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newlywedT
LIF Adolescent
Member since 9/11 793 total posts
Name:
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Is my math right? (health insurance help)
My insurance enrollment for 2017 ends tomorrow!!
Trying to find the best one but not sure if my math skills are correct.
PPO w/HSA - $0 a year / company gives $800 for the HSA / deductible $2,700
PPO+ w/HSA - $400 a year / company gives $800 / deductible $1,500
PPO - $500 a year / deductible - $1,500
PPO+ - $1,200 a year / deductible - $375
so what I did was add the yearly cost to the deductible and also subtract the HSA contribution from the company from the deductible which gives me a final out of pocket cost of:
PPO w/HSA - $1,900
PPO+ w/HSA - $1,100
PPO - $2,000
PPO+ - $1,575
in terms of benefits its basically the same (its also the same insurance company) so I think the main difference would be the money spent.
Looking at this, the best option is PPO+ with HSA....?
Or did I miss something with my math?
Thank you
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Posted 10/20/16 3:27 PM  |
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Kitten1929
LIF Adult
Member since 1/13 6040 total posts
Name:
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Re: Is my math right? (health insurance help)
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| Posted 10/20/16 3:36 PM |
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newlywedT
LIF Adolescent
Member since 9/11 793 total posts
Name:
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Is my math right? (health insurance help)
All I know is...there is a HMO plan that I used back in 2011 that cost $20 a month.
This year it is $100 a month
:(
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| Posted 10/20/16 3:41 PM |
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MrsO
Big Brothers to Be
Member since 1/07 4521 total posts
Name:
Maureen
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Re: Is my math right? (health insurance help)
I would say your math is correct but remember if you don't use your deductible you do not have to spend that money. I guess it really depends on your individual health situation and how much you are under doctors care or anticipate being under dr's care.
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| Posted 10/20/16 3:50 PM |
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JDubs
different, not less
Member since 7/09 13160 total posts
Name:
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Re: Is my math right? (health insurance help)
Posted by MrsO
I would say your math is correct but remember if you don't use your deductible you do not have to spend that money. I guess it really depends on your individual health situation and how much you are under doctors care or anticipate being under dr's care.
Yes , this. Depends on how much you go to the doctor.
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| Posted 10/20/16 3:52 PM |
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newlywedT
LIF Adolescent
Member since 9/11 793 total posts
Name:
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Is my math right? (health insurance help)
True....forgot to add, I want to go to the doctor twice next year:
1. ENT - check my adenoids
2. Go to cardiologist and check on my heart. I have MVP (apparently its more common in women than men) and haven't had a heart checkup in like 10 years.
so those two visits I assume will cost big bucks (heck any doctor visit is big bucks)
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| Posted 10/20/16 4:01 PM |
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ElizaRags35
My 2 Girls
Member since 2/09 20494 total posts
Name:
Me
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Re: Is my math right? (health insurance help)
Posted by JDubs
Posted by MrsO
I would say your math is correct but remember if you don't use your deductible you do not have to spend that money. I guess it really depends on your individual health situation and how much you are under doctors care or anticipate being under dr's care.
Yes , this. Depends on how much you go to the doctor.
But also remember things happen. We chose a cheaper plan with a higher deductible and then my daughter got sick. We met our deductible pretty quickly.
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| Posted 10/20/16 4:02 PM |
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jamnmore
LIF Adult
Member since 6/16 989 total posts
Name:
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Is my math right? (health insurance help)
Is there coinsurance with any of the plans once the deductible is met. I have a $10000 Deductible and then 20% coinsurance for a max OOP of $12700 per year. Also what is the prescription coverage like?
Do prescriptions count toward the deductible?
If the PPO/HSA is $0 cost per year and your employer is covering $800 then you will have no expense for the first $800 of medical care and even after that the deductible is at contracted rates which are significantly less than un-insured rates/billing rates.
Example - with my deductible plan I went to the ER. ER billed the insurance $17000 for my visit. Contracted rates, I paid $300 towards my deductible and that was it. When I go to the cardiologist he bills the insurance $650 and my contract rate is $47.39 which is applied to the deductible.
You could potentially have very little expediture with that plan if you have limited visits and are otherwise healthy.
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| Posted 10/20/16 4:19 PM |
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newlywedT
LIF Adolescent
Member since 9/11 793 total posts
Name:
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Is my math right? (health insurance help)
hmmm all the other rates are pretty similar.
but I don't trust the contracted rates, lol.
