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Dieuwer
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HDHP plans: good or bad?

Sat Nov 02, 2019 1:28 am

My company will start offering a High Deductible Health Plan in 2020 paired with a HSA.
It sounds good on paper: lower monthly premiums coupled with a tax-free savings account to pay for current and future medical expenses.
But to me it feels more like “passing the buck”: you may save with one hand but spend more with the other. And it does nothing to fix the real issue underlying the skyrocketing health care costs, which is that the health care system is a For Profit business where everyone involved seeks to extract as much money as possible.
Is it really so difficult to comprehend that American healthcare is so expensive because doctors, nurses, hospitals and drugs companies love their yachts, caribbean villas and big payouts, while care in Europe is an order of magnitude cheaper because the system is not run by cronies attempting to enrich themselves?

Unless the cost side of the equation is addressed, nothing will change. Certainly not swapping a HMO for a HDHP.
 
NIKV69
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Re: HDHP plans: good or bad?

Sat Nov 02, 2019 1:36 am

Dieuwer wrote:

Unless the cost side of the equation is addressed, nothing will change. Certainly not swapping a HMO for a HDHP.


Which is why the ACA was bad. It didn't address the cost it just passed on the cost to the rich. So you have a dog chasing it's tail. Nobody wants to take any steps to lower the cost but we get this hatred for doctors and pharma companies who are painted as robber barons.
I am the Googlizer!!!
 
Dieuwer
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Re: HDHP plans: good or bad?

Sat Nov 02, 2019 1:39 am

NIKV69 wrote:
Dieuwer wrote:

Unless the cost side of the equation is addressed, nothing will change. Certainly not swapping a HMO for a HDHP.


Which is why the ACA was bad. It didn't address the cost it just passed on the cost to the rich. So you have a dog chasing it's tail. Nobody wants to take any steps to lower the cost but we get this hatred for doctors and pharma companies who are painted as robber barons.


Ever heard of a guy named Shkreli?
 
tommy1808
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Re: HDHP plans: good or bad?

Sat Nov 02, 2019 1:58 am

NIKV69 wrote:
Dieuwer wrote:

Unless the cost side of the equation is addressed, nothing will change. Certainly not swapping a HMO for a HDHP.


Which is why the ACA was bad. It didn't address the cost it just passed on the cost to the rich. So you have a dog chasing it's tail. Nobody wants to take any steps to lower the cost but we get this hatred for doctors and pharma companies who are painted as robber barons.


Give the government the Power to negotiate prices, I think the GOP added language to Medicaid specifically preventing that, just remove that, and make health insurances non-profit for minimum coverage like in Switzerland. If you want to turn a profit with health insurance, sell stuff beyond minimum coverage.

Best regards
Thomas
Well, there is prophecy in the bible after all: 2 Timothy 3:1-6
 
GalaxyFlyer
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Re: HDHP plans: good or bad?

Sat Nov 02, 2019 2:04 am

They are great! Went where I wanted, put almost $40,000 in tax-deferred savings. No problems when we needed care.
 
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casinterest
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Re: HDHP plans: good or bad?

Sat Nov 02, 2019 2:07 am

It is passing the buck, but it also depends on your premiums. Mine have gone sky high, this year, I need another big raise to pay for it.
Where ever you go, there you are.
 
DfwRevolution
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Re: HDHP plans: good or bad?

Sat Nov 02, 2019 4:10 pm

Dieuwer wrote:
My company will start offering a High Deductible Health Plan in 2020 paired with a HSA.
It sounds good on paper: lower monthly premiums coupled with a tax-free savings account to pay for current and future medical expenses.
But to me it feels more like “passing the buck”: you may save with one hand but spend more with the other.


"Passing the buck" means to make a problem someone else's responsibility. The expression makes no sense here because an HDHP is conceptually no different than other insurance types: you pay premiums and the insurance will cover expenses above your deductible threshold. The trade-off between low premiums and high deductibles (or vice versa) is inherent to any insurance product.

Do the math for your all-in cost for a given amount of health care expenses (premium + out-of-pocket) and there's usually little difference between an HDHP and a PPP, HMO, etc. The practical impact is that more of the costs will be out-of-pocket in the HDHP rather than paycheck withholding. If you maintain some savings to cover out-of-pocket expenses, then you have the opportunity for lower total costs if you don't incur medical expenses. Low expenses = you win. High expenses = you're no worse off.

Dieuwer wrote:
And it does nothing to fix the real issue underlying the skyrocketing health care costs


If anything, HDHP does offer a solution to skyrocketing health care costs. People are universally more price sensitive when they pay out-of-pocket. An HDHP creates good incentives for patients to act like responsible consumers as they do in every other walk of life.

Dieuwer wrote:
which is that the health care system is a For Profit business where everyone involved seeks to extract as much money as possible.


There is no inherent moral or ethical shame in a for-profit health care system. It's an advanced, professional service that routinely delivers miracles that extend or improve people's lives dramatically. If you value that, you should pay for it and the people who provide that service should be rewarded handsomely.
I have a three post per topic limit. You're welcome to have the last word.
 
Dieuwer
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Re: HDHP plans: good or bad?

Sat Nov 02, 2019 5:59 pm

DfwRevolution wrote:
Dieuwer wrote:
And it does nothing to fix the real issue underlying the skyrocketing health care costs


If anything, HDHP does offer a solution to skyrocketing health care costs. People are universally more price sensitive when they pay out-of-pocket. An HDHP creates good incentives for patients to act like responsible consumers as they do in every other walk of life.


