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Old 03-20-2022 | 10:34 AM
  #21  
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Originally Posted by Nantonaku
One thing that you failed to account for with the non-DPMP plans is that the company can and has changed the plan details mid year and essentially raised the rates by $200 a month. If the company wants you to get a medical procedure and you don’t get it they can at their discretion decide they want to essentially raise your rates. They are still to this day charging a certain group of people an extra $2400 a year. And nothing says they can’t raise that or instate other fines for whatever they want. This adds extra value to the DPMP plan that you can’t quantify and can’t predict.
I would also add that being contractual, there is a robust appeals process through the R&I Committee.
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Old 03-20-2022 | 11:34 AM
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Originally Posted by tennisguru
I've posted this before, and decided to save what I wrote since this same topic comes up several times throughout the year and warrants re-posting:

Note: All comparisons are for family coverage

Silver HSA:
Yearly premiums: $1,392
Out-of-Pocket Maximum: $13,100
Delta HSA Funding: -$2,200
Maximum financial cost for the year: $12292

Gold HSA:
Yearly premiums: $3,828
Out-of-Pocket Maximum: $7,800
Delta HSA Funding: -$2,200
Maximum financial cost for the year: $9,428

NOTE: The biggest difference in coverage between the gold and silver plans is the gold plan only has a single family deductible of $2,800, while the silver has $2,800 individual and $8,100 family max. If you know you are going to have more than 1 person hit the $2,800 deductible, then the gold plan makes more sense. The silver is guaranteed to save $2,436 on premiums, but you are betting that during the year no more than one person will hit the individual deductible in order to actually save money over being on the gold plan. As long as no more than one person hits the $2,800 deductible then the silver plan will save you money. Whether the risk is worth the $2,436 in premium savings is up to you to decide.

DPMP:
Yearly premiums: $8,016
Out-of-Pocket Maximum: $7,700-12,700 (I’m not sure why there’s a range). Rx has a separate max
Maximum financial cost for the year: $15,716-20,716, not counting Rx co-pays

So as you can see the DPMP premiums alone are only $1,412 less than the absolute worst case yearly spend on the gold HSA plan. The $350 ind/$700 max deductible on the DPMP closes that gap even more, if you are a heavy user the DPMP has a $2,000 ind/$4,000 max co-insurance requirement, so again you’re already spending more on the DPMP than anyone would spend yearly on the gold HSA. Plus you don’t get any of the tax benefits of an HSA (covered below) under the DPMP.

So who benefits from the DPMP? Two types of people:

A family where one or more people are on expensive prescription drugs where using the Rx copay of the DPMP saves significant money over paying out of pocket on the HSA plans.

A family who for whatever reason needs to use out-of-network providers. You will get drilled on the HSA for out-of-network care, but the DPMP has full coverage regardless of network status. If you have no choice but to go out-of-network, use the DPMP.

Tax benefits of an HSA:

Besides the cost savings of the gold and silver HSA plans (even for heavy medical users) the other major benefit of an HSA plan is the ability to contribute and invest in your HSA which allows for double-tax-advantaging your money. At the most basic level, all money contributed to your HSA is tax-deductible on the front end, and you can then immediately use those contributions to cover medical expenses. However, the best use of your HSA is to contribute the yearly maximum each year and never touch the money until retirement. Once the money is in your HSA you can invest it in mutual funds either through Optum, or you can roll the money to an outside HSA administrator (Fidelity is a popular option) and invest in practically anything they have to offer. The best part is that all growth on your money is tax-free if used to cover medical expenses. Hence the double-tax-savings, tax free in and tax free out. If you start your HSA at 35 and max it out for 30 years, at a 10% rate of return that’ll be roughly 1.25 million dollars. And every penny of that balance can be used to cover all sorts of medical expenses in retirement with absolutely zero taxes on it. If you so desire after age 65 the HSA also acts like another traditional retirement account where you can take money out for non-medical reasons and just pay the deferred taxes on it.

