Not sure how to handle high-deductible insurance... UPDATE #8

[crunchy_mommy]

My company just switched to a high-deductible insurance plan this month. It's a "consumer driven health plan" aka we pay for practically everything. I am contributing to a HSA and have a good amount of money in savings. I am trying to figure out the best approach to using this plan.

I need a lot of medical tests... "Need" actually isn't the right word, as far as I know, my life isn't in danger or anything, but I have a lot of issues that would probably benefit from proper diagnosis (suspect something autoimmune and/or neurological). I also want to get allergy testing for me & DS, I need to see the dermatologist, and DH hasn't seen a doctor in years and needs a blood workup and stuff... So basically, we really want to see some doctors and have some tests done but it is nothing life-threatening/time-sensitive really. We will have to pay 100% out of pocket until we reach our deductible.

My quality of life is pretty bad because of my health issues so common sense says to just get everything done, meet the deductible, then get the extras done if they are covered (allergy testing and whatnot) before the year is up -- I think almost everything is covered at 80-100% after we reach our deductible so we'd basically have 'free' health care for the remainder of the year.

But, here's the catch -- DH was laid off a year ago. So, for one thing, we want to keep as much in savings as possible so we have something to fall back on if he hasn't found a job before his unemployment runs out (he has at least half a year left if nothing changes). Meeting our deductible will eat up 1/4 of our emergency fund (or 4 months of mortgage payments!) The other thing to consider is that hopefully DH will find a job with benefits, and if he does, I'm sure the insurance will be much better (it can't really be worse!!) so we'd want to switch. So I would hate to 'waste' our money trying to meet the deductible only for DH to get a job next month & switch insurances or something.

WWYD?
Edited by crunchy_mommy - 2/6/12 at 9:20am

[iowaorganic]

Have you thought about sending your DH to a wellness clinic for the blood work?  I send DH in every couple of months for a lipid panel and it is $20 if you just walk into the lab.  If he went in for a physical it would be $100 for the appt and $85 for the same lab and if they make him come in to 'discuss' the results another $100 appt.  Ohhh if you want it free- apply for life insurance- you will get a free screen out of the deal with blood work and urine and everything else they want.

Some chiros will order allergy testing at independent labs for you- when my sister had it done it was all blood work and for a full panel about $150.  Try getting a prick test for $150 at an allergist.  I don't know if any of these will go towards your deductible- but it will save you a ton of money regardless.  

[erigeron]

Some pharmacies are also offering various bloodwork now. Sometimes, even if it is a chain, only one or two locations in the area will do it, so ask around, and if they say they don't do it at that location ask if any of their other locations do it. An in-store clinic staffed by an NP may also do bloodwork for cheaper, and many pharmacy and grocery-store chains have them at some locations.

Part of the principle behind a CDHP is that the company funds an account for you to use for part of the deductible. So for instance (made up numbers), say your deductible is 3k, your company funds an account for 1.5k for you to use, then when you use up that account you are on the hook for the next 1.5k, and then the plan kicks in. You didn't mention this and I wanted to make sure you're aware that this is often the case. You may have access to money you don't know about. We had a choice of two plans through DH's work, and one was a CDHP. I had to really dig for information about this work-funded account, and the only reason I knew to do said digging is because I work in health care myself and actually took a class on this stuff. We ended up not going with the CDHP, but I wonder how many people don't even know about this aspect of it.

[crunchy_mommy]

My company does contribute a small portion to my HSA (very small, certainly not close to half of the deductible!) but I had totally forgotten about that actually! I'm glad you mentioned it.

I also didn't realize you could go to clinics & pharmacies for these things, though TBH I think only DH could get away with that, but it's a good option to keep in mind. I didn't realize blood testing for allergies was so much cheaper either. Hmm. Lots of things to look into. The frustrating thing is I know when I go to the doc (once I find a new one, that is!) that they will just give me paperwork for XYZ lab that they're affiliated with so... IDK.

So maybe it makes more sense to just get whatever healthcare we need? I know we will come very close to meeting our deductible if we take care of all these things.

[34me]

Don't forget too that many of these expenses are tax deductable for next year so SAVE everything.  Do you have any health fairs in your area (you can call the local hospital)?  We have one in March every year and full blood work is only $20.  So many people do that and then take it to the doc of their choice to go over.