The data says otherwise.
In fact, the majority of people on HDHP plans seem to skip preventive care to save money leading the higher future bills for catastrophic care. For example, not taking your $500 per month pill for your bad kidney eventually leading to kidney failure and an expensive organ transplant operation.
From an insurance company point of view this is obviously bad news: Not only did they take in less monthly premiums but now they have to foot a huge hospital bill for the transplant (minus the HDHP deductible of say $3000).
 
anrec80
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Re: HDHP plans: good or bad?

Sat Nov 02, 2019 6:32 pm

GalaxyFlyer wrote:
They are great! Went where I wanted, put almost $40,000 in tax-deferred savings. No problems when we needed care.


Agree - a great tool in right scenarios, just as anything else.
 
DfwRevolution
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Re: HDHP plans: good or bad?

Sat Nov 02, 2019 6:52 pm

Dieuwer wrote:
DfwRevolution wrote:
Dieuwer wrote:
And it does nothing to fix the real issue underlying the skyrocketing health care costs


If anything, HDHP does offer a solution to skyrocketing health care costs. People are universally more price sensitive when they pay out-of-pocket. An HDHP creates good incentives for patients to act like responsible consumers as they do in every other walk of life.


The data says otherwise.
In fact, the majority of people on HDHP plans seem to skip preventive care to save money leading the higher future bills for catastrophic care. For example, not taking your $500 per month pill for your bad kidney eventually leading to kidney failure and an expensive organ transplant operation.
From an insurance company point of view this is obviously bad news: Not only did they take in less monthly premiums but now they have to foot a huge hospital bill for the transplant (minus the HDHP deductible of say $3000)


HDHPs are required by law to provide preventive care at no out-of-pocket expense. A prescription to treat kidney failure is objectively not preventive care as defined by law. It’s a treatment.

Now I’m not saying some people aren’t terrible consumers. There are people who drive GM cars, drink Coors Light, and watch Big Bang Theory. Sometimes all at once. However, the only mechanisms known to man that can simultaneously improve price, quality, and availability is the free market. Government-mandated price controls will inevitably screw quality and availability.
I have a three post per topic limit. You're welcome to have the last word.
 
Dieuwer
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Re: HDHP plans: good or bad?

Sat Nov 02, 2019 8:18 pm

DfwRevolution wrote:
Dieuwer wrote:
DfwRevolution wrote:

If anything, HDHP does offer a solution to skyrocketing health care costs. People are universally more price sensitive when they pay out-of-pocket. An HDHP creates good incentives for patients to act like responsible consumers as they do in every other walk of life.


The data says otherwise.
In fact, the majority of people on HDHP plans seem to skip preventive care to save money leading the higher future bills for catastrophic care. For example, not taking your $500 per month pill for your bad kidney eventually leading to kidney failure and an expensive organ transplant operation.
From an insurance company point of view this is obviously bad news: Not only did they take in less monthly premiums but now they have to foot a huge hospital bill for the transplant (minus the HDHP deductible of say $3000)


HDHPs are required by law to provide preventive care at no out-of-pocket expense. A prescription to treat kidney failure is objectively not preventive care as defined by law. It’s a treatment.

Now I’m not saying some people aren’t terrible consumers. There are people who drive GM cars, drink Coors Light, and watch Big Bang Theory. Sometimes all at once. However, the only mechanisms known to man that can simultaneously improve price, quality, and availability is the free market. Government-mandated price controls will inevitably screw quality and availability.


Word games. Prescriptions can be as much "preventive" as any other care, as they "prevent" kidney failure.

I agree with you about a "Free Market", but if there is one thing the USA does not have and that is a "Free Market" in health care.
Because if that was the case, you could drive your van across the border with Canada or Mexico, load up on drugs for a fraction of the cost at home, drive back home with a full van and use/sell those drugs much cheaper than you could have had you bought the drugs in your home town.
 
GalaxyFlyer
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Re: HDHP plans: good or bad?

Sat Nov 02, 2019 9:08 pm

I believe you reside in the same state I do, the DPRM. Romney Care has driven out primary care physicians with low reimbursements. I can’t find a replacement for my now-retired doc and many others are in the same boat here.

If only we could rid ourselves of the lack of cost transparency due to third-party payers and consequent backroom pricing we’d have something like a free market.
 
Ken777
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Re: HDHP plans: good or bad?

Sun Nov 03, 2019 2:30 am

GalaxyFlyer wrote:
They are great! Went where I wanted, put almost $40,000 in tax-deferred savings. No problems when we needed care.


And what was the most expensive problem you got treatment for?

My wife got a diagnosis of Acute Leukemia. 27 days in the hospital to get into remission and over 100 days total. 10 trips for blood transfusions. Her total bill for her almost 2 year of care, including chemo, was around $750,000. Today that would be over a million. How does your insurance address that? BTW, my wife was about 60 when diagnosed. Today she got a call from our granddaughter who was on the line with a school friend to get some information on ALL. The friend's cousin in California is in her first year of college and got her diagnosis of ALL this week. St Judes takes car of the kids and ALL is right there at the top of the problems.

In other words, you are one cell going bad from getting 6 digits of health care costs per year for a couple of years.

And, during the 2 or 3 years of chemo you might not be working very much. You can do more if you work from home but working in a crowded open office can be a killer. even if you wear a mask.

Something like AFLAK can help for those long periods of staying in bed. And you might be able to get on Medicare with luck and if you do be sure to get the supplemental policies.

Basically a PPO is the best when a serious (read expensive) health problem hits.

The wife and I have gone through 7 cancers in total and a PPO (and now Medicare + Plan F supplemental) has kept us alive.
 
Dieuwer
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Re: HDHP plans: good or bad?

Sun Nov 03, 2019 5:35 pm

GalaxyFlyer wrote:
I believe you reside in the same state I do, the DPRM. Romney Care has driven out primary care physicians with low reimbursements. I can’t find a replacement for my now-retired doc and many others are in the same boat here.

