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Post by templatequeen on Nov 25, 2020 12:50:33 GMT
I am switching to my DH plan we have always had a plan with a low deductible, 80/20 and a 40 dollar co pay. and we paid 258 a month. Well I am switching jobs and they don't offer insurance so we need to go with my husbands.
His is pretty expensive. We are a family of 3, I am 47 he will be 50 and a dd who is 20 we are pretty healthy. He takes a BP medication and I take a migraine med when I need to.
His insurance offers a plan similar to mine but it is about 425.00 biweekly. OR we can go with a HMO and pay 50 percent of the bill after our 4,000 deductible is met but put money in to an HSA every pay period. Until the deductible is met its 100 percent unless its preventive... Scripts are 50 percent after deductible... that plan is only 250 every 2 weeks. I think with the scripts I may do the scripts RX app it seems like me scripts are pretty cheap.
Or pay the 425.00 and a 30 copay and 80 percent after deductible, and scripts are 15 dollars.
I hate to pay 850 a month ugh when we never go to the dr except for preventive care and maybe 1 a year for lets say Strep.
I thought about doint the 250 and putting the difference in the HSA.
Does anyone have experience with the first plan ? Any insights?
Does the office usually give you a discount if you have a high deductible plan?
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Post by freecharlie on Nov 25, 2020 14:28:04 GMT
I'm not an expert, but IF there were no chronic conditions, I night go with the cheaper plan. Then put half of the money you save a month into the HSA and half into a different interest savings account. That way you have access to that money if you need it for other things but also have it to pay for medical
I dont know how the exchange works as dh has good medical, but could you find it cheaper that way?
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keithurbanlovinpea
Pearl Clutcher
Flowing with the go...
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Jun 29, 2014 3:29:30 GMT
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Post by keithurbanlovinpea on Nov 25, 2020 14:29:54 GMT
You could always just go with the high deductible plan and then pay/negotiate cash prices with providers. Just because you have insurance doesn't mean you have to use it. If you want to be insured in case of something big happening, then go with the HDP
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Post by **GypsyGirl** on Nov 25, 2020 14:45:23 GMT
Based on our experience, I would go with the high deductible and max out that HSA account with the difference in premiums. That HSA account is yours forever and will rollover from year to year. I much prefer having that to the FSA accounts we had for 35+ years. Three years ago DH joined a company and they only have the high deductible plans. The only option we have is how much our deductible is. We are both 60+ and have some fairly common health issues for our age. We pay 100% of all medical costs until we each reach $3,000. After that they cover 100% of all medical and prescription costs. The company deposits most of the deductible in the HSA (quarterly deposits) and we contribute the rest that the government allows. Since we are over 60, we also contribute an additional catchup amount ($1,000 I think).
You can always opt to pay cash and negotiate cash discounts if you want. When I refill prescriptions, I tell the pharmacist I have a high deductible plan and they always work with me to find the best price. The doctors file my claims, and while I do pay 100% of the bill, I get the discounted insurance rate so it is never the full price.
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johnnysmom
Drama Llama
Posts: 5,682
Jun 25, 2014 21:16:33 GMT
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Post by johnnysmom on Nov 25, 2020 22:37:54 GMT
We are slightly younger with similar number of health visits (1 extra kid but he’s healthy too) and have a high deductible plan. With our insurance while we pay 100% it’s 100% of the insurance rate so an office visit is around $60-70 vs the $120ish a straight private way would be. Same with meds, with insurance we pay $4 for something that privately would be around $20.
My husband just switched jobs as well we have the choice to pay $1100/mo for cobra to keep the high deductible plan, $1200/mo to switch to my insurance w/ a $20 copay and low deductible or $1300/mo to switch to his new insurance also with a copay and low deductible. We’re sticking with cobra for now. Yeah it’s less coverage but for us it’s the best option. It’s painful to pay all that and know it’s useless to us right now.
