Why I am going with the HDHP during open enrollment season

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FloridaTim
Posts: 10
Joined: Sat Apr 01, 2017 1:10 pm

Re: Why I am going with the HDHP during open enrollment seas

Post by FloridaTim »

Good points all.

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cswift01
Posts: 819
Joined: Thu Dec 08, 2016 10:46 am

Re: Why I am going with the HDHP during open enrollment seas

Post by cswift01 »

I just switched to the GEHA HSA. Here are my reasons (and probably different than yours).

1. I'm still "somewhat" young. I'm 37 and so I see at least 10 to 15 years of growth in the HSA account.
2. My kids are under my wife's healthcare policy. I intend to change one to my policy after the age of 15 or so. Yes, the accidents kids make at that age can be much more, but I think the likelihood of going to the doctor is much, much less.
3. The HSA will receive not only my pay, but also the pass-through. That's a HUGE win for me.
4. Do not forget that your HSA money is pre-FICA. That means that it's not only pretax (federal/state income tax), but also money not paid into the other mess. This will lower your overall taxes paid.
5. The money could be used for myself or even for my family (even if they're covered under another policy).
6. GEHA pays almost all preventive medicine as well as dental cleanings. 2x per year (I'm sure there's a ceiling amount)! Can't go wrong there.
7. I'm stationed abroad where doctor's visits cost $30. I'm thankful for single payer every single day.

In my situation this works. In reading your situation, you're taking more of a risk because all of your family is under your policy.

Does your wife work? Could she get health insurance via her work?

Just something to consider...

Best,

Me

gclapper
Posts: 69
Joined: Wed Sep 28, 2016 12:04 pm

Re: Why I am going with the HDHP during open enrollment seas

Post by gclapper »

Good Morning all. I have not yet looked at the changes to the 2018 benefits but will relay a little of my story from the last few years. My family (wife+3 kids) was on the BCBS basic plan and for the most part were very happy with the plan. My oldest daughter who is now 17 and a senior in high school was diagnosed as a Type 1 diabetic when she was 14. Well our lives were pretty much turned upside down. While not getting into to much detail, that year (diagnosed in April of that year) was a very financially difficult one. We hit her individual maximum out of pocket and also the family maximum out of pocket. What really sucks is that prescriptions do not count toward your max out of pocket; and she has a bunch. This will be a life time medical issue for her and our family. I did a bunch of research that year and found that going to the BCBS standard and maxing the FSA out was our best bet financially. Now I get her prescriptions through mail order which is not available through BCBS basic. This saved a huge amount. Also, BCBS is one of the most accepted insurance plans from what I have personally experienced. Her Type 1 Diabetic Doctor is one of the best in Texas and we love all the help she has given us. Going to another plan would probably require us to find a new specialist and to us, that is a no go. Sometimes having a plan that may cost a little more pays off in the quality of doctors and services that are available. When it comes to my children that is more important than saving $100 bucks a month.

Just as a side story, make sure that you question everything when dealing with medical insurance, and I do mean everything. My daughter spent 2 days in the pediatric ICU and they screwed the paperwork up. The issue was one single word! Instead of putting "inpatient" they put "observation" on the medical paperwork (even though it was a life/death situation). That difference cost me almost $2000 more out of pocket. I fought it for over 6 months and won! They said she did not meet the requirements to be listed as inpatient but after pushing they finally allowed me to see the giant book that tells them basically the requirements for all diagnoses. Well after hand writing the requirements down on a piece of paper, they would not allow me to make a copy (some proprietary crap) I found that she did meet all the requirements and proved it to them. They still would not change the paperwork but waved the $2000. But they did not take away the hit they put on my credit! I have won numerous battles since then and even one where my dentist was basically doing fraudulent charges to the insurance and myself. I got all my money back from them and now have a new dentist.

skiehawk11
Posts: 2116
Joined: Wed Jan 05, 2011 2:32 pm

Re: Why I am going with the HDHP during open enrollment seas

Post by skiehawk11 »

gclapper, I think you made a financially sound move to better your family's well being. It's smart to look at insurance plans and determine which costs are covered for the health issue that costs the most in your family. Prescription drugs required monthly is extremely costly and it makes sense to go with a plan that helps alleviate some of that financial burden.