Took my daughter to the ER for a fever and they said "its due to the vaccine she got, she will be fine"
Got charged over 3k.
and HAD TO PAY over 3k because we had a high deductible so everything was out of pocket until we reach it lol.
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| Posted 10/20/16 4:31 PM |
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newlywedT
LIF Adolescent
Member since 9/11 793 total posts
Name:
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Is my math right? (health insurance help)
looks like it will be the PPO+ with HSA.
Although the conspiracy part of me thinks that HSAs are helpful for the company so they must have some trick up their sleeve to pass the cost onto me instead of themselves...
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| Posted 10/21/16 2:04 PM |
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jamnmore
LIF Adult
Member since 6/16 989 total posts
Name:
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Re: Is my math right? (health insurance help)
Posted by newlywedT
hmmm all the other rates are pretty similar.
but I don't trust the contracted rates, lol.
Took my daughter to the ER for a fever and they said "its due to the vaccine she got, she will be fine"
Got charged over 3k.
and HAD TO PAY over 3k because we had a high deductible so everything was out of pocket until we reach it lol.
That sounds very odd. Did you verify the explanation of benefits from the insurance carrier that this was your responsibility?
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| Posted 10/21/16 2:13 PM |
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newlywedT
LIF Adolescent
Member since 9/11 793 total posts
Name:
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Re: Is my math right? (health insurance help)
Posted by jamnmore
Posted by newlywedT
hmmm all the other rates are pretty similar.
but I don't trust the contracted rates, lol.
Took my daughter to the ER for a fever and they said "its due to the vaccine she got, she will be fine"
Got charged over 3k.
and HAD TO PAY over 3k because we had a high deductible so everything was out of pocket until we reach it lol.
That sounds very odd. Did you verify the explanation of benefits from the insurance carrier that this was your responsibility?
Yep, insurance said:
everything before the deductible is our responsibility.
Arent most plans like this?
ER visits are X percent AFTER deductible...which means 100% before the deductible
:(
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| Posted 10/21/16 2:36 PM |
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jamnmore
LIF Adult
Member since 6/16 989 total posts
Name:
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Re: Is my math right? (health insurance help)
Posted by newlywedT
Posted by jamnmore
Posted by newlywedT
hmmm all the other rates are pretty similar.
but I don't trust the contracted rates, lol.
Took my daughter to the ER for a fever and they said "its due to the vaccine she got, she will be fine"
Got charged over 3k.
and HAD TO PAY over 3k because we had a high deductible so everything was out of pocket until we reach it lol.
That sounds very odd. Did you verify the explanation of benefits from the insurance carrier that this was your responsibility?
Yep, insurance said:
everything before the deductible is our responsibility.
Arent most plans like this?
ER visits are X percent AFTER deductible...which means 100% before the deductible
:(
With our high deductible I only need to pay the contracted rate while paying my deductible not the full billed amount. I suppose that maybe every insurance carrier has a different policy. I certainly would not have been able to come up with $10000 for my $17000 ER visit. I only paid $300 and it was done. And I had not met my deductible for the year.
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| Posted 10/21/16 4:37 PM |
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BlueDiamonds
mommy to 3 boys
Member since 2/07 3885 total posts
Name:
proud mommy
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Re: Is my math right? (health insurance help)
Posted by newlywedT
Posted by jamnmore
Posted by newlywedT
hmmm all the other rates are pretty similar.
but I don't trust the contracted rates, lol.
Took my daughter to the ER for a fever and they said "its due to the vaccine she got, she will be fine"
Got charged over 3k.
and HAD TO PAY over 3k because we had a high deductible so everything was out of pocket until we reach it lol.
That sounds very odd. Did you verify the explanation of benefits from the insurance carrier that this was your responsibility?
Yep, insurance said:
everything before the deductible is our responsibility.
Arent most plans like this?
ER visits are X percent AFTER deductible...which means 100% before the deductible
:(
i currently have a plan with a $3k deductible, which my company contributes $2k to an HRA. Any charges that are considered in network go through my insurance and I get the discounted contract rate. For example, I still have not met my deductible. I went for blood work at an in-network lab. The lab charged my insurance company $1258, i received a discount of $1141 and the amount I owe is $117.
so even though you had not met the deductible, the ER visit still should have gone through your insurance and you should have received some discount for a contracted rate. i believe most insurance companies have lower contracted rates.