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Post by simplyparticular on Nov 26, 2020 3:41:40 GMT
Based on our experience, I would go with the high deductible and max out that HSA account with the difference in premiums. That HSA account is yours forever and will rollover from year to year. I much prefer having that to the FSA accounts we had for 35+ years. Three years ago DH joined a company and they only have the high deductible plans. The only option we have is how much our deductible is. We are both 60+ and have some fairly common health issues for our age. We pay 100% of all medical costs until we each reach $3,000. After that they cover 100% of all medical and prescription costs. The company deposits most of the deductible in the HSA (quarterly deposits) and we contribute the rest that the government allows. Since we are over 60, we also contribute an additional catchup amount ($1,000 I think). Our situation is similar - but with a family plan our deductible is higher overall, but there are individual deductibles that can be hit, too. I try to keep about what we spend in medical per year in the account, with some cushion that gets us closer to the deductible if we have a rough year (like this one - two surgeries hit deductible) OP - does your new company contribute to the HSA at all? Ours puts in two deposits annually, originally as an incentive to get people to switch. Now it's just standard. That may help offset the switch.
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Post by **GypsyGirl** on Nov 26, 2020 4:03:18 GMT
Our situation is similar - but with a family plan our deductible is higher overall, but there are individual deductibles that can be hit, too. I try to keep about what we spend in medical per year in the account, with some cushion that gets us closer to the deductible if we have a rough year (like this one - two surgeries hit deductible) There is a family deductible for us of $6,000. With just the two of us, it's $6,000 either way we look at it! There is one other plan we could choose, but the family deductible is $10,000 and the difference in premiums isn't enough to warrant going with it, especially at our age. Our plan for the two of us is just $75 every two weeks. The big plus is that they allow you to stay on the plan even after you turn 65, which DH does this year.
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Post by Merge on Nov 26, 2020 4:31:21 GMT
You could always just go with the high deductible plan and then pay/negotiate cash prices with providers. Just because you have insurance doesn't mean you have to use it. If you want to be insured in case of something big happening, then go with the HDP I tried this with my surgery over the summer and some other stuff, and have been flatly told that the price is the same with insurance or with cash (I had not met my deductible so was paying 100% of the cost). Have you actually been able to negotiate with providers? I’ve been treated like a crazy person for even bringing it up.
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keithurbanlovinpea
Pearl Clutcher
Flowing with the go...
Posts: 4,243
Jun 29, 2014 3:29:30 GMT
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Post by keithurbanlovinpea on Nov 26, 2020 13:11:32 GMT
You could always just go with the high deductible plan and then pay/negotiate cash prices with providers. Just because you have insurance doesn't mean you have to use it. If you want to be insured in case of something big happening, then go with the HDP I tried this with my surgery over the summer and some other stuff, and have been flatly told that the price is the same with insurance or with cash (I had not met my deductible so was paying 100% of the cost). Have you actually been able to negotiate with providers? I’ve been treated like a crazy person for even bringing it up. That's interesting. We've had pretty good luck with negotiating
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Post by bearmom on Nov 26, 2020 13:20:33 GMT
We have had a high deductible plan for quite a few years now, some years we don’t even come close to our deductible and other years go over.
Dh is on his plan and I have another with both DD’s. Both of us have it written where if your spouse is offered an insurance plan, they have to take it. We each take half of the $7,200 HSA max for a family. Me paying for the insurance plan + $1000 contribution my company makes + $2600 (to equal my 1/2 of the family max) it is nearly the same cost of the standard 80/20 PPO plan offered. The major difference is that now I have a decent amount in my HSA that has rolled over each year. There has only been one year where I took more out of my HSA that I contributed, and that was a year where I messed up my contribution.
I take a medication that is $500 for a 90 day supply and dd, who is in college, sees a therapist for her eating disorder who is out of network so the last few years I have maxed out so my HSA balance hasn’t grown much. Dh’s has continued to grow since it is just him and he hasn’t had any major issues. But both of us have enough that we feel pretty comfortable with our medical bills.
Dd will be undergoing a major surgery at the end of her school year that will require a hospital stay of 3-5 days, so I know I will max out early in the year. It will all work out.