If only we could rid ourselves of the lack of cost transparency due to third-party payers and consequent backroom pricing we’d have something like a free market.


Indeed, it would be a step forward to see transparent pricing upfront. Now, I have no idea how much say a test costs until I get the "You-Owe-This" bill.
 
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NWAESC
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Re: HDHP plans: good or bad?

Sun Nov 03, 2019 5:45 pm

When making your decision, I would also look at each plan's out-of-pocket max. If the HDHP you're looking at has one you can cover (or tolerate), then I'd go with that. If not, then a more traditional plan may be right for you.
"Nothing ever happens here, " I said. "I just wait."
 
Dieuwer
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Re: HDHP plans: good or bad?

Sun Nov 03, 2019 5:50 pm

NWAESC wrote:
When making your decision, I would also look at each plan's out-of-pocket max. If the HDHP you're looking at has one you can cover (or tolerate), then I'd go with that. If not, then a more traditional plan may be right for you.


We'll find out by the end of this Monday.
 
anrec80
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Re: HDHP plans: good or bad?

Sun Nov 03, 2019 10:17 pm

Ken777 wrote:
GalaxyFlyer wrote:
They are great! Went where I wanted, put almost $40,000 in tax-deferred savings. No problems when we needed care.


And what was the most expensive problem you got treatment for?

My wife got a diagnosis of Acute Leukemia. 27 days in the hospital to get into remission and over 100 days total. 10 trips for blood transfusions. Her total bill for her almost 2 year of care, including chemo, was around $750,000. Today that would be over a million. How does your insurance address that? BTW, my wife was about 60 when diagnosed. Today she got a call from our granddaughter who was on the line with a school friend to get some information on ALL. The friend's cousin in California is in her first year of college and got her diagnosis of ALL this week. St Judes takes car of the kids and ALL is right there at the top of the problems.

In other words, you are one cell going bad from getting 6 digits of health care costs per year for a couple of years.

And, during the 2 or 3 years of chemo you might not be working very much. You can do more if you work from home but working in a crowded open office can be a killer. even if you wear a mask.

Something like AFLAK can help for those long periods of staying in bed. And you might be able to get on Medicare with luck and if you do be sure to get the supplemental policies.

Basically a PPO is the best when a serious (read expensive) health problem hits.

The wife and I have gone through 7 cancers in total and a PPO (and now Medicare + Plan F supplemental) has kept us alive.


In this scenario, frankly, it won’t matter much whether you have HDCP or PPO - difference in premiums over the course of the year is close to the deductible itself. You would have easily hit your out of pocket max in this case (which are roughly the same as well).
 
flyguy89
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Re: HDHP plans: good or bad?

Mon Nov 04, 2019 6:29 am

Depends on your specific situation. I'm fortunate to be young and healthy, thus I rarely have a need to go to the doctor more than once a year. My employer offers an HDHP with an HSA, among other options and I've always gone with the HDHP. It's suited me quite well and saved me a lot. I think they're a great option to have.
 
Dieuwer
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Re: HDHP plans: good or bad?

Mon Nov 04, 2019 8:16 pm

Gonna keep the HMO. Monthly premium savings of the HDHP compared to the HMO is only $60. Not worth the hassle.
 
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Tugger
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Re: HDHP plans: good or bad?

Tue Nov 05, 2019 12:12 am

As others have noted: It depends.

I would recommend that you start your HSA first THEN after you have savings in place you can move to a high deductible plan. A friend of mine selected one for himself a few years back, he was healthy and doing OK. He figured it would save him a couple grand for the year. Less than 2 months into the new plan year he had a heart attack.... the plan covered the high overall costs but the "upfront" portion, monthly medication costs, follow ups, etc. took a big bite out of his finances for that year.

So it can work out fine and does for many people, just be aware and manage for it.

Tugg
I don’t know that I am unafraid to be myself, but it is hard to be somebody else. - W. Shatner
There are many kinds of sentences that we think state facts about the world but that are really just expressions of our attitudes. - F. Ramsey
 
flyguy89
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Re: HDHP plans: good or bad?

Tue Nov 05, 2019 12:31 am

anrec80 wrote:
Ken777 wrote:
GalaxyFlyer wrote:
They are great! Went where I wanted, put almost $40,000 in tax-deferred savings. No problems when we needed care.


And what was the most expensive problem you got treatment for?

My wife got a diagnosis of Acute Leukemia. 27 days in the hospital to get into remission and over 100 days total. 10 trips for blood transfusions. Her total bill for her almost 2 year of care, including chemo, was around $750,000. Today that would be over a million. How does your insurance address that? BTW, my wife was about 60 when diagnosed. Today she got a call from our granddaughter who was on the line with a school friend to get some information on ALL. The friend's cousin in California is in her first year of college and got her diagnosis of ALL this week. St Judes takes car of the kids and ALL is right there at the top of the problems.

In other words, you are one cell going bad from getting 6 digits of health care costs per year for a couple of years.

And, during the 2 or 3 years of chemo you might not be working very much. You can do more if you work from home but working in a crowded open office can be a killer. even if you wear a mask.

Something like AFLAK can help for those long periods of staying in bed. And you might be able to get on Medicare with luck and if you do be sure to get the supplemental policies.

Basically a PPO is the best when a serious (read expensive) health problem hits.

The wife and I have gone through 7 cancers in total and a PPO (and now Medicare + Plan F supplemental) has kept us alive.


In this scenario, frankly, it won’t matter much whether you have HDCP or PPO - difference in premiums over the course of the year is close to the deductible itself. You would have easily hit your out of pocket max in this case (which are roughly the same as well).

:checkmark: Again, all just depends on your specific situation. If you know you have the cash-flow to cover the out-of-pocket max on your HDHP (which, for me, is covered by what I have in my HSA), it doesn't really matter, you're going to get the same care for really a marginal difference in cost when you're talking about almost $1million in medical expenses.