Scorpio70
Posts: 432
Joined: Thu Dec 24, 2015 11:49 am

Re: Why I am going with the HDHP during open enrollment seas

Post by Scorpio70 »

The Blue Cross Basic has taken good care of me and my family through major health crisis, so I am staying.

Timber82
Posts: 166
Joined: Mon Feb 27, 2017 2:39 pm

Re: Why I am going with the HDHP during open enrollment seas

Post by Timber82 »

PoorFed wrote:In general, the purpose of insurance is to pull premiums from a group of people to cover individual members cost based on probability of an event happening. It’s basically all just numbers. For us Feds, health plan premiums are the same regardless of an individual’s age or pre-existing medical conditions. As such, younger and healthier individuals typicallly pay a higher premium than they should and “subsidize” older folks and those with pre-existing conditions.
In determining whether one should switch to a HDPH, I would say that unless you are young and KNOW you are healthy, a HDHP may not work out unless you do the numbers and track your current and anticipated medical expenses into your equation. Although a HDHP premium is generally lower and a portion gets added to your own individual account that you can “bank” you need to factor in that your current $10 co-pay to see the doctor will now cost $100 to see the doctor. That $7 co-pay for your medicine will be $150, etc. I do understand that there is a limit to out of pocket expense and insurance will eventually kick in but ask yourself this question....under a HDHP, will you forgo medical insurance examines and early tratment because of the appearance of higher cost and/or desire to grow your account? My overall opinion is keep insurance as insurance and investment as investment. Don’t mix the two because your actual behaviors may change and you end up doing things opposite of its original intent.
I appreciate the pushback and this is where I might find out something I wasn't aware of or was using incorrect logic. Please review the crude spreadsheet I just made to better illustrate what I was saying. If I contribute the $difference to my HSA along with the "Premium pass through" put in my account by the HSA plan, I only need $350 to ever reach my deductible if it comes to that. then where it really matters is the Max OOP, which BCBS is $500pp/$1000 total per family more than the HDHP.

So taking this all into account as long as I don't reach my deductible I have money to carryover that never expires. So back to the Max OOP, say its just me that requires intense care. On BCBS Not only am I spending $1,149.12 more in premium for the year, but I also need to come up with another $500 on top of the HDHP. Don't forget the copays for everything so on HDHP I have no copays, as long as it is in network 100% of services apply to the deductible. So again if I contribute the extra $95 a month that would of been lost anyway if not used by the BCBS I am in my mind coming out ahead. So my doctor visit I see 2x a year they couldn't give me a actual price but it was capped at $180 per visit. Ok that sucks but in one month my HSA grows $220.76 (if I contribute the BCBS difference and the Premium pass-through).

Again anyone please let me know if there is a flaw in my logic. we are all fairly healthy, I have a minimum of 2 doc visits a year my wife 1 and my daughter now she is out of her every few months required of a newborn I don't foresee anything other than a catastrophic issue arising.
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greengrass
Posts: 334
Joined: Fri Jan 11, 2013 9:28 am

Re: Why I am going with the HDHP during open enrollment seas

Post by greengrass »

What about Foreign Service Benefit Plan (FSBP)?
I'm researching now but wondering if someone has taken a look at this already?

