Opinions about high-deductible health insurance plans?

[piglet1979]

We had one for awhile through DH's work. We opted out of my standard on with my work because at the time we got $250 for not taking the insurance. It started out good as his company put about half of the deductible in our HSA. Each year they lowed the amount until now it is nothing. When my work dropped the incentive the kids and I switched to mine and DH stays on his.

It works for him since he really needs to be on his death bed before he will go to the doctor. For the kids and I the standard plan I feel is better. When we were on the high deductible plan I spent a lot of time calling to different pharmacies to get the lowest cost and then I had prescriptions at several different places. My kids were still young and getting sick often and I was having lots of intestinal issues too. I had payment plans with several places. I feel like I was always on the phone dealing with this stuff. I was also for myself not going to the doctor when I should or going to the CVS minute clinic because it was cheaper. I hated it.

I am still on the standard plan at my work but we have an option to do a high detectable. We will get about half of the detectable from work in a HSA and then when we hit the deductible the plan pays 100%. I just can't switch to deal with it again.

 

[barkley]

Pay attention to the out of pocket maximum on any plan you're considering. No matter what the deductible is, that's your true worst-case scenario.

also keep in mind that it's generally an out of pocket maximum on a PLAN YEAR BASIS so in the best worst case scenario everything happens and is resolved within an individual plan year so you take the financial hit, ideally with that dollar amount you've socked away to meet that max amount and it's taken care of. in reality illnesses, injuries and treatments aren't driven by plan year calendars so those monthly premium savings can be negated over the course of a few months depending on the onset/your plan year. some people are fortunate enough to be able to change plans mid treatment when an open enrollment occurs so that they can opt to pay that higher monthly premium and save on oop expenses BUT keep in mind that not all plans an employer offers nesc. contracts with all doctors/providers so going for that option can mean losing your treatment team and having to reestablish with an entirely new set of providers.

 

[Klayfish]

I love mine. I have some very expensive medicines, something like $5000/month or more. One of the drug makers offers me deductible assistance, so at the beginning of the year when I reorder my medicine, I pay $5 out of pocket due to that assistance. However, the full price of the medicine counts toward my deductible. Win for me.

 

[ctinct]

I’ve been using one for several years now. I don’t actually use it, though, because my medical costs have been very low. I pay out of pocket, keep the receipts, and plan to reimburse myself later. You can reimburse yourself 20years later , if you want. The advantage is this: I put in money into my HSA account every pay period. Offhand, I forget what the max allowable is per year. This money is pretax. My plan has investment choices, so when I build up a decent amount, I transfer the money to my investments. All the growth is also tax free. Then, when I ultimately do reimburse myself, that will also be tax free. In reality, I will probably use the money to help with Medicare costs. The HSA ends up being triple tax advantaged.

Most people don’t realize you can do this. In fact, when the plans were first being offered to us, my employer had people come in to give a presentation and info session. I asked about the investment piece of it. The woman had no clue what I was talking about! It was there, I just had to search on my company’s website.

 

[mjkacmom]

It’s well worth it to my unlucky family of 7, we usually hit the $7000 by May with medications, regular visits, surgeries, hospital stays, ambulance rides... I think we racked up close to $100,000 this year already. Ds15 keeps getting letters from our insurance company to get in touch with their wellness specialist so they can help him with a better lifestyle (he had a bad broken ankle requiring an ambulance ride to a trauma center and surgery a couple of years ago, surgery on it the following year, appendicitis this year...). All but DH has been to the ER at least once, and ridden in ambulances. Dd15 will be having surgery next year, ds20 wisdom teeth removal.

 

[morgan98]

I have continued with my company's PPO which is basically a "cadillac" plan. We have a high deductible option at work, but for now I am sticking to my PPO. Even after adding my husband to the plan, we still feel the monthly premiums are worth it, given the very, very low out of pocket costs (even for worse case scenario). There may be a point where we give it up and have to switch.