[laura163]

I had allergy testing at an allergist done a few months ago and it was $1500 and took 2+ hours. That included many peak flow tests, albuteral and my whole back scratched up for a scratch test.  So, don't assume $150 unless your doc confirms that price!

[iowaorganic]

I am sure blood testing though an independent lab will save you money- but you may or may not find it that cheap- my sisters was but that was a while ago.  I would call around and you will still probably have to have someone order it....  This will take leg work on your part- but that is part of the consumer driven aspect.  

The last time I walked into an allergist it was $300.  So stay away if at all possible.  What do you think you are allergic to that you really can't eliminate and try yourself?  Food you should be able to eliminate...

eta- I have found that doing a liver cleanse really makes my allergies so much easier to handle- I would try that first before shelling out any money....  Also standard process makes a supplement called Antronex that works really well to get your liver working right and makes allergies much better to deal with.  These are probably the cheapest alternatives that really are the best for your body too.

[crunchy_mommy]

OK so my DH just finally got a job!!! Which is great news in & of itself, and also means we are now eligible for "normal" insurance through his employer.

This should be a no-brainer, right? But it's not.

If we switch insurances, the premiums will cost an extra ~$475/mo. That's A LOT to me, considering DH will only be making a couple thousand more at this new job than he was receiving on Unemployment.

I looked more into our current plan and the deductible is much lower than I thought. The numbers look something like this:
$1700 yearly premiums
$3800 family deductible
after that, most things are covered at 80%
$8200 out of pocket max (after that, everything is covered at 100%)
$1000 company contribution to HSA

New insurance
$7200 yearly premiums
I'm assuming we'll have $20 copays and a deductible (probably $500 or so, DH needs to get all the specifics still).

So current plan costs us at minimum ~$1700, maximum $9700 (as long as we stay in-network).
New plan would cost us $7200 minimum, which is almost the max of the current plan!! So it almost seems like the current plan is better? Certainly not for my peace of mind (I'm likely to forego necessary doctor's visits based on the cost), but maybe for my wallet???

Am I missing something here? The new plan is definitely known as a top plan around here, so maybe I am missing a part of the equation.

I don't know if the new plan includes dental or vision. We took a year off from vision insurance this year since we got new glasses a year or two ago... And we are only paying under $300/year for dental (half that if I take DH off it if he's covered on the new plan).

For the record, $7200 is more than 20% of DH's new salary (and I make significantly less than DH). But, even if we don't do the family plan through his new job, he can at least get free individual health care for himself, which would save me $800/yr on premiums if I take him off my insurance, which means our current insurance minimum would only be $900. However, I am the one most in need of some serious medical care... DH is pretty healthy (so is DS, for that matter) so whichever insurance I'm on is going to be the most costly, unless I avoid the doctor. I avoided last year but still had around $3K in health costs for the most necessary stuff. So I could easily see needing $6-10K in health tests/treatment if I went to the doc when I should. Plus, we've been TTC for several years, if I actually got pregnant this year then we'd have lots more medical costs.

This is so confusing to figure out. It's one of those times that I wish someone could just tell me what to do... and maybe foresee the future a bit too lol. Does it all even make sense?!??!

[cristeen]

Something I don't think you've touched on - have you called your doctor and asked what you would be paying out of pocket for a visit?  I know that even with our high deductible plan, the doctor's office has an agreement with the insurance company, so I get billed $X, but a portion of that is negotiated, so I only actually have to pay $Y.  Basically, make sure that you are paying 100% out of pocket, so that you're comparing apples to apples.

Also, something you're forgetting is that premiums come out pre-tax, whereas deductible doesn't.  So you might want to recalculate those figures based on your tax bracket.  Medical costs are deductible at the end of the year if you've hit a minimum level (percentage of income, IIRC), but again, you'd have to calculate what that level is for you and the likelihood that you'd meet it in XYZ circumstances. 

I know when we went from individual plans to group plan at the beginning of the year, it was a tough call for me to make because the numbers looked so close.  I had to do all sorts of calculations to figure out whether it was worth it. 