Timber82
Posts: 166
Joined: Mon Feb 27, 2017 2:39 pm

Re: Why I am going with the HDHP during open enrollment seas

Post by Timber82 »

gclapper wrote:Good Morning all. I have not yet looked at the changes to the 2018 benefits but will relay a little of my story from the last few years. My family (wife+3 kids) was on the BCBS basic plan and for the most part were very happy with the plan. My oldest daughter who is now 17 and a senior in high school was diagnosed as a Type 1 diabetic when she was 14. Well our lives were pretty much turned upside down. While not getting into to much detail, that year (diagnosed in April of that year) was a very financially difficult one. We hit her individual maximum out of pocket and also the family maximum out of pocket. What really sucks is that prescriptions do not count toward your max out of pocket; and she has a bunch. This will be a life time medical issue for her and our family. I did a bunch of research that year and found that going to the BCBS standard and maxing the FSA out was our best bet financially. Now I get her prescriptions through mail order which is not available through BCBS basic. This saved a huge amount. Also, BCBS is one of the most accepted insurance plans from what I have personally experienced. Her Type 1 Diabetic Doctor is one of the best in Texas and we love all the help she has given us. Going to another plan would probably require us to find a new specialist and to us, that is a no go. Sometimes having a plan that may cost a little more pays off in the quality of doctors and services that are available. When it comes to my children that is more important than saving $100 bucks a month.

Just as a side story, make sure that you question everything when dealing with medical insurance, and I do mean everything. My daughter spent 2 days in the pediatric ICU and they screwed the paperwork up. The issue was one single word! Instead of putting "inpatient" they put "observation" on the medical paperwork (even though it was a life/death situation). That difference cost me almost $2000 more out of pocket. I fought it for over 6 months and won! They said she did not meet the requirements to be listed as inpatient but after pushing they finally allowed me to see the giant book that tells them basically the requirements for all diagnoses. Well after hand writing the requirements down on a piece of paper, they would not allow me to make a copy (some proprietary crap) I found that she did meet all the requirements and proved it to them. They still would not change the paperwork but waved the $2000. But they did not take away the hit they put on my credit! I have won numerous battles since then and even one where my dentist was basically doing fraudulent charges to the insurance and myself. I got all my money back from them and now have a new dentist.
Thank you GCLAPPER for that story, and it gives me more to ask them in making my decision. But I did read these few things from the GEHA HDHP booklet for 2018

Pg. 83 (Prescription Drug Benefits)
•The deductible is $1,500 for Self Only and $3,000 for Self Plus One or Self and Family. The Self Plus One or the Self and Family deductible can be satisfied by one or more family members. The deductible applies to all benefits in this Section

•After you have satisfied your deductible, your traditional medical coverage begins.
•Under your Traditional medical coverage, you will be responsible for your coinsurance amounts for eligible medical expenses and eligible prescriptions.
Pg.87
Covered medications and supplies
You may purchase the following medications and supplies prescribed by a physician from either a pharmacy or by mail:
• Drugs and medicines (including those administered during a non-covered admission or in a non-covered facility) that by Federal Law of the United States require a physician's prescription for their purchase, except those listed as not covered;
• Diabetic medications and supplies, such as:
- Insulin;
- Needles and syringes for the administration of covered medications;
- OneTouch blood glucose meter - provided at no charge by the manufacturer, through the CVS Caremark Mail Service Pharmacy, call toll free: 877-418-4746;
Now again I am no scholar and a lot of this is very new to me (I didn't even know what a coinsurance was until last week). But at first glance it appears that Prescription drugs (which diabetic stuff is covered) does get applied to your deductible, and then your "co insurance" also applies to the max OOP. Regarding Network of doctors, I love my PCP doctor and so I verified he and all of our other doctors are in their network. don't quote me but I read somewhere in this booklet that the network is the same as Aetna in some states and the same as united in others.

GCLAPPER, you may want to give GEHA a email and lay out what your costs were and do the work I have been doing (contact pharmacy, labs, doctors office), and of course check their network for your doc. you might have some higher upfront costs but remember the OOP is lower, and from my understanding of the above prescriptions do count toward it so once the threshold is triggered you might be good to go. either way I hope the situation gets better my brother is a diabetic and his drugs just left the covered schedule so he is in a big bind right now.

