I need Health Insurance for Dummies

ASmallWonder

Since DS1 was born we've just kept the same insurance plan we had.  High monthly rate but zero deductible.  This year they're adding a $1000 deductible and, looking at the info it seems we're getting screwed but I am such an idiot with this that I worry I'm missing something.  Who has patience and wants to verifying that my thinking isn't skewed?  If we add the premium amount and the annual OOP max, this is the absolute most we can expect to pay for the year, correct?  I know that sounds dumb since OOP max says max right in it.  The company will put $1500 into an HSA for us so if we pay our premium and put the OOP max amount, minus the company contribution, into an HSA, we won't get hit with owing anyone anything more than that in a worst case scenario, right?

And is my research correct that HSA funds roll over?  So if we don't have a bad health year, anything left over can be applied to next year, right?

Eleventy11

I'm thinking an HSA is like a flexible spending account of pre-tax dollars?? If so, it will not roll over. You might be able to use it for other things such as medicine and co-pays.

ETA: It looks like they do roll over, but are only for individuals with high deductible plans...I'm not sure $1000 would qualify. That is a pretty standard deductible for most of my friends and family.

ASmallWonder

GhostMonkey said:

Nope. You will pay the following:

-Monthly Premium
-Deductible
-Co Insurance until max OOP (deductibles rarely count toward OOP max, so check your policy)
-Co pays (not included in deductible or OOP max)

@ghostmonkey Crap.  Ok, this is what our information says as far as charges: "premium" / Annual Deductible $2500 minus $1500 company contribution / Annual OOP max $5000.  Preventative care covered in full, all other office visits, specialists, surgeries, hospital admissions and ER visits are 10% our responsibility after our deductible.

Other plans specifically call out deductibles and this one does not - just the 10%. So, does that mean that the 10% is counted toward our $5000 OOP max?  If I'm understanding you correctly, if our deductible does not count toward our OOP max, we pay, at worst, our premiums, our deductible and our OOP max.  Am I still missing something?

ASmallWonder

LoisLayn23 said:

courtnif said:

I'm thinking an HSA is like a flexible spending account of pre-tax dollars?? If so, it will not roll over. You might be able to use it for other things such as medicine and co-pays.

It is, except HSA's typically do rollover.

And with HSA's, you can't use that money until it's deposited. So if you contribute 100/month to the HSA and need to pay $300 in February, you can't. With Flex, it is deposited as a lump sum on Jan 1 and then expires on Dec 31 without rolling over.

Christ, see, I'm glad I asked.  I've been able to be dumb about this stuff for too long because the plan we had was very straight forward.  Thanks.

aglenn

A $1,000 deductible is not high enough to qualify for an HSA. The minimum for 2014 is $1,250 for individuals or $2,500 for family coverage.  So something is not adding up in your description.

That said, if you have a qualifying high deductible plan plus HSA, yes, the funds you don't use in your HSA roll over and are yours to keep permanently.  Also, if you have copays in the plan (whether it is an HSA or not) the majority of these are required to count toward the out of pocket limit starting in 2014 as part of health care reform.  There are certain exceptions depending on the circumstances of your plan.

ASmallWonder

GhostMonkey said:

elmoali said:

GhostMonkey said:

Nope. You will pay the following:

-Monthly Premium
-Deductible
-Co Insurance until max OOP (deductibles rarely count toward OOP max, so check your policy)
-Co pays (not included in deductible or OOP max)

@ghostmonkey Crap.  Ok, this is what our information says as far as charges: "premium" / Annual Deductible $2500 minus $1500 company contribution / Annual OOP max $5000.  Preventative care covered in full, all other office visits, specialists, surgeries, hospital admissions and ER visits are 10% our responsibility after our deductible.

Other plans specifically call out deductibles and this one does not - just the 10%. So, does that mean that the 10% is counted toward our $5000 OOP max?  If I'm understanding you correctly, if our deductible does not count toward our OOP max, we pay, at worst, our premiums, our deductible and our OOP max.  Am I still missing something?

You don't have co-pays, so that isn't an issue. Find out if your deductible applies to your OOP max. Usually it doesn't, but there are exceptions like Lois' plan. So yes, you are looking at either OOP max + deductible or just OOP max.

And are those deductibles for the family, or is that per person?

That's the family OOP max.  Thanks for your help.

ASmallWonder

aglenn said:

A $1,000 deductible is not high enough to qualify for an HSA. The minimum for 2014 is $1,250 for individuals or $2,500 for family coverage.  So something is not adding up in your description.

That said, if you have a qualifying high deductible plan plus HSA, yes, the funds you don't use in your HSA roll over and are yours to keep permanently.  Also, if you have copays in the plan (whether it is an HSA or not) the majority of these are required to count toward the out of pocket limit starting in 2014 as part of health care reform.  There are certain exceptions depending on the circumstances of your plan.

This plan is specifically called "PPO Plus Open Access with HSA."  The deductible is $2500 but the company puts $1500 into the HSA so I was saying $1000 is all that would be left for US of the total deductible.  That makes sense, right?

aglenn

Yes, if the total deductible is $2,500 then that can qualify for an HSA.  Sorry I wasn't tracking that.

Regarding copays and OOP, yes, this is mandated by ACA.  (I work in benefits consulting).  It does not apply if the plan is "grandfathered" and in certain circumstances certain copays can still be excluded next year.  For example, if the pharmacy claims are paid by a different company than the medical claims, the plan can exclude pharmacy copays from the out of pocket limit (for 2014 only).  It is a long and convoluted story, like all of ACA.

ASmallWonder

Welp, I found the catch I knew was coming.  The list of exclusions on the less expensive plan they're pushing: Allergies, CANCER, depression, lung ailments, joint and muscle ailments and coronary artery disease.  So basically we will be going with the fucking crazy expensive plan and live poor now so that we don't run the risk of being financially screwed if we ever got one of these illnesses.