network expenses count towards the out-of-network deductible and maximum. Otherwise, if you had met the out-of-network maximum but not the in-network maximum, you would have an incentive to see out-of-network providers, costing the plan more money.

In any case, the risk is the same with a conventional plan and an HDHP; you will get reduced coverage if you go out of network. And the real risk is not what the plan covers, but what it doesn't cover at all; if an out-of-network surgeon bills $10,000 and the plan allowance is $4000, you get insurance benefits against the $4000, and will be billed for the other $6000, which does not count toward your out-of-network limit. (Some states have limitations on surprise bills for out-of-network providers, particularly when you do not have a choice.)
Wiki David Grabiner

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