- advertisement -

High deductible health plan questions

Discussion in 'Parents of Children with Type 1' started by RomeoEcho, Feb 22, 2014.

  1. RomeoEcho

    RomeoEcho Approved members

    Joined:
    Dec 22, 2008
    Messages:
    483
    I have to choose a new health insurance, and I was looking at my two options and was surprised. I have always assumed that HMO/PPOs were better for people who use their insurance regularly, and HDHPs were for people who were healthy and only needed "catastrophic" insurance. However, the deductible on my HDHP is surprisingly low, $2500 for in-network individual, and then they pay 100% except for a copay for prescriptions. Plus I can have an HSA, and my employer will pay $900 into it. This sounds a lot better than the PPO option where I pay premiums, a $500 deductible, plus a copay and coinsurance. Am I missing something? Insulin and strips alone are going to be way more than the $2500 a year. If I'm going to reach the deductible every year, then they'll cover everything above that, right? It can't be this simple...
     
  2. mmgirls

    mmgirls Approved members

    Joined:
    Nov 28, 2008
    Messages:
    6,030
    We ended up choosing a HDHP plan this year, and yes the ones offered us are very different from the ones that we have looked at in the past. individual deductible of 1300 and family 2600. Coinsurance the same but 100% RX coverage over all levels. Max out of pocket is not bad either 3 and 6K for family.

    The reason we picked the HD plan was that the traditional Plan had an additional RX deductible and paid 90-70%.

    The only thing that Will really hurt is not having a FSA to pay into and be able to use for medical, that has been our saving grace for the last few years and made the "deductible" a non issue. Yes we are too offered a HSA and employer will put in 500 a year, I like that you don't lose the money, but can't use what you have not put in like the medical FSA.

    I am not sure if the HD plans offered from "employers" are different now because they have to meet a standard for the affordable care act. When I think of High deductible I always thought 10-15K
     
  3. Melissata

    Melissata Approved members

    Joined:
    Feb 19, 2009
    Messages:
    1,650
    Ya, it kind of is that simple! Our deductible is higher but we still meet it usually by March. And then everything is paid 100%, for us that includes prescriptions.
     
  4. mom2ejca

    mom2ejca Approved members

    Joined:
    Dec 9, 2008
    Messages:
    614
    We've had a high deductible plan for several years, and we've been very happy with it. I don't know if all plans are as easy-going as ours, but they never even batted an eye at covering a CGM. Our plan is also extremely flexible about what brand of strips & insulin we use. Once we hit the deductible for the year, everything in-network is covered at 100%.
     
  5. dianas

    dianas Approved members

    Joined:
    Nov 2, 2009
    Messages:
    314
    Make sure that prescriptions are included in that deductible. Generally prescription coverage is separate from your medical coverage on a lot of insurance plans. On my insurance plan the deductible and copays and out of pocket costs only apply to medical and DME costs and doesn't include the prescription drug coverage. I have prescription drug coverage but it's managed by a pharmacy benefits manager and has it's own deductibles and copays. Even if they are separate you still would most likely be able to use the HSA for either your medical or prescription expenses though.
     
  6. RomeoEcho

    RomeoEcho Approved members

    Joined:
    Dec 22, 2008
    Messages:
    483
    Thanks for the help! It just sounded too good to be true. Both options are much better than what I have now so I'm pretty happy either way.

    That was my understanding of high deductible plans too, and I'd never even considered them an option before. I think you're right, this must be part of the affordable care act. I'm ok with that. I didn't realize the difference between the HSA and FSA, I've never had access to either before. Mine will let you contribute a lump sum at the beginning of the year, so I guess it makes sense then to put it in at the beginning so that I can use it when the expenses come in.


    My current plan has separate prescription coverage with a separate deductible and doesn't count towards your out of pocket expenses. This one appears to count for both, but I will definitely ask before signing anything.
     
  7. chalke43

    chalke43 Approved members

    Joined:
    Oct 31, 2013
    Messages:
    20
    Yes, this. My fiance's employer presented their new health plan options to employees less than a week before their new plan year started, giving them only one day to decide on a plan so they could get all of the paperwork submitted in time. They were presented with 2 PPO options and 1 HSA. At first, the HSA looked like a no brainer, but once we determined that Rx costs did not count toward the deductible or OOP max on any of the three plans, we crunched the numbers again and figured out that one of the PPOs was actually better. Definitely double check on that.
     
  8. sincity2003

    sincity2003 Approved members

    Joined:
    Jun 1, 2013
    Messages:
    315
    Another one chiming in to say make sure your "preventative medicines" go towards your $2500 deductible. DH did not do a good job of explaining his coverage to me for this year and I'm a little upset. He explained it to me that we would have to meet our $2500 deductible before anything was paid out, even prescriptions. Well, imagine my surprise when I looked up the cost of a medicine and saw a blurb that said "Preventative medicine is not subject to deductible; however, it also does not count towards your yearly deductible." Sigh. Now, his employer did put $1,000 in our HSA, which helps, but I wasn't really worried about the $2500 because I knew we would meet that in RX costs. Now, we'll be lucky if we meet our deductible by the end of the year based on that one little exclusion.
     
  9. quiltinmom

    quiltinmom Approved members

    Joined:
    Jun 24, 2010
    Messages:
    1,189
    It does kinda seem too good to be true. You'd have to make sure that it actually covers what you need it to. If the deductible is comparatively low they have to make money somehow. Sometimes plans won't cover as much. Like if you will need to buy or replace a pump, check for dme coverage for example. Just take a look and perhaps call hr or whatever to be sure it will be good...it's dumb that you're stuck for the whole year. That's awesome if it really is that good. :)
     
  10. Mish

    Mish Approved members

    Joined:
    Aug 20, 2009
    Messages:
    1,393
    I'm also echoing others - make sure that pharmacy items aren't excluded from that deductible. For me, strips and insulin fall under pharmacy, so I only pay the copay from day one. That's good in my case, but it also means that if I were trying to hit a deductible it would be hard to get there. Other items that might be excluded are things like routine doctors visits.

    If your rx items are covered under that deductible, then you've probably found a good deal. :)
     
  11. RomeoEcho

    RomeoEcho Approved members

    Joined:
    Dec 22, 2008
    Messages:
    483
    I asked some more questions and they confirmed that prescriptions are included and that the covered/excluded services are identical under both plans. This is also the first I'll be seeing anything of the affordable care act, since my current plan is grandfathered and is in an edge case that allows it to stay that way for the forseeable future. I'm thrilled. Thanks for the help.
     

Share This Page

- advertisement -

  1. This site uses cookies to help personalise content, tailor your experience and to keep you logged in if you register.
    By continuing to use this site, you are consenting to our use of cookies.
    Dismiss Notice