Health Insurance: Not able to decide between HDHP/HSA and PPO

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HasHas
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Health Insurance: Not able to decide between HDHP/HSA and PPO

Post by HasHas »

Hello Bogleheads,

I have been enrolled in PPO (COVA Care) ever since I started my employment. I am 34 now and currently in the 22% Federal and 5.75% State tax tax bracket. I recently started getting my investments in order and was advised to check the Prioritizing investments page on this forum. This is where I came across HSA.

I checked my benefits package and noticed that I do have the option of selecting a HDHP/HSA. I am now wondering whether it makes sense to make this change. Here is the document containing information about both the plans: Benefits page. I am trying to decide between CovaCare + Expanded Dental (PPO; current premium: $351) and COVA HDHP + Expanded Dental (current premium: $88). The premium information is available on page 3 of the above document and the benefits are described on pages 4 and 5 of the above document.

I don't think my employer is going to make any matching contributions to HSA but this needs to be confirmed with HR after the Thanksgiving break.

Could anyone provide any suggestions/thoughts/advice on how to think through this logically? Also, if anyone has gone through this thought process recently, I would love to hear your experience.

Thanks.
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rterickson
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Re: Health Insurance: Not able to decide between COVA HDHP/HSA and COVA Care

Post by rterickson »

There have been many previous threads on this topic.

AARP has a comparison tool where you can plug in your yearly estimated health care usage and see the difference: https://www.aarp.org/health/medicare-in ... lator.html

Generally speaking, the HSA comes out ahead if you go to the doctor very little or very much. In the middle, there may not be a lot of difference.

Many Bogleheads don't use the HSA for paying medical bills, choosing rather to make the full contribution and let it grow completely tax free, and use for retirement healthcare tax free. This assumes of course you are in a position to self-finance your out of pocket expenses.

From personal experience, I only participated for the last two years of my employment and never touched the balance. When I retired last year, I transferred my HSA to Fidelity, invested in a Zero Fund, and am letting it grow.
Topic Author
HasHas
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Re: Health Insurance: Not able to decide between COVA HDHP/HSA and COVA Care

Post by HasHas »

rterickson wrote: Sat Nov 28, 2020 3:24 pm There have been many previous threads on this topic.

AARP has a comparison tool where you can plug in your yearly estimated health care usage and see the difference: https://www.aarp.org/health/medicare-in ... lator.html

Generally speaking, the HSA comes out ahead if you go to the doctor very little or very much. In the middle, there may not be a lot of difference.

Many Bogleheads don't use the HSA for paying medical bills, choosing rather to make the full contribution and let it grow completely tax free, and use for retirement healthcare tax free. This assumes of course you are in a position to self-finance your out of pocket expenses.

From personal experience, I only participated for the last two years of my employment and never touched the balance. When I retired last year, I transferred my HSA to Fidelity, invested in a Zero Fund, and am letting it grow.
Thank you for responding. I went over some of the early threads and did in fact use a Health Savings Account (HSA) vs. Traditional Health Plan calculator, which I believe is the same calculator that you suggested. Using some ball park numbers, here is what I found:

Annual doctor visits: 20
Annual prescriptions: 20
Marginal income tax rate: 28%

HSA:

Annual HSA Contribution: $3,156 [My current PPP premium - HDHP premium]
Monthly premium: $88
Annual deductible: $3,500 [Two or more persons]
Annual out-of-pocket: $10,000 [Two or more persons]
Co-insurance: 0%
Other expenses: $0
Total annual costs: $2,172

Traditional Health Plan:

Monthly premium: $351
Annual deductible: $600
Annual out-of-pocket: $3,000
Co-pay for doctor visits: $25
Co-pay for prescriptions: $15
Co-insurance: 0%
Other expenses: $0
Total annual costs: $5,012

Looking at this, it appears that HDHP/HSA is significantly superior than my current PPO plan. Since I did not intuitively understand it, I was wondering if someone more trained/experienced could shed some light on it. Thanks in advance.
Hiker-Biker
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Re: Health Insurance: Not able to decide between HDHP/HSA and PPO

Post by Hiker-Biker »

I ran the numbers using HSA 2021 Limits for Married - $7200

Using your premium figures.
COVA PPO + dental Annual premium $4,212
Maximum out of pocket $3000
Total Costs $7212

COVA HDHP + Dental Annual Premium $1056
Max Out of pocket $10,000
Total Costs before HSA contribution $11,056
$7200 HSA Contribution - would defray your Total Cost to $3856

Your tax savings for a max HSA Contribution $7200 X 0.2275 (Fed + VA state) = $1998
So you would come out ahead using the HDHP plan in this scenario.