[Mulvah]

Originally Posted by crunchy_mommy 


For the record, $7200 is more than 20% of DH's new salary (and I make significantly less than DH). But, even if we don't do the family plan through his new job, he can at least get free individual health care for himself, which would save me $800/yr on premiums if I take him off my insurance, which means our current insurance minimum would only be $900. However, I am the one most in need of some serious medical care... DH is pretty healthy (so is DS, for that matter) so whichever insurance I'm on is going to be the most costly, unless I avoid the doctor. I avoided last year but still had around $3K in health costs for the most necessary stuff. So I could easily see needing $6-10K in health tests/treatment if I went to the doc when I should. Plus, we've been TTC for several years, if I actually got pregnant this year then we'd have lots more medical costs.
This is so confusing to figure out. It's one of those times that I wish someone could just tell me what to do... and maybe foresee the future a bit too lol. Does it all even make sense?!??!

First of all, congrats to you and your husband on the new job! 

If your husband is getting completely free health insurance through his company, take him off your plan once his plan starts. From there, if I were you, I would stick with the plan you have.  If his plan is going to cost $7200 in just premiums, you are probably going to have to pay co-pays and possibly a deductible (even a low one, at $500, pushes up your total).  Overall it sounds like you are best to stay with your health insurance, especially if your DH can get onto his plan for free. 

I'm not sure what you're expecting your health issues to be, but you may be surprised that your expenses aren't as high as you think.  Then again, I know that one hospital visit can be $100K.  That said, you really should have your health evaluated if you suspect you have an issue.  I know it's easy for me to say, but one thing I have learned (the hard way) is that the longer you wait, the worse and costlier the problem can be.  If you do have an issue, it is likely your expenses could be high this year, in trying to determine the problem, but that they would taper off as you are treated, even if that treatment goes beyond this year. 

Anyway, down to the nitty gritty - you're looking at tax benefits with your current plan and you're also looking at a lower cost potential, overall.  If I understand how you've laid things out, your plan will cost you $8100 max (without your DH on it) and your DH's plan will cost you $7200 min + potential copays and deductible(s).  I would pick your plan, hands down.

Sorry for the disjointed reply; I've done about 800 things in between replying to this.

[JPiper]

Hi There~

Congrats on the new job!  I don't pretend to know everything about insurance, but I do have some experience using a high deductible plan.  After much research, my family -- 2 adults, 3 kids-- have used a HD plan for the last 2 years, and for us it has worked remarkably well.  It has allowed me to quit a corporate job to become self employed.  By severing the dependence on a "real job" for health insurance, our family's quality of life and stress level has improved by SOOO much!

Certainly all HD plans are different.  We have an annual ind. deductible of $2700 and a family deductible of $5200.  After meeting deductibles we are 100% covered.  Well visits for children are 100% covered, and 1 physical per year for adults is covered in full.  Screening tests/exams, such as mammograms, pap tests etc.. are covered @ 100% according to a set schedule.  I found that specialist visits have been between $50-150 per visit (this includes cost of co-pay).  We definitely pay less than our previous monthly premium of $750, plus co-pays between $25-40 per visit.  We do not have prescription or vision care, but our pharmacy offers a very reasonable plan for assistance with prescriptions.  Sometimes we need to negotiate the prescribed drug to get a reasonable cost, but so far we have not sacrificed care-- just a bit of time to advocate for a drug that will do the job and is affordable.  My husband sees a specialist and family Dr. 3-4 X per year, and my kids get well visits as usual, with my son seeing 2 specialists 3-4 X per year.  The couple of sick/urgent care visits have averaged $75, and fortunately have not happened often.

We made the decision to switch to a HD plan based on our overall good health, our ability to cover up to the full deductible if necessary, and the fact that some of the major health costs for us were done with at this stage of the game-- ie.) done with maternity/child birth/vasectomy/birth control.  I was able to quit a regular job and, as a result, reduce the need for childcare which also helped our reduce our overall monthly costs.

When we have a scheduled visit, I am MUCH more pro active about calling ahead to determine exactly what services we are needing and will be paying for.  The billing department people are not always helpful, but if you are polite and persistent, you CAN get answers.  When at all possible,  I get the actual medical billing codes from the Dr's office and I check with insurance PRIOR to the visit.  It does take a bit of time, but it has been worth it to make sure we are not getting unnecessary tests/procedures.  I have been proactive about questioning care/treatment instead of just going along with whatever the experts say.  I have found that if when I question, they almost always immediately reduce the suggested treatment or services, and then are able to focus on/explain the rationale of the rest of the treatment.  I have approached these conversations having done some research (when possible) and with respect for the practitioner's expertise, and have found the explanations of of what/why/how to be beneficial for overall understanding/ treatment AND the bottom line!