Dieuwer wrote:
Gonna keep the HMO. Monthly premium savings of the HDHP compared to the HMO is only $60. Not worth the hassle.

Nice, yes for such a marginal difference in cost I'd say you made the right choice there.
 
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fr8mech
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Re: HDHP plans: good or bad?

Tue Nov 05, 2019 1:47 am

I’m in a HDHP. We had the option to go to it about 6 years ago. I jumped right at it. Put the maximum amount in each year, with limited withdrawals until the cancer. Since then, I’ve reached my individual deductible each tear, and the first year I reached the max out-of-pocket.

The billed amount that first years was over $850,000. That was surgery, chemo, radiation and a 10 day hospitalization for neutropenia.

I have yet to write a check from outside that account.

Now, that I’ve stabilized and am only doing quarterly scans, I’ve started to grow the balance again.

Quite simply, any money I would have spent towards the premium of a “traditional” plan went directly to the HSA.
When seconds count, the police are minutes away, or may not come at all.
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Tugger
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Re: HDHP plans: good or bad?

Tue Nov 05, 2019 6:16 am

fr8mech wrote:
I’m in a HDHP. We had the option to go to it about 6 years ago. I jumped right at it. Put the maximum amount in each year, with limited withdrawals until the cancer. Since then, I’ve reached my individual deductible each tear, and the first year I reached the max out-of-pocket.

The billed amount that first years was over $850,000. That was surgery, chemo, radiation and a 10 day hospitalization for neutropenia.

I have yet to write a check from outside that account.

Now, that I’ve stabilized and am only doing quarterly scans, I’ve started to grow the balance again.

Quite simply, any money I would have spent towards the premium of a “traditional” plan went directly to the HSA.

So it sounds like there was no actual benefit or advantage over a more standard plan?

Tugg
I don’t know that I am unafraid to be myself, but it is hard to be somebody else. - W. Shatner
There are many kinds of sentences that we think state facts about the world but that are really just expressions of our attitudes. - F. Ramsey
 
Kiwirob
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Re: HDHP plans: good or bad?

Tue Nov 05, 2019 7:01 am

DfwRevolution wrote:

Government-mandated price controls will inevitably screw quality and availability.


Except in every other first world country with a public healthcare system they don't.
 
flyguy89
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Re: HDHP plans: good or bad?

Tue Nov 05, 2019 7:51 am

Tugger wrote:
fr8mech wrote:
I’m in a HDHP. We had the option to go to it about 6 years ago. I jumped right at it. Put the maximum amount in each year, with limited withdrawals until the cancer. Since then, I’ve reached my individual deductible each tear, and the first year I reached the max out-of-pocket.

The billed amount that first years was over $850,000. That was surgery, chemo, radiation and a 10 day hospitalization for neutropenia.

I have yet to write a check from outside that account.

Now, that I’ve stabilized and am only doing quarterly scans, I’ve started to grow the balance again.

Quite simply, any money I would have spent towards the premium of a “traditional” plan went directly to the HSA.

So it sounds like there was no actual benefit or advantage over a more standard plan?

Tugg

In a catastrophic event, it can be a wash. But if you're generally healthy for most of your life, once you reach 65 you have full access to your HSA funds (which are interest-bearing) plus the savings from the premiums over the years.
 
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fr8mech
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Re: HDHP plans: good or bad?

Tue Nov 05, 2019 3:04 pm

Tugger wrote:
So it sounds like there was no actual benefit or advantage over a more standard plan?

Tugg



Actually, there is. In a standard plan, the premium paid is “lost”. It can no longer serve any function for me. In an HDHP, with an HSA, so long as I’m disciplined and continue to pay into the HSA, I only lose a small portion of what I’ve paid (the premium) everything else above that goes into an interest bearing savings account. An account that I can take from one employer to another or use for anyone covered by my plan. The money is tax-free out of my paycheck and remains tax-free so long as it is used to pay for covered medical costs.

The thing is, I have to choose to pay the differences in premiums into the HSA and remain disciplined in doing so. So, to the OP ‘s assertion that having an HDHP with an HSA is somehow passing the buck, I just don’t see it. By paying into the HSA I am taking responsibility.

flyguy89 wrote:
In a catastrophic event, it can be a wash. But if you're generally healthy for most of your life, once you reach 65 you have full access to your HSA funds (which are interest-bearing) plus the savings from the premiums over the years.


If you get a couple of good years in, while putting as much as you can in, over the premium difference, you should be able to weather the catastrophic event. My balance will cover 2 max out of pocket years, at this point.

I wish I could contribute more, but the IRS caps the amount you can put towards the HSA ($7100 in 2020). I would gladly take a couple of percentage points off my 401K contribution and move it to the HSA. My net pay wouldn’t change, but I would grow the HSA quicker, to help deal with the biggest cost driver of old age...health care.

I think the key to an HDHP is to get in while you’re young and relatively healthy and pay into it as much as you can. Just think of it as another retirement plan. I got in while in my early 40’s, and while that is not too late, it’s getting close. You need a few years, at max contribution, to build a large enough balance.

Like I said earlier, I was only in a few years when the cancer diagnosis came. And, I haven’t had to pay a thing outside of the HSA.
When seconds count, the police are minutes away, or may not come at all.
It’s hard to win an argument with a smart person, but it’s damn near impossible to win an argument with a stupid person. ~B. Murray
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NWAESC
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Re: HDHP plans: good or bad?

Tue Nov 05, 2019 3:22 pm

I was in my early 40's before starting one as well. I wish I'd done it earlier too...
"Nothing ever happens here, " I said. "I just wait."
 
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Aaron747
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Re: HDHP plans: good or bad?