One of the benefits in working in my industry is we have a HUGE young, healthy workforce that allows us to keep insurance costs down. Even though I am not one of the young ones any longer...lol! I still take advantage of the firm offering this plan.

 

[MrsJackSparrow4Life]

The high deductible plan through my work works out really well for us.

The deductible is only $2600 (so not super high) and my employer adds $1300 to the HSA each year, basically covering half of the deductible. I did the math and the cost difference between the high deductible plan and the regular PPO plan was actually more than $1300 so it didn’t make sense to pay more plus have copays in the end.

The HD plan has 100% coverage for preventative, the $1300 put in the HSA rolls over if I don’t use it and since I work for a hospital any hospital bills are cover 100% once the deductible has been met.

I didn’t have to pay a penny of my personal money when my daughter had her tonsils out at 12 since I had enough in the HSA to cover the deductible. Same thing for her ER visit last year when she had a reaction to peanuts.

If we had severe chronic conditions, the other plans might make more sense but as we don’t the HD plan is best for us.

 

[dhardawa]

Yeah, the insurance companies know from the stats how much they are going to have to pay out, and base premiums on that number.
What drives their costs up are the cost of processing lots of small claims. That is the unpredictable portion of their cost that they try and cut down by offering the higher deductible plans with lower rates.

I work for an insurance company and the cost to process claims is negligible. Almost all are processed in an automated fashion, so it doesn’t really matter how many come in.

 

[tvguy]

I work for an insurance company and the cost to process claims is negligible. Almost all are processed in an automated fashion, so it doesn’t really matter how many come in.

Interesting. Not what our Corporate Insurance Coordinator told us.

 

[StacyStrong]

I'm young and healthy so I'm in a high deductible plan. I pay less than 100 a month out of pocket as I'm single.

If I decide I want to have a family (or as I age), I might have to revisit.

I contribute to my HSA as well.

 

[PatMcDuck]

It would scare the heck out of me to have one of these plans. You can be perfectly healthy and then suddenly, you aren't. I know, that is the devil of all insurance decisions.

Our case was daughter was 14, HS freshmen, athlete, rarely rarely sick. Then, BOOM. Critically ill, ICU for weeks, dialysis, chemo (but it was not cancer thank god), multiple hospitalizations, more ICU, complications and many surgeries over the next 4 years. NO WARNING that our world was about to explode. Well over $1 million in medical bills. (If I gave the details of those 4 years you would not even believe it.)

But sometimes, it is the best or only option of course. I understand the situation, and why many buy these plans. Luckily, we did not, lol. (it was union health coverage, we paid almost nothing for all those bills)

 

[AquamarineSteph]

Last year our employer's plan only offered one plan. One. The OOP for two of us came to $10,000. Unfortunately, I required emergency surgery. So that was $10,000 I had to find right away.

This year the employer offered multiple plans. They included the one previously referenced, although the OOP for two people is now $13,000. We decided to go with the higher premium, WAY lower deductible/OOP.

At the end of the day, it's all about how lucky do you feel. If something unexpected happens, can you meet the deductible/OOP of the lower cost plan? Do both plans cover the same costs, even at different levels? (ER? Hospital stay? MD visits? Prescription drugs?)


If yes, then go with the cheaper option. If nothing happens, it's all good. It's when the unexpected arrives at your doorstep that you find yourself in a bit of a sticky issue with the lower cost/potentially lower coverage plans.

 

[adamak]

In general, HDP works well if you have a large family, high end OR lowest end of medical bills. Aka if you have super healthy or chronic illness. And when OOP amount isn't super high.

 

[bianca]

We've had a HD plan for about 8 years. We've only met the deductible once the year I had my hip replaced. Other than that, it's just been routine blood work. My DH turns 60 this year and I know bigger things are on the horizon. My only dislike is that I feel they keep moving the goalpost. Every year the deductible amount goes up. It's currently $5,800 just for the 2 of us.

 

[DVCKev]

Hi deductable plans are great until you actually get sick and need to use one.

 

[Darcy03231]

Hi deductable plans are great until you actually get sick and need to use one.