PoorFed
Posts: 43
Joined: Sat Oct 08, 2016 8:27 pm

Re: Why I am going with the HDHP during open enrollment seas

Post by PoorFed »

Timber82 wrote:
PoorFed wrote:In general, the purpose of insurance is to pull premiums from a group of people to cover individual members cost based on probability of an event happening. It’s basically all just numbers. For us Feds, health plan premiums are the same regardless of an individual’s age or pre-existing medical conditions. As such, younger and healthier individuals typicallly pay a higher premium than they should and “subsidize” older folks and those with pre-existing conditions.
In determining whether one should switch to a HDPH, I would say that unless you are young and KNOW you are healthy, a HDHP may not work out unless you do the numbers and track your current and anticipated medical expenses into your equation. Although a HDHP premium is generally lower and a portion gets added to your own individual account that you can “bank” you need to factor in that your current $10 co-pay to see the doctor will now cost $100 to see the doctor. That $7 co-pay for your medicine will be $150, etc. I do understand that there is a limit to out of pocket expense and insurance will eventually kick in but ask yourself this question....under a HDHP, will you forgo medical insurance examines and early tratment because of the appearance of higher cost and/or desire to grow your account? My overall opinion is keep insurance as insurance and investment as investment. Don’t mix the two because your actual behaviors may change and you end up doing things opposite of its original intent.
I appreciate the pushback and this is where I might find out something I wasn't aware of or was using incorrect logic. Please review the crude spreadsheet I just made to better illustrate what I was saying. If I contribute the $difference to my HSA along with the "Premium pass through" put in my account by the HSA plan, I only need $350 to ever reach my deductible if it comes to that. then where it really matters is the Max OOP, which BCBS is $500pp/$1000 total per family more than the HDHP.

So taking this all into account as long as I don't reach my deductible I have money to carryover that never expires. So back to the Max OOP, say its just me that requires intense care. On BCBS Not only am I spending $1,149.12 more in premium for the year, but I also need to come up with another $500 on top of the HDHP. Don't forget the copays for everything so on HDHP I have no copays, as long as it is in network 100% of services apply to the deductible. So again if I contribute the extra $95 a month that would of been lost anyway if not used by the BCBS I am in my mind coming out ahead. So my doctor visit I see 2x a year they couldn't give me a actual price but it was capped at $180 per visit. Ok that sucks but in one month my HSA grows $220.76 (if I contribute the BCBS difference and the Premium pass-through).

Again anyone please let me know if there is a flaw in my logic. we are all fairly healthy, I have a minimum of 2 doc visits a year my wife 1 and my daughter now she is out of her every few months required of a newborn I don't foresee anything other than a catastrophic issue arising.
Based on looking at your spreadsheet and your situation, the HDHP may work out for you. Not considering the taxes, your "break-even" point would be $2,649.12. Even if we assume two doctor visits per year for you and each of your family members, at $180 per visit, you would still have $1,569.12 remaining [$2.649.12 - (3 family members x 2 visits per family members x $180 per visit)] to cover additional doctor visits, emergencies, medications, etc.

In my particular situation, assuming the same "break-even" point as you, the HDHP would not work out for me. I visit my doctor about 6 times a year but take several medications on a monthly basis. At $80 per visit (versus $15 with "normal" insurance) plus the full cost of medicines, I would easily pass the "break-even" point.

I am not sure about your particular insurance but in general, even with a HDHP, you typically pay a "discounted/negotiated" rate than a "retail" rate. For example, having no insurance, my doctor visit would be $100. I only pay $15 co-pay and the insurance company pays the doctor $65 because they negotiated the "retail" rate to $80.

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evilanne
Posts: 2067
Joined: Thu May 14, 2015 6:52 pm

Re: Why I am going with the HDHP during open enrollment seas

Post by evilanne »

Timber82 wrote:So taking this all into account as long as I don't reach my deductible I have money to carryover that never expires. So back to the Max OOP, say its just me that requires intense care. On BCBS Not only am I spending $1,149.12 more in premium for the year, but I also need to come up with another $500 on top of the HDHP. Don't forget the copays for everything so on HDHP I have no copays, as long as it is in network 100% of services apply to the deductible. So again if I contribute the extra $95 a month that would of been lost anyway if not used by the BCBS I am in my mind coming out ahead. So my doctor visit I see 2x a year they couldn't give me a actual price but it was capped at $180 per visit. Ok that sucks but in one month my HSA grows $220.76 (if I contribute the BCBS difference and the Premium pass-through).

