Health insurance conundrum
December 10, 2013 8:52 AM Subscribe
I am totally paralyzed with indecision about the health insurance options I have at work this coming year. Halp! High deductible plan with an HSA vs tried-and-true HMO.
posted by banjo_and_the_pork to Health & Fitness (32 answers total) 1 user marked this as a favorite
Option 1: High Deductible Plan (PPO) with HSA
HSA: employer contributes $2000 at the start of the year, rolls over year to year
Copays for preventative care are $30
After deductible copays for prescriptions run from $20-50
After deductible copay for ER is $100
After deductible all in-network services (excluding preventative care, prescriptions, and ER copay) are covered 100% (out of network services have 20% co-insurance charge, I do not anticipate needing to go out of network)
Preventative care and prescriptions do not count towards deductible
Out of pocket max is $10,000
Monthly premium is $135 and I would add $100/month to the HSA
Option 2: HMO
Copays are $25
Prescription copays are about the same as above
ER copay is $100
Inpatient copay is $1000 but employer reimburses about ¾ of that
Monthly premium is $286/month
Other relevant facts- Both are offered by Blue Cross, I’m in Massachusetts so Blue Cross is accepted almost everywhere. This is family coverage for myself, husband, and our 3 year old. So far we have all been very healthy. No chronic illnesses or chronic prescription needs, a few sick visits a year, usually a couple of antibiotic prescriptions a year, that’s usually it. But I know that especially with a kid, an ER trip is just one playground mishap away, and kid is in daycare so is exposed to a lot of illnesses all year.
We’ve always had the HMO option, and it works just fine for us, but the potential savings with the high deductible plan are pretty attractive this year. I keep thinking that there must be a gigantic catch that I am not anticipating. Researching high deductible plans and HSAs leads me to a lot of insurance/HSA company propaganda about how great they are, and lots of better supported arguments about why high deductible plans can sometimes unexpectedly cost you way more out of pocket than you think when you sign up for them. It seems like a gamble for only saving $50/month, but then I start thinking that if we have another healthy year and don’t use up all the HSA funds, we’ll have started a decent little health emergencies fund. Also, with the HSA I could be paying copays with pre-tax money, as opposed to paying HMO copays post-tax.
What are the catches to high deductible plans that I am not thinking about? In this situation is the tax benefit of the HSA actually worth the risk?