A woman I work with is going through this now. She opted for the high deductible plan so she has to pay the first $6,000 and then 30% after that. Max OOP is $12,000. She had to have emergency surgery and has no idea how she's going to pay her medical bills.

I opted for the higher premium plan and have to pay the first $3000 and then 10% after than. Max OOP is $6000.

 

[meriface11]

When my last company started to offer them, I was afraid to do it because I didn’t have enough money saved up in case I had to pay the deductible. So I saved up money for a year and then took the plunge. It worked out great for us. We maxed out our HSA every year, luckily had very few medical bills, and leveraged the investment option. We saved up over $30k in the HSA while spending very little in premiums while I had the plan. With a different employer, I no longer have a high deductible option and I miss it. Now we just pay premiums with little in return as we are relatively healthy.

 

[Patches Lee]

My employer switched to high deductible 6 years ago. Options are $5000 deductible at $48/week for family $3000 deductible individual with 10k out of pocket minimum. Or $8000 deductible at @25/week family $5000 individual deductible with 15k out of pocket. Both pay 80%. To get those premiums we have to reach a certain level on Virgin Health Miles which means wearing pedometers, getting health screening once a year, ect to reach their goal. If you don't then pay an extra $600 in premiums a year. They have slowly had less ways to earn towards the goal and this year I've barely made it. Also have an HSA which the company contributes $1000 a year for single people or $2000 a year for families. They stop contributing to it if you make over 38k a year though which I passed in 2017 by $200 FOR THE YEAR BEFORE TAXES so took a $1800 loss there unless I take a lower paying role. I have to have screening for glaucoma twice a year which racks up $800 each time but isn't covered so all out of pocket. Vision is included for yearly screening and $200 towards glasses or contacts not both. Since I am almost blind glasses cost me around $500 each time, so I only get new ones maybe every 3 years. In the whole time of having it the only other things we have had is yearly checkups and the occasional doctor visit which doesn't even come close to the lower deductible. For us putting the money saved by paying the cheaper premium and putting the difference in the HSA makes sense. The hoops we have to jump through to get the lower premium is a whole other monster in itself. Also DH asthma medication has had to be switched 3 times cause they change coverage.

 

[kathy884]

I've been on a high deductible plan for several years now and have been putting what I have saved in premiums into an HSA. My deductible is $3000 pp and my OOP max is $6000 (if I go in network which I always try to do). I now have about $7000 in the HSA, so it has worked pretty well for me. Where it hurts is if you have something fairly expensive that you go to the doctor for regularly. That's not us, but that could be a situation where a traditional plan might be better. If that's the case, estimate medical expenses and do the math.

It's wonderful, though, that HSA money is pretax vs. post tax (another substantial savings depending on your tax bracket). Also, HSA monies can be used for a spouses medical expenses too. My company really charges high premiums for the non high deductible plan, making the high deductible plan with HSA look way more attractive in my particular circumstances.

You really, though, need to have emergency reserves in mind until your HSA has grown to a certain point, etc.

 

[smadath]

My DH's employer switched to high deductible plans 5 years ago. That is all they offer. We put the max in the HSA from the first year. DH became ill, but no one knew what was wrong with him. We visited every specialist, and were still ok with the high deductible plan because everyone was in network. Then he was diagnosed, and the specialist we needed to see was not in network. We had a $6000 in network deductible, which we hit early every year until then between the two of us. But now, his specialist had a separate out of network $6000 deductible. So, we didn't hit either. Also, in 2017, he ended up needing to get IV treatments twice a week for 3 months. Didn't hit the $6000 until the end of November. There went the entire HSA buildup. So, basically, for the last 2 years we paid everything out of pocket because we just missed the deductible, and now we have no cushion in the HSA.

So, the high deductible plans are great unless someone suddenly becomes ill, there aren't many specialists in the field, and you're forced outside of the network. Then it gets pricey very fast!

This year, I'm going to check out options outside of his employer, while I can still get something that accepts preexisting conditions. Just in case.