I'm a Fed living in VA and the GEHA HDHP Self + 1 policy will cost me $3,4306 in annual premiums, with a $3000 deductible, and a max out of pocket $10,000. However, the employer contribution is $1,800.
furwut
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Re: Health Insurance: Not able to decide between HDHP/HSA and PPO

Post by furwut »

I’ve had an HSA insurance policy since the start of the ACA marketplace in 2014. If you require little to no medical care an HSA will save you money (lower premium + tax benefits). If one has a chronic condition that requires on-going care then the PPO may be better (some expenses covered first dollar + lower deductible).

You should also consider the network of providers each policy offers.

One behavioral aspect of using an HSA is that one can be reluctant to see a doctor since the cost will be out of pocket until the deductible is met. Therefore an HSA may be false savings if overall health suffers. If you do go with an HSA I suggest you commit to contributing the annual max to the HSA account and leaving it in cash. Then, as the year progresses, tell yourself you’ve prepaid for your medical care and visit the doctor as necessary. At the end of the year you can invest any remainder above the max out of pocket limit.
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HasHas
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Re: Health Insurance: Not able to decide between HDHP/HSA and PPO

Post by HasHas »

Hiker-Biker wrote: Sat Nov 28, 2020 7:06 pm I ran the numbers using HSA 2021 Limits for Married - $7200

Using your premium figures.
COVA PPO + dental Annual premium $4,212
Maximum out of pocket $3000
Total Costs $7212

COVA HDHP + Dental Annual Premium $1056
Max Out of pocket $10,000
Total Costs before HSA contribution $11,056
$7200 HSA Contribution - would defray your Total Cost to $3856

Your tax savings for a max HSA Contribution $7200 X 0.2275 (Fed + VA state) = $1998 [Edit: 7200 X 0.2775 = $1998]
So you would come out ahead using the HDHP plan in this scenario.

I'm a Fed living in VA and the GEHA HDHP Self + 1 policy will cost me $3,4306 in annual premiums, with a $3000 deductible, and a max out of pocket $10,000. However, the employer contribution is $1,800.
Thank you for sharing this calculation. This comparison of "worst case" scenarios in which we consider maximum out of pocket in both cases is indeed meaningful. I am not sure if I completely follow your argument. Please allow me to explain.

I agree that the total worst case cost of COVA PPO is $7212, as you stated.

However, for COVA HDHP/HSA, the total worst case cost is $11,056 - $1998 (tax savings) = $9058 (since I am still paying for the $7200 HSA contribution for that year).

Am I missing something? I do understand the earning potential of HSA, especially if we don't need to use healthcare for a few years and keep making the maximum allowed contributions.

Thank you so much for helping me think through this.
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HasHas
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Re: Health Insurance: Not able to decide between HDHP/HSA and PPO

Post by HasHas »

furwut wrote: Sat Nov 28, 2020 7:44 pm I’ve had an HSA insurance policy since the start of the ACA marketplace in 2014. If you require little to no medical care an HSA will save you money (lower premium + tax benefits). If one has a chronic condition that requires on-going care then the PPO may be better (some expenses covered first dollar + lower deductible).

You should also consider the network of providers each policy offers.

One behavioral aspect of using an HSA is that one can be reluctant to see a doctor since the cost will be out of pocket until the deductible is met. Therefore an HSA may be false savings if overall health suffers. If you do go with an HSA I suggest you commit to contributing the annual max to the HSA account and leaving it in cash. Then, as the year progresses, tell yourself you’ve prepaid for your medical care and visit the doctor as necessary. At the end of the year you can invest any remainder above the max out of pocket limit.
Thank you for the great advice. My wife and I were discussing the same behavioral aspect of the HSA in the afternoon. We also concluded that if we are going to go with a HDHP/HSA plan, we need to change our mindset about healthcare and stop "worrying" about the out of pocket charges. We were thinking of keeping aside a $10K emergency healthcare fund to cover out-of-pocket charges until we have a healthy balance in HSA. However, what you suggested about contributing the annual max to the HSA account and leaving it in cash until the end of the year is a great idea.

Yes, I will compare our network of providers in both the plans.