Tue Nov 05, 2019 3:37 pm

Since returning to the States I have not found a single plan as good as the NHS I was covered under when living in Japan - a monthly tax of about 6% of pay for healthcare, an IC card accepted by any clinic, hospital or pharmacy anywhere, and never paid more than $15 out of pocket at any provider. Change employers? No big deal - no coverage lapse, pay your monthly tax, and just update the card information online. Mandatory annual checkup for any full-time employee anywhere, over 35 includes EKG and metabolic bloodwork which is how they keep overall system costs down. It was so hard to fill out all the mindless paperwork to be on the mindless system over here again.
If you need someone to blame / throw a rock in the air / you'll hit someone guilty
 
Dieuwer
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Re: HDHP plans: good or bad?

Tue Nov 05, 2019 7:22 pm

fr8mech wrote:
I’m in a HDHP. We had the option to go to it about 6 years ago. I jumped right at it. Put the maximum amount in each year, with limited withdrawals until the cancer. Since then, I’ve reached my individual deductible each tear, and the first year I reached the max out-of-pocket.

The billed amount that first years was over $850,000. That was surgery, chemo, radiation and a 10 day hospitalization for neutropenia.

I have yet to write a check from outside that account.

Now, that I’ve stabilized and am only doing quarterly scans, I’ve started to grow the balance again.

Quite simply, any money I would have spent towards the premium of a “traditional” plan went directly to the HSA.


Without any math examples, it is hard to see how you could have saved in the first place.
In my case, I would save about $750 per per year in premiums, but be on the hook for the first $3000 in medical bills.
A simple doctors visit for a potential sinus infection, a diagnosis, and a treatment would blow right through the $750 in savings. And you are not gonna sue the person who was sitting next to you in an aircraft for giving you a sinus infection.
 
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fr8mech
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Re: HDHP plans: good or bad?

Tue Nov 05, 2019 8:31 pm

Dieuwer wrote:

Without any math examples, it is hard to see how you could have saved in the first place.
In my case, I would save about $750 per per year in premiums, but be on the hook for the first $3000 in medical bills.
A simple doctors visit for a potential sinus infection, a diagnosis, and a treatment would blow right through the $750 in savings. And you are not gonna sue the person who was sitting next to you in an aircraft for giving you a sinus infection.


You’re right, without numbers it’s hard, but our open enrollment closed last week, so I can’t see the premium for our traditional plans.

$750 does seem a little low, though. Are you single? I think my first year, myself+family, provided over $1500 in savings over the year. All that went right to the HSA. We also added some on top of that.

As for the cost of care. Any of the HDHP I’ve looked at will bill for the negotiated rate. That’s the normal rate the insurance company will reimburse a provider, which tends to be substantially less than an uninsured person is billed.

As stated earlier, you need to be diligent in contributing to your HSA, and you probably need a couple of good years to help build that balance.

Another thing that the HDHP provided was “free” preventative care. Immunizations, kids and adults, and annual physicals (including ELG, x-rays & bloodwork) and screens (mammogram, pap, etc. ) are included with the premium paid.

The traditional plan required a co-pay and the 80/20 thing for some procedures.

Of course, the coverage is dependent on the specific plan, but I’ve found that employers and insurance companies are pushing the HDHP, so they tend to make it a sweeter deal than just what’s the premium would indicate.

My advice to you is that if you are young and in good health, jump into the HDHP, and contribute as much as you can, but at the minimum, contribute the premium difference.

A quick point: around the office, we do call it the Vegas Plan, because you are gambling on good health, at least for the first few years.
When seconds count, the police are minutes away, or may not come at all.
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flyguy89
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Re: HDHP plans: good or bad?

Tue Nov 05, 2019 9:12 pm

Dieuwer wrote:
fr8mech wrote:
I’m in a HDHP. We had the option to go to it about 6 years ago. I jumped right at it. Put the maximum amount in each year, with limited withdrawals until the cancer. Since then, I’ve reached my individual deductible each tear, and the first year I reached the max out-of-pocket.

The billed amount that first years was over $850,000. That was surgery, chemo, radiation and a 10 day hospitalization for neutropenia.

I have yet to write a check from outside that account.

Now, that I’ve stabilized and am only doing quarterly scans, I’ve started to grow the balance again.

Quite simply, any money I would have spent towards the premium of a “traditional” plan went directly to the HSA.


Without any math examples, it is hard to see how you could have saved in the first place.
In my case, I would save about $750 per per year in premiums, but be on the hook for the first $3000 in medical bills.
A simple doctors visit for a potential sinus infection, a diagnosis, and a treatment would blow right through the $750 in savings. And you are not gonna sue the person who was sitting next to you in an aircraft for giving you a sinus infection.

$750 for a sinus infection?
 
Dieuwer
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Re: HDHP plans: good or bad?

Wed Nov 06, 2019 12:13 am

flyguy89 wrote:
Dieuwer wrote:
fr8mech wrote:
I’m in a HDHP. We had the option to go to it about 6 years ago. I jumped right at it. Put the maximum amount in each year, with limited withdrawals until the cancer. Since then, I’ve reached my individual deductible each tear, and the first year I reached the max out-of-pocket.

The billed amount that first years was over $850,000. That was surgery, chemo, radiation and a 10 day hospitalization for neutropenia.

I have yet to write a check from outside that account.

Now, that I’ve stabilized and am only doing quarterly scans, I’ve started to grow the balance again.

Quite simply, any money I would have spent towards the premium of a “traditional” plan went directly to the HSA.


Without any math examples, it is hard to see how you could have saved in the first place.
In my case, I would save about $750 per per year in premiums, but be on the hook for the first $3000 in medical bills.
A simple doctors visit for a potential sinus infection, a diagnosis, and a treatment would blow right through the $750 in savings. And you are not gonna sue the person who was sitting next to you in an aircraft for giving you a sinus infection.