The other things to note is that there is no time limit for reimbursing yourself from your HSA for medical expenses. So, over many decades you pay all your medical expenses out of your own pocket and not your HSA, all while letting your HSA money grow in investments. Then 30+ years later (save all your receipts!) you can reimburse yourself for expenses paid years and years ago after the money has grown for you tax free. For example, say you’re 35 and have a $1,000 medical bill. If you just pay that bill out of your HSA you can, but if you have the cash to pay the bill out of your pocket and keep the money in your HSA that is the way to go. If that $1000 grows for 30 years @ 10%, it’ll turn into ~$17,000. Then at age 65 you reimburse yourself for your $1000 expense from 30 years ago, and you get to keep the additional $16,000 in growth to be used tax free on future medical expenses.
excellent post. I just expand on the “expensive prescriptions” portion of who benefits from DPMP. My wife needed fertility drugs. DPMP saved me well over $10,000. If you or your significant other find yourself in that situation, it is very beneficial to use the DPMP.
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Old 03-20-2022 | 11:50 AM
  #23  
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Can somebody expand on the prescription drug thing? We’ve been fortunate enough not to go there yet so my impression was always that once you hit oop max you were covered, even for expensive drugs?

Is this not necessarily the case for the HSA plans? How does drug coverage differ on dpmp?
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Old 03-20-2022 | 12:39 PM
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Originally Posted by Nantonaku
If the company wants you to get a medical procedure and you don’t get it they can at their discretion decide they want to essentially raise your rates.
Without delving into the predictable talking points about "the thing" in question, this process is a huge problem. IMO we need language in the CBA to say that says if the company unilaterally raises plan costs mid-year then that should generate a new open enrollment window.

Even if someone was in favor of the rationale behind the higher premiums, that process exposed a huge vulnerability in our coverage as a whole. What they did to some this time over one thing, they can do to all next time for no specific reason.

If the company is going to raise rates mid year, after we have locked in our choices, for any reason, then all pilots should have a new open enrollment opportunity to go to the pilot plan (or any other tier of the existing other plans) if they so choose.
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Old 03-20-2022 | 12:47 PM
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Originally Posted by Vsop
excellent post. I just expand on the “expensive prescriptions” portion of who benefits from DPMP. My wife needed fertility drugs. DPMP saved me well over $10,000. If you or your significant other find yourself in that situation, it is very beneficial to use the DPMP.
Another overlooked thing is that the main purpose of insurance is to cover the unexpected. While DPMP is better for known out of network, many may think that can't apply to them because they're in network. Until they're not...even when you think you're in network you can be out of network. We've all heard the horror stories of stereotypical out of network anesthesiologists slamming people with life wrecking bills. Medical billing is a swamp so murky people go to school just to learn how to do it.

Us thinking we can always navigate all that by reading a leaflet once a year and then trusting "the system" to be honest, forthright and transparent is like flying VFR solo cross country with foggles on. It always works out. Until that one time it doesn't.
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Old 03-20-2022 | 01:24 PM
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Originally Posted by Vsop
excellent post. I just expand on the “expensive prescriptions” portion of who benefits from DPMP. My wife needed fertility drugs. DPMP saved me well over $10,000. If you or your significant other find yourself in that situation, it is very beneficial to use the DPMP.
I’m glad you got those savings!

What people sometimes forget is that they’re only ~12 months maximum (and often much less) from changing over to DPMP. There’s a break even point where even if you’re stuck paying surprise prescription charges toward the end of the year, you still made out ahead by having HSA deposits and Silver HSA premiums for the whole year. If you KNOW you have prescriptions that do better under DPMP, of course go for it. But hedging against the POSSIBILITY of large bills lasting long enough throughout the benefit year to offset the huge DPMP premiums is pretty expensive. Do that for a few years with no surprises arising and you’ve spent a buttload of money you’ll never get back.
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Old 03-20-2022 | 06:17 PM
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Originally Posted by gloopy
Another overlooked thing is that the main purpose of insurance is to cover the unexpected. While DPMP is better for known out of network, many may think that can't apply to them because they're in network. Until they're not...even when you think you're in network you can be out of network. We've all heard the horror stories of stereotypical out of network anesthesiologists slamming people with life wrecking bills. Medical billing is a swamp so murky people go to school just to learn how to do it.

Us thinking we can always navigate all that by reading a leaflet once a year and then trusting "the system" to be honest, forthright and transparent is like flying VFR solo cross country with foggles on. It always works out. Until that one time it doesn't.
Not to mention that we pick once a year. The Mayo Clinic in JAX will vacillate (sometimes in the same year) as to wether they will accept TRICARE (which is really medicare rates) for insurance. So I've had reasons in the past to have a family member seen there and once they took it, then they didn't and lately since the pandemic, it's back on. It all amounts to the patient load they can keep that pay full freight or much closer to it than the govt does.
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