The first thing I want to say is that we are very fortunate to have excellent health care through the years and that H’s employer self insures.
So I received our first mailing on the plans that will be available for next year and that enrollment will start at the end of October so I have time to try and figure this out.
The plan we have used for years has been eliminated so here are the choices we have.
Traditional BCBS 80/20 $500 individual/$1000 family deductible- in years past expensive, don’t expect that to change.
HSA PPO plan. Here are the particulars
Deductible 1500/3000, with family coverage there is no individual deductible or out of pocket limit
Out of pocket limit: $3000/individual $6000/family
Co insurance 20%
Mail order pharmacy 20% after deductible
Company HSA contribution $1500
This is where I am super confused. I know it says no individual deductible or out of pocket limit but I’m thinking that applies to the the $3000 for the individual out of pocket limit, that we are responsible for the first $3000 of coverage and then 20% until we hit $6000.
My H has an auto immune disease and is on an injectible medicine that costs $12000/year. He is also on another expensive drug. We have great prescription coverage. So far this year we have had $20,300 in charges for prescriptions and have paid a little under $200.
The company really wants everyone to switch to the HSA but I can’t figure out that we should pick this option. We have had other medical expenses and one of us has reached out out of pocket on the plan we have now and we always use our maximum $3000 in our health flex care account.
I can’t remember what the 80/20 traditional plan was last year but I think it was in the $500/month range.
Thanks for reading so far, really. I know it’s a lot and I really appreciate any input anyone can give me.
Can we make the HSA plan work or should we pick the traditional BCBS plan?
H can ask any questions that we have but we need to know what those questions should be.
I am thinking it means that your family has to pay $3000 in deductible expenses before they start paying anything. Our insurance has a family deductible but also a lower individual deductible for each person so once DH reached his individual deductible they started paying for him and then once the rest of us made up the family deductible they started paying for all of us. However yours says no individual deductible so I don’t think it works like ours.
The cost of the BCBS plan will be an important part of your decision. This years changes in the BCBS prescription drug program will also be important to understand.
I have no experience with mail order medications but have read in the past that people have had difficulty getting the correct medicine, the correct amt. of medicine and getting it in a timely manner. Since medications are so important to your health care this would be my biggest concern.
This would be something I would want to check and understand completely prior to making a decision to change to the HSA program.
You might want to check with the PPO plan specifically on coverage for the 2 drugs your husband takes. There isn’t a standard formulary list across the industry, and even the same insurance company can change their coverages from year to year.
Also, you didn’t mention this, but if you have any college kids on your plan who don’t live near home, in my experience BCBS plans are more likely to meet the college requirements so you don’t have to pay for the college insurance.
We have used the mail order prescription for years and years with no problems. No worries there.
With the traditional BCBS plan, the cost will be $100 for a 90 day supply for the most expensive medicines. At least that is how I am interpreting the information. Right now we are paying $60 for a 90 day supply for the most expensive medicine. So I am thinking that with the tradional plan as he has 2 expensive medicines, the cost for the year will be $800.
The mail order pharmacy is not changing according to the info I have and the pharmacy has verified that he will be covered for at least the next 2 years. Both plans are BCBS and also what our plan is this year. The plan they are not offering is a 70/30 plan and are only offering a 80/20 plan which has an additional cost. I am not anticipating any changes in our drug coverage.
I thought with an HSA that all aspects of treatment, other than preventive, had to be subject to the deductible in order to be HSA eligible. With our HSA plan, meds are subject to the deductible as well. Considering how expensive your husband’s meds are, I would verify whether or not you have to pay $3000 out of pocket in total medical costs before the insurance pays for the meds.
Drug coverage is different in the HSA plan we went with this year. Our presription costs is very low now, even though we have not hit the deductable. My copay on several scripts is less than $1. You may want to ask your pharmacist. We switched from a PPO to the HSA this year because the premiums were $4500 cheaper ($6400 vs $1900), the company gave us $2000 for our HSA and when I calculated our max OOP (adding in the money saved and what the company gave us) the HSA was cheaper.
