(Closed) Understanding health insurance… or, why being an adult gives me a headache

posted 7 years ago in Legal
Post # 3
7293 posts
Busy Beekeeper
  • Wedding: October 2011

Oh lord, this stuff drives me nuts too! Im not sure what an HSA plan is.

 I thought that the deductible was for if you have doctors visits or get work done. Your perscription rate should be on a set tier. Like generics are 10 dollars. Legit is 30 and what not.

I wanna say regardless of your deductible and meeting it, you will get a prescription price, it should say what they are in your plan.

 Calling or health care bees! SOS lol

Post # 4
4824 posts
Honey bee

A lot will depend on what the company is providing. IE are they giving you money towards it? If so its not all your money you are paying towards the deductible

I am not sure on the birth control but its law under HSA’s that preventative healthcare be covered for free so that means you dont pay at all- no copay or anything. You only pay on stuff that isnt preventative which goes towards your deductable

So say you normally see a dentist and your gyno and PCP once a year. It would normally coust you about $20 per visit with copay. It should now cost you $0 to see these people.

So say you dont need anything above the normal preventative stuff, he money that goes into the HSA account (like a bank account) will rollover year to year so you can save up for anything that might occur in the future that is still below your deductable. (instead of paying monthly premiums money will go monthly into the HSA account and accrue)

So say you put 2,000 a year into the HSA.  And you only use $500 of it. At the end of the year you have $1500 to roll over into next year. Next year you have a large surgery that cost $100,000. Your deductable is $5000. So in your HSA account you have 1500 from last year plus 2000 from this year for a total of 3500. This means this amt will go towards your deductable. then you will be responsible for the last 1500 to total the 5000 deductable. Everything will be covered by insurance.

Post # 5
3520 posts
Sugar bee
  • Wedding: March 2012

Depending on the number of options you have, the Benefits office should have some sort of grid showing you what kind of insurance you can get.  It sounds like your Fi is opting for the least expensive option which generally comes with the highest deductible. 

See if you can get your hands on the grid, or make your own.  Do a comparison of the co-pays per office visit, co-insurance per ER visit, and % paid for labwork and hospital visits.  Prescription plan should be separate, and you probably don’t have as many options for that.  I always get the middle tier of what is offered.  Hope that helps.

Post # 8
351 posts
Helper bee
  • Wedding: September 2014

@MrsLongcoatPeacoat: “It sounds like your Fi is opting for the least expensive option which generally comes with the highest deductible.” THIS THIS THIS!

Make sure he understands all of his options! I signed up with health insurance through my work (first time available to me through any place I’ve worked at). It was nice because they completely explained every option and there is an 800-number I can call if I have any questions about anything having to do with the plan, prescriptions, etc.

It can be a bit frustrating; but the private insurance I had before was frustrating too. And I’m saving at least $500 a month on visits, co-pay, monthly payment and scripts. 

Make sure you guys ask any questions you can think of. 

Post # 9
1944 posts
Buzzing bee
  • Wedding: June 2009

For my HSA everything is taken out of that amount first till it is used up. I have no copays. Once that amount is used my 80/20% kicks in and so does my deductible. But this is my HSA through Aetna.

Post # 10
257 posts
Helper bee
  • Wedding: May 2012

okay — i do this for a living so i’ll try my best to explain it.  if you have any other questions, you can send me a message or ask it here.

HSA is a health savings account that is like an IRA for your health expenses.  You can open it at any bank or at the bank that your employer chooses.  We use Merrill Lynch because of our relationship with them.  It is not the best option in terms of HSAs but it works for us.

An HSA has to be paired with a high deductible health plan (deductibles have to be at least $1,200 to qualify as high deductible plan for 2011).  If you have an HMO or PPO, you are not allowed to have an HSA.  The annual maximum contribution is $3,050 (single) and $6,150 (family).  If you have expenses above this you can also open up a limited flexible spending account.  I have both accounts.

With a high deductible plan, you are paying the full amount each time you see a doctor or fill a prescription.  It’s not the “retail” amount but it’s the health carrier’s contracted rate which should reflect some sort of discount.  For example you go see your doctor, I find this usually ranges about $150 (primary care) to $400 (specialists).  My prescriptions also range depending on how “new” they are.  So when I pick up my Singulair, it was about $120 per month.

What the other poster mentioned about preventive care doesn’t cover many visits.  Most carriers go by the AMA guidelines for your gender and health.  So for me I get my annual gyno visit covered but that’s about it.  For birth control pills, it’s currently not covered but Obama is requiring health insurance companies to cover them starting August 2012.

So why have insurance if you’re paying out of pocket for everything? So how the plan is supposed to work is that you pay for everything and it gets applied to your deductible.  In your case it’s $5,000.  Once you hit your deductible, the carrier picks up 100% but not 100% of everything.  My plan has a $1,500 deductible (that I met by having sinus surgery earlier this year) so now almost everything is covered at 100% with the exception of my prescriptions.  My prescriptions are now on a copay system so instead of paying $125 for Singulair, I pay the $50 copay. 

So what is the HSA for?  You should be able to pay your expenses directly or reimburse yourself from your HSA.  My employer funds $3,000 per year into an HSA for me so doing the math, after meeting my deductible, I’m still up $1,5000.  However, most employers are not as generous so employees are stuck doing pre-taxed contributions to their HSA.  Some employers don’t even assist with opening up an HSA so employees are forced to do it on their own.  HSAs got a bad reputation because many employers starting switching over from traditional PPOs to high deductible plans for the monthly premium savings without using some (or all) of the premium savings to fund an HSA for their employees.  I think employers should at the very least provide the seed money by at least covering the deductible for the first year and since the money rolls overs form year to year, the idea is that there’s leftover money to help with the following year. 

I like my high deductible plan because my employer funds my HSA.  If I don’t go to the doctor, I can save the money in my HSA.  If I leave my employer, I can use HSA money to pay my COBRA premiums and when I retire, I can use the money for non-medical expenses. 

I know you said you were concerned about birth control pills. I find that most run about $65.  Sometimes you can sign up for a promotion card from the pill’s manufacturer.  For example, I was able to get Yaz for $25 because Bayer covered the rest.  I know a few coworkers go to Planned Parenthood because it’s cheaper.

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