$750 for a sinus infection?


My point is: there are plenty of things out of your control that can impact your health.
Also, a high upfront deductible IMO seems contrary to the "Philosophy of Insurance" where the whole point is that you should not be worried about being able to afford that what you have been insured for.
 
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fr8mech
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Re: HDHP plans: good or bad?

Wed Nov 06, 2019 12:41 am

Dieuwer wrote:
My point is: there are plenty of things out of your control that can impact your health.
Also, a high upfront deductible IMO seems contrary to the "Philosophy of Insurance" where the whole point is that you should not be worried about being able to afford that what you have been insured for.


Your point is taken, but health insurance has strayed very far from what it was. Growing up we carried something called "major medical", and it covered just what it says, major medical. If you had a cold, you paid for it. If you got cancer, the insurance paid for it.

The HDHP, with an associated HSA returns us to some semblance of that. Truth is, the high deductible will deter some from going to the doctor for every sniffle or ache they feel. This tendency to avoid the doctor is balanced by the "free" annual visits and screens that the insurance should cover.

In the end, the HDHP is designed, in my opinion, to reshape how we think about and use healthcare & healthcare insurance.
When seconds count, the police are minutes away, or may not come at all.
It’s hard to win an argument with a smart person, but it’s damn near impossible to win an argument with a stupid person. ~B. Murray
Ego Bibere Capulus, Ut Aliis Sit Vivere
 
flyguy89
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Re: HDHP plans: good or bad?

Wed Nov 06, 2019 1:36 am

Dieuwer wrote:
flyguy89 wrote:
Dieuwer wrote:

Without any math examples, it is hard to see how you could have saved in the first place.
In my case, I would save about $750 per per year in premiums, but be on the hook for the first $3000 in medical bills.
A simple doctors visit for a potential sinus infection, a diagnosis, and a treatment would blow right through the $750 in savings. And you are not gonna sue the person who was sitting next to you in an aircraft for giving you a sinus infection.

$750 for a sinus infection?


My point is: there are plenty of things out of your control that can impact your health.
Also, a high upfront deductible IMO seems contrary to the "Philosophy of Insurance" where the whole point is that you should not be worried about being able to afford that what you have been insured for.

There's certainly a bit of gamble there and whether it makes sense obviously depends on your health and financial position. If you're healthy and contributing to your HSA, you're coming out ahead while still covering yourself for basic care and catastrophic illness or injury...if something ever happened to me and I'm staring down $1 million in medical expenses however, whether I have to pay $3000 max out of pocket (PPO) or $6000 max out of pocket (HDHP) is going to matter very little to me at that point.
 
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fr8mech
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Re: HDHP plans: good or bad?

Wed Nov 06, 2019 2:06 am

Dieuwer wrote:
My point is: there are plenty of things out of your control that can impact your health.
Also, a high upfront deductible IMO seems contrary to the "Philosophy of Insurance" where the whole point is that you should not be worried about being able to afford that what you have been insured for.


I went back into some claim forms from last year and found one for my daughter. My daughter had an ankle injury that kept nagging her, so we went to an orthopedic. We had not met the family deductible.

Exam, x-ray and cortisone shot. Billed $164.35, we paid $19.05.

flyguy89 wrote:
If you're healthy and contributing to your HSA, you're coming out ahead while still covering yourself for basic care and catastrophic illness or injury...if something ever happened to me and I'm staring down $1 million in medical expenses however, whether I have to pay $3000 max out of pocket (PPO) or $6000 max out of pocket (HDHP) is going to matter very little to me at that point.


That's the point. HDHP w/HSA is a long-term strategy. Near as I can remember, I've had an HSA since 2011. Until 2017, I didn't even come close to my deductible. In 2017 I met my max-out-of-pocket ($6500), since then I have met my deductible, but not the max-out-of-pocket. Projecting forward, and barring a recurrence of the cancer or some other "major medical" event, my out-of-pocket expenses should continue to go down.

In fact, I increase my deductible from $1500 to $2000, decreasing my premium by $30/month. I plowed that right back into the HSA.
When seconds count, the police are minutes away, or may not come at all.
It’s hard to win an argument with a smart person, but it’s damn near impossible to win an argument with a stupid person. ~B. Murray
Ego Bibere Capulus, Ut Aliis Sit Vivere
 
Dieuwer
Topic Author
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Re: HDHP plans: good or bad?

Wed Nov 06, 2019 2:47 am

fr8mech wrote:
Dieuwer wrote:
My point is: there are plenty of things out of your control that can impact your health.
Also, a high upfront deductible IMO seems contrary to the "Philosophy of Insurance" where the whole point is that you should not be worried about being able to afford that what you have been insured for.


Your point is taken, but health insurance has strayed very far from what it was. Growing up we carried something called "major medical", and it covered just what it says, major medical. If you had a cold, you paid for it. If you got cancer, the insurance paid for it.

The HDHP, with an associated HSA returns us to some semblance of that. Truth is, the high deductible will deter some from going to the doctor for every sniffle or ache they feel. This tendency to avoid the doctor is balanced by the "free" annual visits and screens that the insurance should cover.

In the end, the HDHP is designed, in my opinion, to reshape how we think about and use healthcare & healthcare insurance.


Growing up, we had some sort of Medicare for All. No deductible whatsoever. The current system in the USA therefore is worse in any respect IMO compared to what I used to as a kid.
 
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fr8mech
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Re: HDHP plans: good or bad?

Sun Nov 10, 2019 3:44 pm

Dieuwer wrote:

Growing up, we had some sort of Medicare for All. No deductible whatsoever. The current system in the USA therefore is worse in any respect IMO compared to what I used to as a kid.