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Post by **GypsyGirl** on Nov 26, 2020 14:38:09 GMT
I tried this with my surgery over the summer and some other stuff, and have been flatly told that the price is the same with insurance or with cash (I had not met my deductible so was paying 100% of the cost). Have you actually been able to negotiate with providers? I’ve been treated like a crazy person for even bringing it up. That's interesting. We've had pretty good luck with negotiating @merge - I suspect how successful negotiating is will depend on the doctor/practice you are dealing with. If they are in one of the big practices (Methodist, Kelsey, etc), the odds aren't good that they will negotiate. An independent doctor with his own practice might be more likely to do so.
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Post by Darcy Collins on Nov 26, 2020 15:02:36 GMT
That's interesting. We've had pretty good luck with negotiating @merge - I suspect how successful negotiating is will depend on the doctor/practice you are dealing with. If they are in one of the big practices (Methodist, Kelsey, etc), the odds aren't good that they will negotiate. An independent doctor with his own practice might be more likely to do so. I think it also depends if you still get the insurance rate. So even with our high deductible plan, we receive Aetna's negotiated rate - so even though we're paying cash, it's not the same as the initial billed rate.
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Post by littlemama on Nov 26, 2020 15:41:20 GMT
Ok, I like to apply math to these situatiions
850 - 500 = 350 premiun diff per month 350*12= 4200 premium diff per year.
Say something expensive happens.
Hsa plan, you cam apply the 4200 that you "saved", but then still have to pay 50% of anything above that. Say the bill was $100,000. 100000-4000= 96000 96000/2 = 48000 out of pocket. You didnt list your out of pocket maximum, so that would also apply here.
Other plan, you said you have a small deductible, so we'll say that's 1000. 100000-1000= 99000 99000*20%= 19800 out of pocket- again apply your out of pocket max to this.
It is great that you rarely go to the doctor, but you guys are close to 50, so you cant count on that continuing. Added to that, there is a pandemic raging and you cant guarantee that you wont be impactdd by that.
Ultimately, you have to decide how much risk you are willing to take.
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mlana
Pearl Clutcher
Posts: 2,522
Jun 27, 2014 19:58:15 GMT
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Post by mlana on Nov 26, 2020 20:28:14 GMT
This year we are going to go with insurance thru my husband's employer as we no longer qualify for Kaiser thru ACA. We didn't really qualify for assistance in 2019 or 2020, so we had to re-pay all the financial aid we received, but I expected that and just put aside the difference between our premium and what the premium should have been. Basically, Kaiser cost us about $2300/month and we paid some monthly and some at tax time. I chose for us to stick with Kaiser as long as possible because of my husband's kidneys. Kaiser offered managed care that really worked for us as all of his drs communicated so easily and they REALLY stayed on top of his medical needs. He is pretty stable now, so it's as good a time as any to make the switch. This year we will have Aetna and we're going with a high deductible plan ($1500per/ $3000family) so we can use a HSA. We may also be able to use a FSA for part of the expenses. Our monthly premium will be just over $300 for the 2 of us, so that is a huge monthly savings. In effect, we will save the cost of the FAMILY deductible in less than 2 months. For us, the difference between the HDP and the PPO plan decision wasn't the just cost of the premiums or the deductibles, but rather also the value of the HSA. We plan to max this out as soon as possible so as many of the costs can come out of his pre-tax pay. I am really hopeful that this will be a good thing for us. We have part of the benefits package now and we will get the rest next week. IF we are able to set things up the way I want, we will, basically, get an almost $20k raise. I'm sure the savings won't be that good for us, but they will still be better than what we pay now. Of course, my biggest concern is can we get the access to the drs DH needs. His company offers several services to help navigate care for chronic illnesses, so I am hopeful. templatequeen, before making this decision, I compared the costs anywhere that the 2 available plans differed. For us, that was primarily the cost of office visits and ERs. Before I make a final decision, I'll actually call some of the drs and specialists on the list to see what their visits cost. I don't expect to see enough difference to justify the higher premium and loss of tax deduction, but I do like to dot my I's and cross my Ts. Good luck with whichever plan you choose. Marcy
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