By the way, I understand why you said that HSA will be better if we don't need much medical care in a given year. However, would you elaborate a bit more on why PPO would be better in case of a chronic condition or on-going care? Is this because of the worst case calculations in Hiker-Biker's post and some follow up arguments in my response to his/her post?
furwut
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Re: Health Insurance: Not able to decide between HDHP/HSA and PPO

Post by furwut »

However, would you elaborate a bit more on why PPO would be better in case of a chronic condition or on-going care?
In the Traditional versus HDHP/HSA Health Insurance models there is usually some level of moderate medical expense where the total cost (premium + expenses - employer contribution - tax savings) of the traditional policy becomes less. Premium, employer contribution, and probable tax savings are knowable so all one has to do is look at various expenditure scenarios to determine at what point a PPO policy becomes the better financial deal.

Approach 1 - Prior Experience
Gather up last year’s expenses, throw out any one-off expenses (e.g., freak accident), and add in any planned upcoming expenses (e.g., birth). Use this amount to see which plan gives you the least total cost.

Approach 2 - Back of Envelope
Compare the plans using an incremental increasing amount of presumed expenses (e.g. $0, $1000, $2000, ...). If the point at which the PPO becomes cheaper seems really high then go with the HSA.

Approach 3 - Spreadsheet
Harry Sit, who posts here and writes the blog ‘The Finance Buff’, has developed a spreadsheet to plug all the numbers into.
Do The Math: HMO/PPO vs High Deductible Plan With HSA

Finally, picking an insurance plan isn’t just a dollar & cents exercise. We buy insurance to protect us from the awful things in life not the everyday and mundane. A bargain plan that has a skimpy network is not such a bargain if one is diagnosed with a serious illness and the preferred doctors/facilities are out of network.
Hiker-Biker
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Re: Health Insurance: Not able to decide between HDHP/HSA and PPO

Post by Hiker-Biker »

HasHas wrote: Sat Nov 28, 2020 11:08 pm
Hiker-Biker wrote: Sat Nov 28, 2020 7:06 pm I ran the numbers using HSA 2021 Limits for Married - $7200

Using your premium figures.
COVA PPO + dental Annual premium $4,212
Maximum out of pocket $3000
Total Costs $7212

COVA HDHP + Dental Annual Premium $1056
Max Out of pocket $10,000
Total Costs before HSA contribution $11,056
$7200 HSA Contribution - would defray your Total Cost to $3856

Your tax savings for a max HSA Contribution $7200 X 0.2275 (Fed + VA state) = $1998 [Edit: 7200 X 0.2775 = $1998]
So you would come out ahead using the HDHP plan in this scenario.

I'm a Fed living in VA and the GEHA HDHP Self + 1 policy will cost me $3,4306 in annual premiums, with a $3000 deductible, and a max out of pocket $10,000. However, the employer contribution is $1,800.
Thank you for sharing this calculation. This comparison of "worst case" scenarios in which we consider maximum out of pocket in both cases is indeed meaningful. I am not sure if I completely follow your argument. Please allow me to explain.

I agree that the total worst case cost of COVA PPO is $7212, as you stated.

However, for COVA HDHP/HSA, the total worst case cost is $11,056 - $1998 (tax savings) = $9058 (since I am still paying for the $7200 HSA contribution for that year).

Am I missing something? I do understand the earning potential of HSA, especially if we don't need to use healthcare for a few years and keep making the maximum allowed contributions.

Thank you so much for helping me think through this.
My point is in the worst case scenario is you spend all of your HSA to reduce your total insurance outlay. That is no different than the worst case scenario of spending $7,212 for the PPO option. The lower annual premium and tax savings makes the HSA option less expensive than the PPO option. If you do not have significant expenses, then you come out further ahead.
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SB1234
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Re: Health Insurance: Not able to decide between HDHP/HSA and PPO

Post by SB1234 »

HasHas wrote: Sat Nov 28, 2020 11:31 pm
furwut wrote: Sat Nov 28, 2020 7:44 pm I’ve had an HSA insurance policy since the start of the ACA marketplace in 2014. If you require little to no medical care an HSA will save you money (lower premium + tax benefits). If one has a chronic condition that requires on-going care then the PPO may be better (some expenses covered first dollar + lower deductible).

You should also consider the network of providers each policy offers.