OP-- are you able to get some of these diagnostic tests done before you have to switch coverage?  

From my understanding, and in my state (NY) it is important not to have a lapse in coverage b/c then all kinds of 'pre-existing' condition issues CAN surface.

Good Luck with sorting all of these plans/scenarios out.  I think you are on the right track to make a smart, informed decision!

[shoes]

I have a plan similar to yours and something to consider that I just found out- 

My daughter has a serious heart defect and sees her cardiologist twice a year.  Her checkup bill is right at $3000!!!!! (This is with us payin 100%)  BUT- On large bills, if I pay in full (and I do because we put money in the HSA with each pay check) the hospital gives up an automatic 25% discount!  Our insurance "credits" out deductable as if we've paid all 3 grand, even though it didn't actually cost us this much.  So by the end of the year where we should have hit our $6000 out of pocket, we actually have paid less than $5000.  Pretty cool, huh?  I had never been offered this on our old insurance.  Maybe becuase her check up "only" cost between $700-1200 (depending on if we hit our deductable yet)? 

Also, I believe her medication counts toward out max out of pocket.  And since there are no copays, I essentially save that $20-40 each time anyone has to go to the doctor, because the copays don't count in the other plan.

With our plan, vision is included but dental is separate.  You should check with yours though.  It could make a big difference.

We actually really like our insurance now!  Good luck with your decision!

[wendyland]

Originally Posted by cristeen 

Something I don't think you've touched on - have you called your doctor and asked what you would be paying out of pocket for a visit?  I know that even with our high deductible plan, the doctor's office has an agreement with the insurance company, so I get billed $X, but a portion of that is negotiated, so I only actually have to pay $Y.  Basically, make sure that you are paying 100% out of pocket, so that you're comparing apples to apples.

Also, something you're forgetting is that premiums come out pre-tax, whereas deductible doesn't.  So you might want to recalculate those figures based on your tax bracket.  Medical costs are deductible at the end of the year if you've hit a minimum level (percentage of income, IIRC), but again, you'd have to calculate what that level is for you and the likelihood that you'd meet it in XYZ circumstances. 

I know when we went from individual plans to group plan at the beginning of the year, it was a tough call for me to make because the numbers looked so close.  I had to do all sorts of calculations to figure out whether it was worth it. 

I have this type of insurance.  I had like $1600 dollars worth of blood tests last year (which told me nothing but I'm low in vit d) and I only had to pay $140 out of pocket because the insurance company still has negotiated prices.  The only year I actually met the deductible was the year I had my daughter.  I actually like having the high deductible plan.  It has saved us money.  

[Super~Single~Mama]

The other concern that I would have, is whose employment (and therefore insurance) is more stable. I think (if I remember right) that you have said elsewhere that you don't know how long you will be at your current job, since when your project ends you may be let go.

If that is the case, you need to find out when open enrollment is at your DH's job so that you know when you will be able to get on his insurance in the case you lose the insurance you have now. Most places, its in January. I work at a university so its in October for me (don't ask why, I have no clue).

It's a tough call, but you might also look and see if his employer has Flex Spending Accounts (which are max $5,000/year but its all pre-tax). I only put $500 in mine this year, because I didn't anticipate needing more than that - turns out I needed 2 wisdom teeth extracted but my insurance covered most of it, and I was left with $160 out of pocket (above the FSA).

I'm certainly no expert - but more than anything you need to make sure that your insurance doesn't lapse.

[crunchy_mommy]

Thanks for all the thoughts!! SuperSingleMama, you are right that my job is a bit unstable but I should have a while hopefully. I believe we can add/subtract people from either plan (I know we can from mine, I should verify with DH's) at any time during the year, as long as we have a qualifying life change -- and loss of other insurance would qualify. But I will verify that to make sure!!

I'm still waiting on the details of the new plan but I'm pretty sure DS & I will end up staying on our current plan, and DH will go on the new one. I just need to force myself to still go to the doctor!