But, this isn’t a discussion about that. You requested opinions on HDHP’s. You’ll find if you go through the responses, those of us that have them, are happy with them. In fact, at least one other person agrees with me, in that we wish we could’ve gotten into one earlier.

Likely, you’re open enrollment period has closed. I hope you’ve made the right decision for yourself.
When seconds count, the police are minutes away, or may not come at all.
It’s hard to win an argument with a smart person, but it’s damn near impossible to win an argument with a stupid person. ~B. Murray
Ego Bibere Capulus, Ut Aliis Sit Vivere
 
GalaxyFlyer
Posts: 6076
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Re: HDHP plans: good or bad?

Sun Nov 10, 2019 9:35 pm

Dieuwer wrote:
fr8mech wrote:
Dieuwer wrote:
My point is: there are plenty of things out of your control that can impact your health.
Also, a high upfront deductible IMO seems contrary to the "Philosophy of Insurance" where the whole point is that you should not be worried about being able to afford that what you have been insured for.


Your point is taken, but health insurance has strayed very far from what it was. Growing up we carried something called "major medical", and it covered just what it says, major medical. If you had a cold, you paid for it. If you got cancer, the insurance paid for it.

The HDHP, with an associated HSA returns us to some semblance of that. Truth is, the high deductible will deter some from going to the doctor for every sniffle or ache they feel. This tendency to avoid the doctor is balanced by the "free" annual visits and screens that the insurance should cover.

In the end, the HDHP is designed, in my opinion, to reshape how we think about and use healthcare & healthcare insurance.


Growing up, we had some sort of Medicare for All. No deductible whatsoever. The current system in the USA therefore is worse in any respect IMO compared to what I used to as a kid.


Maybe you didn’t grow up in the US because there ever was anything like that and Medicare came in 1965.
 
PPVRA
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Re: HDHP plans: good or bad?

Sun Nov 10, 2019 10:00 pm

Use this calculator to compare health plans:


http://health-plan-compare.com/
"If goods do not cross borders, soldiers will" - Frederic Bastiat
 
Dieuwer
Topic Author
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Re: HDHP plans: good or bad?

Sun Nov 10, 2019 11:33 pm

fr8mech wrote:
Dieuwer wrote:

Growing up, we had some sort of Medicare for All. No deductible whatsoever. The current system in the USA therefore is worse in any respect IMO compared to what I used to as a kid.


But, this isn’t a discussion about that. You requested opinions on HDHP’s. You’ll find if you go through the responses, those of us that have them, are happy with them. In fact, at least one other person agrees with me, in that we wish we could’ve gotten into one earlier.

Likely, you’re open enrollment period has closed. I hope you’ve made the right decision for yourself.


The math was pretty simple and came down to the cost of drugs. HMO = $0. HDHP = $3000.
 
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Aesma
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Re: HDHP plans: good or bad?

Mon Nov 11, 2019 2:25 am

Do you take into account the time it takes to choose a plan, review it regularly, compute all these "deductible, max this, premium that", look at what exactly is covered or not, etc. ? Time is money, after all.

It's a good thing we have a chip card here that means I get reimbursed automatically for my doctor's visits, and don't pay for medication, as if I had to fill the paperwork as before (well not much to fill in fact, the doctor did most of it) and send it, I would probably not bother half the time, as a visit is 25€, drugs often less than that.
New Technology is the name we give to stuff that doesn't work yet. Douglas Adams
 
PPVRA
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Re: HDHP plans: good or bad?

Mon Nov 11, 2019 3:49 am

Aesma wrote:
Do you take into account the time it takes to choose a plan, review it regularly, compute all these "deductible, max this, premium that", look at what exactly is covered or not, etc. ? Time is money, after all.

It's a good thing we have a chip card here that means I get reimbursed automatically for my doctor's visits, and don't pay for medication, as if I had to fill the paperwork as before (well not much to fill in fact, the doctor did most of it) and send it, I would probably not bother half the time, as a visit is 25€, drugs often less than that.


My visits are $0.

But that’s part of the problem. They shouldn’t cost zero.
"If goods do not cross borders, soldiers will" - Frederic Bastiat
 
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fr8mech
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Re: HDHP plans: good or bad?

Mon Nov 11, 2019 8:20 pm

Dieuwer wrote:

The math was pretty simple and came down to the cost of drugs. HMO = $0. HDHP = $3000.


By the end of this year, I will have contributed $7000 (tax-free) to my HSA. I will have paid right at $500 in premiums for the HDHP. So, a total outlay of $7500 for the year. Barring anything happening between now an 31-Dec, I will have paid out of my HSA just under $2000 (tax-free). That leaves $5000 to carry over to next year.

How much does your HMO allow you to carry to next year, or the year after, or to a different employer, or into retirement, or to your heirs?

By the way, my maintenance drug cost: $0 for the generic cholesterol (which upsets me greatly that I can’t seem to rid myself of the need for that) and ~$120/year for the thyroid stuff.

Look, if it’s the right decision for you, it’s the right decision for you. I just think, that if you look at it objectively, an HDHP w/HSA makes sense economically, in the long term. Especially if you’re young and healthy.
When seconds count, the police are minutes away, or may not come at all.
It’s hard to win an argument with a smart person, but it’s damn near impossible to win an argument with a stupid person. ~B. Murray
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Tugger
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Re: HDHP plans: good or bad?

Mon Nov 11, 2019 8:47 pm

The key thing is if you can and if you want the option to have such funds in the future, to start saving in an HSA. That changes the whole equation once you have something there.

Ultimately the conversation isn't about the saving on an annual comparison, but rather options going forward and possibly being able to do something more down the road.

