Health Insurance: which would you choose?

[fieryred33143]

I'm trying to decide whether to go from Avmed HMO to Aetna HRA or an HSA plan. Thanks so much in advance for any opinions you have. I'm not going to list the cost to me bi-weekly unless you feel that info is important in your decision. Just let me know

Here are the facts (keep in mind I'll be taking on coverage for myself, daughter, and FI):

AVMED
Deductible indv/family: None
Co-insurance: NA
Out of pocket max indv/family: $1500/$3000
Emergency Services: $150 Copay
Prescriptions generic/brand: $15/45
Primary Care: $15 copay
Specialist: $25 copay
Hospital in patient/out patient: $250 copay
Well baby exams: 100% covered
Adult preventative 100% covered

With HRA I have two options: pay more out of pocket, get a higher contribution from the company, but can't contribute any funds of my own; OR pay less out of pocket but get less from the company.

Deductible indv/family: $350/$700 OR $700/$1400
Co-insurance: 20%
Out of pocket max indv/family: $2350/$4700 OR $3500/$7000
Emergency Services: $100 Copay; waived if admitted
Prescriptions generic/brand: $4/50% coinsurance with $75 max
Primary Care: 20% after deductible
Specialist: 20% after deductible
Hospital in patient/out patient: 20% after deductible
Well baby exams: 100% covered
Adult preventative 100% covered

And then the HSA.

Deductible indv/family: $2500/4500
Co-insurance: 10%
Out of pocket max indv/family: $2000/$4000
Emergency Services: $100 Copay; waived if admitted
Prescriptions generic/brand: $4/50% coinsurance with $75 max
Primary Care: 10% after deductible
Specialist: 10% after deductible
Hospital in patient/out patient: 10% after deductible
Well baby exams: 100% covered
Adult preventative 100% covered

Something to consider: Avmed has always worked really well for me and on paper it seems (at least to me) to be the best option, but it's more expensive bi-weekly AND a lot of specialists/PCP are dropping them due to needing a referal (sp?). Again, thanks so much for your opinion!

 

[NovemberBride]

Fiery - I just went through a similar analysis myself and opted for the high deductible HSA plan. Here was my thought process:

1. I did not want an HMO - it limits your choice too much for me personally, I want to preserve the ability to go out of network to choose the best provider in the event there was a serious condition to treat. I.e., god forbid one of us got cancer, I want the best provider in my city, not the HMO dr. I realize this comes at an increased cost, but I am willing to pay for this option and luckily am fortunate to be able to do so.
2. My other options were a PPO or the high deductible PPO with HSA. That choice I made based solely on finances - it was cheaper for me to pay the premiums plus fund the HSA up to the amount of the deductible (my plan has no co-insurance once the deductible is met, so there's really no way to end up paying more than the deductible).

I did a lot of research on the HSaAplans before I chose this option because they get some negative press. What I found was that the negative press was related to people who chose the high deductible plan for the cheaper premiums but did not contribute to the HSA and then were unable to pay their medical bills until they reached the deductible. I think that in choosing an HSA plan you have to count on paying the full amount of the deductible out of pocket so that you aren't caught short.

 

[fieryred33143]

November-thanks for your insight!

The fear I've always had with a high deductible is that I much prefer having no deductible. But, as you mentioned, Avmed is very limited. I never considered the limitation when it was just me on the plan but now with Sophia I'd like the option to go to the best doctor possible even if that means out of network.

Some more details on our HSA:

Our company contributes up to $500. I have the option of contributing up to $5,650. The only issue I see with HSA (and perhaps you can help me out here) is that it doesn't count for domestic partner coverage. If I use these funds for FI it is subject to income tax and a 20% tax penalty. He would have to open up his own HSA account and contribute. Do you know more details about this?

 

[meresal]

Fiery, I prefer no deductible. My husband and I do not get sick very often, so if we had used a plan that had one, I would end up paying everything and Insurance would never kick in. Personally, I would choose your first option. I understand it is more expensive bi-weekly, but if you break it down, is it still cheaper than the deductible?