One behavioral aspect of using an HSA is that one can be reluctant to see a doctor since the cost will be out of pocket until the deductible is met. Therefore an HSA may be false savings if overall health suffers. If you do go with an HSA I suggest you commit to contributing the annual max to the HSA account and leaving it in cash. Then, as the year progresses, tell yourself you’ve prepaid for your medical care and visit the doctor as necessary. At the end of the year you can invest any remainder above the max out of pocket limit.
Thank you for the great advice. My wife and I were discussing the same behavioral aspect of the HSA in the afternoon. We also concluded that if we are going to go with a HDHP/HSA plan, we need to change our mindset about healthcare and stop "worrying" about the out of pocket charges. We were thinking of keeping aside a $10K emergency healthcare fund to cover out-of-pocket charges until we have a healthy balance in HSA. However, what you suggested about contributing the annual max to the HSA account and leaving it in cash until the end of the year is a great idea.

Yes, I will compare our network of providers in both the plans.

By the way, I understand why you said that HSA will be better if we don't need much medical care in a given year. However, would you elaborate a bit more on why PPO would be better in case of a chronic condition or on-going care? Is this because of the worst case calculations in Hiker-Biker's post and some follow up arguments in my response to his/her post?
Actually based on your premium numbers, I am finding that the HSA is better in all cases, as long as you stay in network.

Because for HSA, insurance will start paying 100% after 3500+ 12*81 = $4472.
While for the traditional plan even you will keep paying because of the copays. And just the premiums is 12*351=$4212. If HSA plan has good network then that's what I would choose.
In many cases the decision is not so clear cut because of coinsurance. E.g for me the non hsa has zero coinsurance but the hsa has 10% coinsurance, but because of the annual out of pocket max that coinsurance has a limited impact even if there was a major medical bill e.g in 50-60k or more.
But in your case I think HSA comes out best in all cases.
superstition: belief that market will one day come around to your concept of fair value
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HasHas
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Re: Health Insurance: Not able to decide between HDHP/HSA and PPO

Post by HasHas »

furwut wrote: Sun Nov 29, 2020 9:23 am
However, would you elaborate a bit more on why PPO would be better in case of a chronic condition or on-going care?
In the Traditional versus HDHP/HSA Health Insurance models there is usually some level of moderate medical expense where the total cost (premium + expenses - employer contribution - tax savings) of the traditional policy becomes less. Premium, employer contribution, and probable tax savings are knowable so all one has to do is look at various expenditure scenarios to determine at what point a PPO policy becomes the better financial deal.

Approach 1 - Prior Experience
Gather up last year’s expenses, throw out any one-off expenses (e.g., freak accident), and add in any planned upcoming expenses (e.g., birth). Use this amount to see which plan gives you the least total cost.

Approach 2 - Back of Envelope
Compare the plans using an incremental increasing amount of presumed expenses (e.g. $0, $1000, $2000, ...). If the point at which the PPO becomes cheaper seems really high then go with the HSA.

Approach 3 - Spreadsheet
Harry Sit, who posts here and writes the blog ‘The Finance Buff’, has developed a spreadsheet to plug all the numbers into.
Do The Math: HMO/PPO vs High Deductible Plan With HSA
Thanks for sharing your thoughts, especially the spreadsheet in Approach 3.
furwut wrote: Sun Nov 29, 2020 9:23 am
However, would you elaborate a bit more on why PPO would be better in case of a chronic condition or on-going care?
Finally, picking an insurance plan isn’t just a dollar & cents exercise. We buy insurance to protect us from the awful things in life not the everyday and mundane. A bargain plan that has a skimpy network is not such a bargain if one is diagnosed with a serious illness and the preferred doctors/facilities are out of network.
Exactly! This is the reason why I have been slightly reluctant in leaving our current PPO plan (even though HDHP appears appealing for our nominal medical care needs). I will definitely do my due diligence in checking the network of providers in HDHP before we consider pulling the plug. Thanks for your advice.
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HasHas
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Re: Health Insurance: Not able to decide between HDHP/HSA and PPO

Post by HasHas »

Hiker-Biker wrote: Sun Nov 29, 2020 10:19 am
My point is in the worst case scenario is you spend all of your HSA to reduce your total insurance outlay. That is no different than the worst case scenario of spending $7,212 for the PPO option. The lower annual premium and tax savings makes the HSA option less expensive than the PPO option. If you do not have significant expenses, then you come out further ahead.
Got it. I agree that if there are no unforeseen large medical expenses, HSA is better. I will also check the network of providers in the two plans to make an informed decision. Thank you for your advice.
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HasHas
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Re: Health Insurance: Not able to decide between HDHP/HSA and PPO

Post by HasHas »

SB1234 wrote: Sun Nov 29, 2020 12:27 pm Actually based on your premium numbers, I am finding that the HSA is better in all cases, as long as you stay in network.