Tugg
I don’t know that I am unafraid to be myself, but it is hard to be somebody else. - W. Shatner
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Dieuwer
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Re: HDHP plans: good or bad?

Mon Nov 11, 2019 9:26 pm

fr8mech wrote:
Dieuwer wrote:

The math was pretty simple and came down to the cost of drugs. HMO = $0. HDHP = $3000.


Look, if it’s the right decision for you, it’s the right decision for you. I just think, that if you look at it objectively, an HDHP w/HSA makes sense economically, in the long term. Especially if you’re young and healthy.


Yes, if you are a 20-something a HSA is probably a good deal as you probably are very healthy. But if you get older you get all these little medical problems that add up and plunder your HSA. Take diabetes for instance. A large part of the population is suffering from it. Just one EpiPen pack a month will wipe out your annual HSA contribution.

And for those that tout the "tax savings" of an HSA for future medical bills. Just wait when congress decides to "Mean Test" those eligible for Medicare and decide that those people that have "Large HSA assets" will get whacked with a "Rich Guy Tax".
 
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fr8mech
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Re: HDHP plans: good or bad?

Mon Nov 11, 2019 9:56 pm

Dieuwer wrote:
Yes, if you are a 20-something a HSA is probably a good deal as you probably are very healthy. But if you get older you get all these little medical problems that add up and plunder your HSA. Take diabetes for instance. A large part of the population is suffering from it. Just one EpiPen pack a month will wipe out your annual HSA contribution.

And for those that tout the "tax savings" of an HSA for future medical bills. Just wait when congress decides to "Mean Test" those eligible for Medicare and decide that those people that have "Large HSA assets" will get whacked with a "Rich Guy Tax".


Do you have diabetes? Are you planning on getting diabetes? Do you suffer a condition where you have to carry an EpiPen? If you’re young and healthy, there’s very little reason to skip the HDHP as long as you’re disciplined enough to make contributions. Hell, I was 41 when started my HSA, and I have yet to pay $0.01 outside of my HSA. But, you have to make the contributions.

As for future, potential tax issues: you can say that about any tax-free vehicle. There’s no talk of touching HSA’s or means testing Medicare based on assets. I think they’ve been means testing based on income for several years now.

I’m comfortable with the risk.
When seconds count, the police are minutes away, or may not come at all.
It’s hard to win an argument with a smart person, but it’s damn near impossible to win an argument with a stupid person. ~B. Murray
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Aesma
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Re: HDHP plans: good or bad?

Mon Nov 11, 2019 10:28 pm

600$ for the EpiPen pack ! That's crazy.

Here in France the same one, not a generic, the real Mylan product, is 70,61€. And it's not reserved to French people, or payers into the system, get a prescription, go to a pharmacy, you'll pay that. A French person will get 65% back from the system, 35% back from their private insurance (often a non-profit mutual).

I'm sure the system you're discussing makes sense financially especially if you have a good income (because here you would pay a lot in taxes into the system), however these crazy prices have to have an impact, and if they're not kept in check, at some point there will be only losers.
New Technology is the name we give to stuff that doesn't work yet. Douglas Adams
 
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einsteinboricua
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Re: HDHP plans: good or bad?

Wed Nov 13, 2019 7:34 pm

I was skeptical about HDHPs, especially because I was insured through my mom whose health plan was simply unbelievable. My first year with the company I went with the HDHP and put money into the HSA (but small amounts). That first year was rough because I was not expecting costs to be so high. The second year I switched to a HMO but that was money wasted. $65/paycheck just to have a $20 copay with specialists was simply not what I wanted (especially because I didn't really visit many specialists and never got sick that year). The following year I switched back to HDHP and haven't gone anywhere else since. My company contributes half the deductible to my HSA and I contribute far beyond normal (and get a nice kickback at tax time). I have about $5000 in HSA investments, always try to keep $1400 liquid (my deductible limit), and next year I will max out the HSA for the first time ever.

Last year I suffered from anxiety attacks (though didn't know what it was at the time). I breached my deductible limit around April, and for the rest of the year, the plan covered 90% of services.

Initially, HDHPs are harsh, but considering that it's low cost (or free) and if you're relatively healthy you won't really be using the services, they offer a nice way to save money (both in terms of costs and for investments). Think about it. Would you spend $100+/month for a plan you won't use but will allow you a small copay or would you rather spend little to no money (or redirect that to an HSA) knowing that if you're healthy, you're not wasting money?
"You haven't seen a tree until you've seen its shadow from the sky."
 
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cranberrysaus
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Re: HDHP plans: good or bad?

Thu Nov 14, 2019 9:01 pm

I've been putting off nasal surgery for years now because of our health plan. Last year they made both our deductible and out of pocket maximum $4,000. That means I need to spend that much each year in my own money before insurance will even contribute a dime.
 
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fr8mech
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Re: HDHP plans: good or bad?

Thu Nov 14, 2019 10:34 pm

cranberrysaus wrote:
I've been putting off nasal surgery for years now because of our health plan. Last year they made both our deductible and out of pocket maximum $4,000. That means I need to spend that much each year in my own money before insurance will even contribute a dime.


That’s a pretty high deductible for a “traditional” plan. Add, that every dime you and your employer paid into the plan for premiums is lost.

Without your specific numbers it’s hard to draw a comparison, but if you look at examples, you’ll find that you’re way ahead with a HDHP w/HSA.

In my case, my my premium is about 1/5 of the traditional plan premium. I plow the difference into my HSA, plus some additional to get me up to the max. Now, I understand that not everyone is in the position to make the max contribution, but there is no excuse for not contributing the difference in premiums. That balance is your money to use against your deductible.
When seconds count, the police are minutes away, or may not come at all.
It’s hard to win an argument with a smart person, but it’s damn near impossible to win an argument with a stupid person. ~B. Murray
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