I understand loosing the specialists, however, I guess you just need to ask yourself, how often do you need a specialist?

(With all of that said, I have always used Aetna HMO. So I had the convenience of no deductible and lower bi-weekly rates.)

 

[janinegirly]

I'm with Meresal on this one. A co-worker of mine did the calculations on the Health Savings Plan and claims he comes out ahead, but it is just too complicated for me to figure out the break even point and I also dislike deductibles. BUT be thankful you even have an option with no deductible, all our plans got more expensive this year (no surprise on that) and now have deductibles..just less than the Health Savings ones etc. I prefer a lower bar before insurance kicks in and although my plan is an HMO it has very big pool (Oxford) so maybe look into that to see if your doc IS part of the network. I also tend to never go to the doc etc., but still that wasn't necessarily the deciding factor.

 

[NovemberBride]

Fiery, I am sorry, I don't know anything about domestic partner coverage, since I am just covering DD and myself. But HSA's are governed by federal law, so it would probably be quite easy to look it up.

I know choosing plans seems complicated, but it's worth it to me to work through the options to get the best health care for my money. Having a deductible doesn't bother me, especially with the HSA, because I have the money on a debit card, so I just run it through at the dr. office, it's not like it comes out of my account. Plus, the HSA option has one huge incentive over all other plans - if the money is not spent at the end of the year, it's yours to keep forever (to be used for qualified medical expenses).

Here's a simple example -

Option 1 - I have a regular HMO with a monthly premium of $200. At the end of the year, I've paid $2400 regardless of how much care I received.

Option 2 - I have a high deductible plan with HSA, monthly premium is $50, and I contribute the other $150/month ($1800/year) to the HSA to pay the annual deductible. I am relatively healthy, so I only go to my annual appointments with GP and OB/Gyn, for a total cost of $200. At the end of the year, I have paid the same out of pocket cost, but I still have $1600 of my money in the HSA that I can use next year. SO in the next plan year I don't need to contribute to the HSA, and my health plan expenses are much, much lower.

 

[janinegirly]

november-good points. I did not mean to insinuate not doing the research, just that all the calculations make me realize I'd rather spend more for peace of mind. I guess it comes down to each person's situation. In yours it makes sense. In mine, I wonder about unplanned things (kids, what if I stop working to stay at home,etc) and I also have a baby so don't want to subconsciously limit her dr. visits because of not wanting to spend $. Not that I would of course, but just do not want all these elements in the mix. Would love to hear what others who have HSA options decided!

fiery - do you have a 3rd option..like a premium HMO with a bigger network? I also do not know about domestic partner but it sounds like it might be an obstacle for the HSA based on what you said.

 

[fieryred33143]

Thanks for the pointers ladies.

Janine-Avmed is the only HMO option the company is offering. They had information sessions to day but because they aren't promoting Avmed, they did't discuss it so that did me no good.

I've tried to look at my history. In the past 4 years (with the exception of the pregnancy), I've only been to the gyno for my annual and once to PCP for a sore throat that wouldn't go away. Sophia, on the other hand, went to all of her doctor's visits, plus her urologist, and was at the pedi about 4 additional times for suspected UTIs this year alone. Her urologist is on Avmed and doesn't seem to be switching any time soon.

The HSA makes a lot more sense for me because of the costs (I did not know you could roll it over. Thanks NB!). I'm just hung up on Sophia.

The difference between the HSA and HMO is $250 fyi!

 

[NovemberBride]

Janine, I agree that you have to look at the individual plans to see what makes sense. I do have a 1 year old DD, which is why I set up the plan to have the full deductible available in the HSA since as I am sure you know, sometimes it feels like I am at the dr. every other week!

A lot of companies are setting up plans so that the HSA is very attractive because it greatly reduces their health care costs. Individual employees need to make sure it will reduce their costs as well, in my case it does, but that may not always be true. As an incentive to take the HSA, my company also contribute a significant amount to my HSA, further lowering my costs.