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| Posted 10/21/16 4:38 PM |
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MrsS2005
Mom of 3
Member since 11/05 13118 total posts
Name:
B
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Re: Is my math right? (health insurance help)
Posted by newlywedT
looks like it will be the PPO+ with HSA.
Although the conspiracy part of me thinks that HSAs are helpful for the company so they must have some trick up their sleeve to pass the cost onto me instead of themselves...
HSAs are beneficial for both employers and insurance companies because they're supposed to encourage people taking a more active role in managing healthcare. People are more likely to go to the doctor or even the ER at the first sign of illness when they only have to pay a minimal co-pay. When you're being billed for the contractual rate, which can be very high especially at an ER, you'd be less likely to go for something that isn't serious. People are also encouraged to shop around. If you need an MRI and there are 3 places you could go, HSAs encourage you to do research beforehand because the cost for the exact same procedure can vary widely among facilities.
Generally, HSAs make sense financially for those who are very sick/have very expensive monthly maintenance drugs or those who are very healthy. My current employer makes the HSA so much more attractive than the traditional PPO plans between the huge difference in monthly cost for the premium and my employer's contribution towards the deductible. Even if we blow through the deductible and maximum OOP costs with the HSA, we will be paying less overall than if I took the richest PPO plan and had 1 ER visit or a few doctor's visits in a year. We've never had a fully healthy year so it makes sense for us to take the HSA. It sucks though getting huge bills before the deductible is met.
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| Posted 10/21/16 4:45 PM |
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MrsS2005
Mom of 3
Member since 11/05 13118 total posts
Name:
B
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Re: Is my math right? (health insurance help)
Posted by jamnmore
Posted by newlywedT
hmmm all the other rates are pretty similar.
but I don't trust the contracted rates, lol.
Took my daughter to the ER for a fever and they said "its due to the vaccine she got, she will be fine"
Got charged over 3k.
and HAD TO PAY over 3k because we had a high deductible so everything was out of pocket until we reach it lol.
That sounds very odd. Did you verify the explanation of benefits from the insurance carrier that this was your responsibility?
That sounds totally normal. With a lot of high deductible health plans, the contracted rates for hospital services are still very high. DH had to have an MRI on his knee recently and the negotiated rate was $950. We owed that because we hadn't met our deductible.
Every plan is structured differently so what's a normal negotiated rate for one plan is very different in another plan. Some plans also have deductibles apply to certain services and co-insurance or co-pays apply to different services. With most traditional HSAs that I've seen, a relatively minor surgery or an ER visit can eat up most, if not all, of a deductible because the negotiated rates are still very high and several providers may bill for the services (i.e. doctor, anesthesia department, hospital).
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| Posted 10/21/16 5:01 PM |
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newlywedT
LIF Adolescent
Member since 9/11 793 total posts
Name:
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Re: Is my math right? (health insurance help)
Posted by jamnmore
With our high deductible I only need to pay the contracted rate while paying my deductible not the full billed amount. I suppose that maybe every insurance carrier has a different policy. I certainly would not have been able to come up with $10000 for my $17000 ER visit. I only paid $300 and it was done. And I had not met my deductible for the year.
The 4k for the ER visit...
That WAS the contracted rate lol
Message edited 10/21/2016 5:18:26 PM.
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| Posted 10/21/16 5:16 PM |
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Re: Is my math right? (health insurance help)
Do the ppo's without hsa have different co payments? I pay more for those plans because I know I'll never reach my deductible and prefer to pay $20 for primary care and $40 for specialists.
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| Posted 10/21/16 5:36 PM |
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newlywedT
LIF Adolescent
Member since 9/11 793 total posts
Name:
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Is my math right? (health insurance help)
Forget those plans...I'm going with the EPO plan (which was hidden among the other plans)
I pay 1,500 a year (which is a lot) and then only a $30 copay every time I see the doctor.
I like that better because theres no surprises on how much I have to pay.
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| Posted 10/21/16 5:51 PM |
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newlywedT
LIF Adolescent
Member since 9/11 793 total posts
Name:
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Is my math right? (health insurance help)
Correction, its not EPO it is a HMO.
But it was still hidden (not listed in the documentation given out).
Its the most expensive plan (a little over 1,500 a year for myself) but there are no surprised when I visit the doctor.
$30 copayment and that's it.
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| Posted 10/26/16 2:45 PM |
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