Because for HSA, insurance will start paying 100% after 3500+ 12*81 = $4472.
While for the traditional plan even you will keep paying because of the copays. And just the premiums is 12*351=$4212. If HSA plan has good network then that's what I would choose.
In many cases the decision is not so clear cut because of coinsurance. E.g for me the non hsa has zero coinsurance but the hsa has 10% coinsurance, but because of the annual out of pocket max that coinsurance has a limited impact even if there was a major medical bill e.g in 50-60k or more.
But in your case I think HSA comes out best in all cases.
Thank you for sharing your inputs. I follow your thought process but could not completely understand why you said that in HSA, insurance will pay 100% after 3500[deductible] + 12*81[premium] = $4472. Similar to the traditional plan, won't we have copays and other charges until we reach the out-of-pocket limit in HDHP/HSA? For instance, for doctor's visits, we will have to pay 20% after deductible whereas in PPO, we will be paying a flat fee ($25 for the primary care physician and $40 for the specialist). Could you please clarify?

I do agree with the importance of checking the quality of the in-network providers (as also suggested in the responses above).
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Re: Health Insurance: Not able to decide between HDHP/HSA and PPO

Post by grabiner »

Hiker-Biker wrote: Sat Nov 28, 2020 7:06 pm I'm a Fed living in VA and the GEHA HDHP Self + 1 policy will cost me $3,4306 in annual premiums, with a $3000 deductible, and a max out of pocket $10,000. However, the employer contribution is $1,800.
I have worked this out several times for the DC Bogleheads. The Federal HDHPs are usually so good that you come out ahead, compared to the conventional plan from the same provider, even if you hit the worst case of using the whole deductible. That is, the plan's contribution to your HSA, plus your own tax savings on the HSA contribution, plus or minus any premium difference (with GEHA, premiums are about equal), is about equal to the deductible.

But the reason for this is the result of the way that the federal plans are subsidized. The government pays 75% of your premium for most plans, and that means that it pays 75% of the cost of the plan contributing $1800 to your HSA; this is $1350 of free money. Most employers don't subsidize the same way.
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Re: Health Insurance: Not able to decide between HDHP/HSA and PPO

Post by JBTX »

I don't understand 0% Coinsurance? If no coinsurance, then deductible = out of pocket??
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HasHas
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Re: Health Insurance: Not able to decide between HDHP/HSA and PPO

Post by HasHas »

JBTX wrote: Sun Nov 29, 2020 6:15 pm I don't understand 0% Coinsurance? If no coinsurance, then deductible = out of pocket??
No, that's a mistake. I just checked both the plans again and here is what I found out:

PPO (COVA Care):
20% coinsurance after deductible for certain services, including:
• Outpatient lab tests, x-rays, and injections
• Ambulance travel
• Medical equipment, appliances, and supplies
• Infusionservices
HDHP (COVA):
Coinsurance
• 20% coinsurance after deductible
• Zero coinsurance and no deductible for Routine Wellness and Preventive services
To answer your question, if there is no coinsurance, I think the out of pocket can still be higher than deductible because of the copayments. However, as you can tell from the post, I am not an expert at this :happy. Your advice and suggestions are welcome.
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Re: Health Insurance: Not able to decide between HDHP/HSA and PPO

Post by JBTX »

HasHas wrote: Sun Nov 29, 2020 6:41 pm
JBTX wrote: Sun Nov 29, 2020 6:15 pm I don't understand 0% Coinsurance? If no coinsurance, then deductible = out of pocket??
No, that's a mistake. I just checked both the plans again and here is what I found out:

PPO (COVA Care):
20% coinsurance after deductible for certain services, including:
• Outpatient lab tests, x-rays, and injections
• Ambulance travel
• Medical equipment, appliances, and supplies
• Infusionservices
HDHP (COVA):
Coinsurance
• 20% coinsurance after deductible
• Zero coinsurance and no deductible for Routine Wellness and Preventive services
To answer your question, if there is no coinsurance, I think the out of pocket can still be higher than deductible because of the copayments. However, as you can tell from the post, I am not an expert at this :happy. Your advice and suggestions are welcome.
That makes more sense.