One other point on HSAs is that they can be used as a vehicle for saving for retirement health care costs with pre-tax dollars. You can contribute up to a certain limit each year as long as you are eligible (i.e. are participating in an HSA eligible plan) and the money is there forever. Even if you are no longer in an eligible plan, you can still use the money, you just can't contribute more.

 

[NovemberBride]

Fiery, check the terms of your plan, under mine, preventive care, which includes all regularly scheduled pediatric visits and immunizations, are exempt from the deductible and I just pay a regular co-pay. That made a big difference to me.

 

[janinegirly]

Janine, I agree that you have to look at the individual plans to see what makes sense. I do have a 1 year old DD, which is why I set up the plan to have the full deductible available in the HSA since as I am sure you know, sometimes it feels like I am at the dr. every other week!

A lot of companies are setting up plans so that the HSA is very attractive because it greatly reduces their health care costs. Individual employees need to make sure it will reduce their costs as well, in my case it does, but that may not always be true. As an incentive to take the HSA, my company also contribute a significant amount to my HSA, further lowering my costs.

One other point on HSAs is that they can be used as a vehicle for saving for retirement health care costs with pre-tax dollars. You can contribute up to a certain limit each year as long as you are eligible (i.e. are participating in an HSA eligible plan) and the money is there forever. Even if you are no longer in an eligible plan, you can still use the money, you just can't contribute more.

Hmm, maybe I"ll take a closer look at our HSA . And and I just finished submitting my benefits too! Do you know if it carries over even if you are not working/not covered (just curious). And yes all these companies have introduced HSA as a way to lower their costs, it really is becoming a burden that everyone is having to shoulder (increasing costs).

 

[CurlySue]

Fiery, check the terms of your plan, under mine, preventive care, which includes all regularly scheduled pediatric visits and immunizations, are exempt from the deductible and I just pay a regular co-pay. That made a big difference to me.

With healthcare reforms kicking into effect in 2011, all preventive care will be covered at 100% - no co-pays or coinsurance. That's yet another thing to consider in any decisions you make.

NovemberBride, you have given some great insight to the HSA plans. I've been using one for several years, and I take the same approach you do. I make contributions with every paycheck in addition to the contributions my company makes so that I have money to cover me in future years, should I need the money for care.

Because I have been blessed with good health in the last several years, have no prescriptions, etc., the only money that I am paying each year is for my premium and to build up my HSA savings. With preventive visits covered at 100%, I haven't had to spend a thing beyond that. So for me, if I had chosen our PPO plan, I would have "lost" money.

But I do agree it's a very personal choice based on your personal comfort level with taking the risk - do you put more money in up front and pay more towards your premium only to pay less if you use the plan a lot more in future... or do you pay less up front and more later should you need to use the plan. So try to evaluate what your healthcare usage is each year, taking into consideration the fact that preventive visits are free starting in 1/1/11, and identify where you fall in the risk aversion spectrum.

 

[NovemberBride]

CS - Just to clarify, preventive care is only free (i.e. no co-pay or deductible) for new plans established after September 2010. Old plans are grandfathered in, so this won't apply to everyone.

 

[fieryred33143]

WEll, I have until 5pm today to choose and still can't decide lol.

 

[janinegirly]

Fiery, another thought. Check your HSA in -network to see if Sophia's pedi is included. I just did this and mine is not. I hope you make a decision you are comfortable with - not much time to decide. I also procrastinated a bit

 

[fieryred33143]

I decided to stay with HMO. At the end of the day, I didn't want to have to deal with deductible issues. In reality, the difference between HMO and HSA was equal to the deductible for the HSA. Being able to roll over the account balance was really attractive to me but until we figure out whether Sophia will need to continue on her medication for the urinary reflux or not (which we find out in March), I didn't want to risk unknown costs.

Next year I'll look into the HSA a bit more.

ETA: thanks so much for the help girls. It was really appreciated