I am reading this to say a singe person buying the plan gets a $1500 deductible, a family gets a $3000 deductible
including medications & with the company contributing $1500 to the HSA, you then are spending $1500 of their money and $1500 of yours
and this
if you had a health flex account was that company money or yours? pretax or after tax? if you take the HSA, I assume this option goes away?
Health flex account was our money, pre tax. It’s for things our insurance doesn’t pay, co pay, medicine co pays, eyeglasses, hearing aids.
I am so confused about this HSA option and how it would pay for his medicine, I’m inclined to pick the traditional plan and be done with it. It’s familiar and I know what it will pay as it’s basically the plan we have now but with better coverage. For an increased price.
H can call but we’ve found that HR isn’t any better informed than we are. I know our situation is complicated and unusual.
An HSA is a pretax account, the money you put in that account comes off your AGI on page 1 of the 1040, hence you use those funds as pre-tax dollars to pay for allowed medical expenses. For an example, a healthy couple with low medical usage could fund the HSA account and use that money toward dental expenses not covered by insurance.
In your case, HSA $ are better than health flex especially since $1500 of it comes from the employer. I think you should run the numbers each way, assuming first that both plans cover the same medications.
You also have to check and verify which meds & docs are covered and that there are no differences there.
So, you put in $1500 (instead of $3k into flex) and the company puts in $1500. You immediately begin using the usual services, at X point in time, you have hit the $3k deductible, then you pay 20% up to the max of $6k out of pocket, which should include the deductible amount, so you would an additional $15k in billing beyond the deductible before you have maxed your OOP.
Obviously how they cover the planned Rx is critical to this, but you would add up the $3k deductible, credit the $1500 from the company, then add in the 20% of whatever the Rx coverage is, then add to that the cost of the premiums. Do the same for the other plan to get a side by side idea as to how the plans would compare in a regular year.
Go to all the meetings your HR department gives and asks lots of questions. They may be able to point you to a website that would allow you to enter your intormation and compare prices (kinda like financial aid calculator). The HSA is funded with your pre-tax dollars and will continue into the next year if you haven’t spent it. The limit for funding the HSA is something like $5,000 - 6,0000.
The biggest thing about the HSA is you are paying everything until the deductible is met for your family $3000. There is no 'inidividual" deductible if you have family coverage since it doesn’t matter what family member is getting the charges. The deductible is one single pot for your family.
The biggest thing in our plan is that we pay for all prescriptions out of pocket until the deductibleis met. Then once the decuctible is met we have a prescription plan that has a copay 20/40/60 for a 90 day supply. The amount we pay for the prescriptions counts towards the deductible. We have a couple of expensive prescriptions which always takes us to $3,000 at some point.
Once you meet the out of pocket limit, then you are paying Nothing for medical and we still have co-pay for prescriptions.
Since you know your prescriptions are a big expense be sure that you find out how these will work with your new plans.
Thanks Python20. Very helpful. Unfortunately the meeting at our site happened before we received the information about the changes to our health plan. Got to love that planning.
I would check on the way they handle health flex accounts vs HSA. The way my husbands company works it is if you have a health flex account you can get reimbursed before you have had it taken out of your pay check. So we usually have used up our amount by July. With the HSA the money has to be in the account first. So if we were to have a large expense in January we would need to wait to have that money trickle in from his paycheck deductions. “Supposedly” this would only occur the first year you have a HSA if you have money left over from the previous year. For us it becomes a cash flow issue.
At one point we had some expensive prescriptions (though not nearly as expensive as yours) and found that the HSA with a $4,000 family deductible was a LOT cheaper than the drug copays. I realize that varies tremendously drug-by-drug, so I would find out specifically how each of the available plans handles the expensive drug, and then figure out what your bottom line cost would be.
For us, the annual premium + $4,000 deductible was << the (higher) annual premium for the PPO + copays for drug/doctors + deductible. But, it took some calculation to figure that out.