Again anyone please let me know if there is a flaw in my logic. we are all fairly healthy, I have a minimum of 2 doc visits a year my wife 1 and my daughter now she is out of her every few months required of a newborn I don't foresee anything other than a catastrophic issue arising.
I don't think there is anything wrong with your logic, we don't plan to get sick or hurt. You can only realistically plan for your family's anticipated needs. Even with BC/BS, if something happens your medical costs will increase based on increased doctor visits and copays. Most standard medical plans don't cover dental so that is also an extra expense. You can also look at the worse case scenario under each plan...how will you cover the additional expenses under each? How would another pregnancy/child impact the amount you would pay under each option? Open Season occurs once a year so if things change you can always go back. Either option under FEHB is a pretty good deal compared to what is available outside the government.

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evilanne
Posts: 2067
Joined: Thu May 14, 2015 6:52 pm

Re: Why I am going with the HDHP during open enrollment seas

Post by evilanne »

greengrass wrote:What about Foreign Service Benefit Plan (FSBP)?
I'm researching now but wondering if someone has taken a look at this already?
If you are in one of the agencies covered, I would recommend it over BC/BS Standard (105) Self & Family. It covers more alternative medicine visits for Chiropractic & Acupuncture. Had one compound medicine that was not covered but savings of $175-$200+/month more than cover that expense.

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head
Posts: 104
Joined: Mon Mar 28, 2016 9:06 pm

Re: Why I am going with the HDHP during open enrollment seas

Post by head »

I would recommend looking at the Foreign Service Benefit Plan, AFSPA. I had GEHA while stationed in Germany and it was such a hassle to receive payment due to the medical bills being written in German. GEHA's policy states they have translation services due to Fed employees being stationed all over the world. Well they do not. So I ended up having to translate all medical documents so I could receive payments. This is why I changed to the Foreign Service Benefit Plan. Hint: You do not have to be stationed overseas to have this insurance. Check them out.

greengrass
Posts: 334
Joined: Fri Jan 11, 2013 9:28 am

Re: Why I am going with the HDHP during open enrollment seas

Post by greengrass »

head wrote:I would recommend looking at the Foreign Service Benefit Plan, AFSPA. I had GEHA while stationed in Germany and it was such a hassle to receive payment due to the medical bills being written in German. GEHA's policy states they have translation services due to Fed employees being stationed all over the world. Well they do not. So I ended up having to translate all medical documents so I could receive payments. This is why I changed to the Foreign Service Benefit Plan. Hint: You do not have to be stationed overseas to have this insurance. Check them out.
They've been great for me too. Never needed to worry about translations. I kept them when I came to the states and the hospitals kept asking me what kind of insurance it was. They we're surprised at how low the costs were.

never_nuff
Posts: 17
Joined: Sat Oct 21, 2017 4:25 pm

Re: Why I am going with the HDHP during open enrollment seas

Post by never_nuff »

I have been with BCBS basic for a couple of years now and am thinking about switching to GEHA standard because of the cost. Can someone tell me if most doctors/hospitals accept GEHA in DC metro area? I checked online if my doctors/hospitals accept GEHA, but none showed up.

Timber82
Posts: 166
Joined: Mon Feb 27, 2017 2:39 pm

Re: Why I am going with the HDHP during open enrollment seas

Post by Timber82 »

Well some new developments.. I was talking to my best friend this weekend he just finished all his medical boards and what not so he is a licensed practitioner now. I mentioned a spot on my stomach that felt harder than the rest of my stomach, and it hurts in that area when I work out.. he told me hes 90% certain its a hernia, so i already have a appointment set up for 2 weeks from now, thankfully i should be able to have this performed under my bcbs coverage.

This hasn't strayed me from my consideration of HDHP but it will be interesting to run it by both insurances as this is one of those unexpected costs.

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