BlackKnight

I'm going with Purple and will tell you how it goes...

urinmyseat

I can't believe this hasn't come up yet, so here goes!

I was once told by a doctor, that if you are doing something and it turns purple, or orange for that matter, STOP! He also said that I could go blind if I didn't stop, but that hasn't happened yet. Now where are those darn glasses?

Back to the original message.

busdriver12

What you are missing is that most people have more than two minor doctor's visits. A good guide would be to look at all your claims over the last couple of years, what was paid out? And that's what you would have paid out from your pocket, only getting reimbursement up to what's left in your account. You take a look at that, and even minor procedures can cost a buttload. However, if you're on your own, enjoy managing this stuff by yourself, and rarely go to the doctor, sounds like you'll come out well ahead.

What cloudsailor said really resonates with me: "We had to deal with receipts/reimbursements in CGN, and it was an absolute pain in the a$$. Really, it was the most challenging part of our time in the FDA. I see the potential for that huge additional workload with the CDHP, no thanks".

USMCFDX

I'm not missing that part at all. My example illustrates that with just two minor doctor visits you are already being on the Purple plan if my example is correct.

I think two visits a year is "rarely going to the doctor".

busdriver12

I agree. You come out ahead if you are on the Purple plan and you only go to the doctors office for a minor issue twice. I wish we could all be so healthy, and never have to get anything done. But it doesn't take a major emergency to come out behind, just a couple of relatively minor procedures. Health care is crazy expensive, and seemingly impossible to negotiate.

TonyC

I realize it's a little late to influence decisions, but I thought I'd add in a couple of my own observations.


First, I'm given to believe that a big selling feature of the CDHP is the ability to carry forward unused funds from the HSA or HRA. If you have a few "good years", you can "self-insure" from then on, covering the gap between the annual out-of-pocket maximum and the annual HSA or HRA contribution. The problem for my family is the minimum of 3 prescription medications we buy each month. Given that I'm on the hook for the entire cost until the deductible is met, my HSA would be wiped out by August just for those prescriptions alone. I would never have a "good year." That's before I even start adding in doctor's visits, lab tests, etc., that we already know will be needed. Add in surprises, and the fun begins.


Second, all the examples shown in videos and in descriptions above assume everything is done "IN-network." That's nice if you can plan your medical disasters to occur In network. Mr. Murphy never sees it my way. F/O Bender describes the worst case in his white-board explanation of the Purple CDHP using IN-Network numbers; I guess I should prepare for the worst-ER case. The deductible for Out-of-Network services is $10,000, and the Out-of-Pocket maximum is $18,000. That, minus the HSA and Wellness credits works out to $13,400, or an additional $1,116.67 per month. Add that to the $355.51 premium, and my worst-er case average monthly cost would be $1,472.18.


The same "worst case" math for the BuyUp plan would cost me $9,750 maximum out-of-pocket for the year, or an average of 812.50 per month. Added to the $396.43 per month premium, I'd be on the hook for an average of $1,208.93 per month, or $263.25 per month LESS than the Purple CDHP for me and my family.


I stuck with the Buy Up plan, and a Flexible Spending Account contribution to cover my anticipated costs (prescriptions, office visits, labs, vision exams, lenses, frames, dental exams). Since I don't have a CDHP, those tax-free dollars (which are all loaded on Day 1) can be used to pay my co-insurance share of everything I plan to spend next year (not just Dental and Vision). After that, I'll have to use after-tax dollars, just like it would have been at that point for a CDHP, but I'll be on the hook for a much smaller out-of-pocket maximum.






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kc10/c130

This I really what we need, an ongoing discussion over the next year and we may see people go to the new plan then. I am very happy with staying with the buy up if for nothing more than the anxiety if something goes amiss.

Oddly enough, family is usually healthy & other than broken leg, no issues in last decade. BUT, in last 2 weeks, 2 MRI's on 2 different members of family and we may be dealing w a very significant issue w another member. 10 days & 3 issues, not good but no worries with whether or not I should get a test run. I know everyone will say of course you get all test but I swear on my issue I found myself wondering "do I really need the test"? Then I remembered I it didn't matter insurance wise, I was covered in network with buy up.

Right now, Buy up=No anxiety. Maybe next go around it will be different.

dckozak

Tony, I agree, an academic discussion today and forward (for y 2017) but I do question one part of your personal equation. You mention 3 prescriptions every month. I too have a similar issue, but in my research found that mine, at least, will be covered at 100% as preventive care, not affecting the HRA/HSA. That too will be the case under Buy up. Not knowing (or asking) your situation, I would guess most continuous use of meds on a known and continuous basis would be a preventative care. YMMV


My understanding of In Network vs Out of Network regarding ER. All emergency room visits, if due to circumstances are treated as In Network. Have never put that to the test, as always went to a hospital that was "In Network" when we have gone to the ER, but thats my understanding. The premise being no one shops for health care in an emergency, as long as it is deemed truly an emergency.

TonyC

You're right, preventative care is covered 100% under any plan.

Unfortunately, ... well, you know the rest.

It's convenient that Walgreen's prints the "Your Insurance Saved You: $XXX.XX" on the packages so I could start with the total costs and apply the appropriate Co-Insurance percentages.



Ehh, my bad there. I didn't mean ER as in Emergency Room. I was making up a word that was worse than worst. Binder presented In-Network numbers as "Worst Case" in his YouTube whiteboard TA Sales pitch. My point was that Out-of-Network -- whether it be doctor visits, prescriptions, or lab tests -- are subject to a higher deductible and higher Out-of-pocket Maximum. If Ken's case is worst, the Out-of-Network is worster.

But not Worcestershire.

I'm thinking particularly of 2 kids in college on the other end of the state. I've already had one significant medical event there, and, like you said, the peace of mind that comes with knowing I don't have to (or THEY don't have to) interview health care providers before seeking urgent care is worth a few bucks to me.






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kronan

The bigger threat is In and Out of Network are exclusive

Deductibles in one don't transfer to the other