I've done comparisons over the years, and they are notoriously difficult to do, due to different an unknown variables. But if you are a typically light medical user, the HDHP is probably better, although there is always the chance of large unexpected expenditure that makes it worse.

A couple of notes:

- with an HDHP, you will pay a lot more for meds, if you use your insurance to buy them. You will get the full insurance negotiated price. However, if you go with something like Goodrx they will be substantially cheaper. But goodrx purchases don't go against your deductible. We have an HDHP and I've been using goodrx lately vs purchasing through optum pharmacy.

In a PPO plan usually drugs are cheaper, because you don't pay the full insurance price. Most likely some sort of copay depending on the type of drug.

I have seen in some PPOs where office visit co-pays don't apply against out of pocket max. There was a year kids were doing a lot of therapies and the PPO killed me because co-pays did not go against out of pocket max. An HDHP has a hard max, by law, and would have been cheaper. This is probably not a common scenario.
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HasHas
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Re: Health Insurance: Not able to decide between HDHP/HSA and PPO

Post by HasHas »

JBTX wrote: Sun Nov 29, 2020 8:41 pm
That makes more sense.

I've done comparisons over the years, and they are notoriously difficult to do, due to different an unknown variables. But if you are a typically light medical user, the HDHP is probably better, although there is always the chance of large unexpected expenditure that makes it worse.

A couple of notes:

- with an HDHP, you will pay a lot more for meds, if you use your insurance to buy them. You will get the full insurance negotiated price. However, if you go with something like Goodrx they will be substantially cheaper. But goodrx purchases don't go against your deductible. We have an HDHP and I've been using goodrx lately vs purchasing through optum pharmacy.

In a PPO plan usually drugs are cheaper, because you don't pay the full insurance price. Most likely some sort of copay depending on the type of drug.

I have seen in some PPOs where office visit co-pays don't apply against out of pocket max. There was a year kids were doing a lot of therapies and the PPO killed me because co-pays did not go against out of pocket max. An HDHP has a hard max, by law, and would have been cheaper. This is probably not a common scenario.
Thanks for sharing your experience. This is very useful to know. You mentioned that an HDHP has a hard max by law. I need to read more about it but can't there be a scenario where a medical provider say that a certain expense is not "qualified/covered" and hence will not be counted towards the max? Thank you once again.
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Re: Health Insurance: Not able to decide between HDHP/HSA and PPO

Post by JBTX »

HasHas wrote: Sun Nov 29, 2020 9:07 pm
JBTX wrote: Sun Nov 29, 2020 8:41 pm
That makes more sense.

I've done comparisons over the years, and they are notoriously difficult to do, due to different an unknown variables. But if you are a typically light medical user, the HDHP is probably better, although there is always the chance of large unexpected expenditure that makes it worse.

A couple of notes:

- with an HDHP, you will pay a lot more for meds, if you use your insurance to buy them. You will get the full insurance negotiated price. However, if you go with something like Goodrx they will be substantially cheaper. But goodrx purchases don't go against your deductible. We have an HDHP and I've been using goodrx lately vs purchasing through optum pharmacy.

In a PPO plan usually drugs are cheaper, because you don't pay the full insurance price. Most likely some sort of copay depending on the type of drug.

I have seen in some PPOs where office visit co-pays don't apply against out of pocket max. There was a year kids were doing a lot of therapies and the PPO killed me because co-pays did not go against out of pocket max. An HDHP has a hard max, by law, and would have been cheaper. This is probably not a common scenario.
Thanks for sharing your experience. This is very useful to know. You mentioned that an HDHP has a hard max by law. I need to read more about it but can't there be a scenario where a medical provider say that a certain expense is not "qualified/covered" and hence will not be counted towards the max? Thank you once again.
Typically it is the insurance company that is making decisions what is or isn't covered, but yes, the hard max is for covered in network expenses. Out of network or non covered procedures are not counted towards the max.
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HasHas
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Re: Health Insurance: Not able to decide between HDHP/HSA and PPO

Post by HasHas »

JBTX wrote: Sun Nov 29, 2020 9:20 pm
Typically it is the insurance company that is making decisions what is or isn't covered, but yes, the hard max is for covered in network expenses. Out of network or non covered procedures are not counted towards the max.
Yes, that makes sense. Sorry, I also meant to say insurance company.

Well, as you mentioned earlier, comparing the two plans is indeed quite difficult because of the many unknowns. I guess I will start by comparing the in-network providers in both the plans and go from there.
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