We have health insurance through my wife’s work, and previously had a platinum plan with no deductible. For next year, we are being moved to a combination of a high-deductible plan and a Section 105 Medical Expense Reimbursement Plan (MERP), which is a new one on me.
From what I can tell, on our new health insurance plan we now have a $7K individual/$14K family deductible/out of pocket max (I know these are sometimes different but they seem to be the same on this plan). However, the MERP, which is administered by yet another company separate from our health insurer, will pay for the first $10K of that deductable; that money is not deducted from her paycheck or anything, we just will have a Visa card for the MERP and they’ll pay directly to the provider. So basically as near as I can tell we have a “donut hole” situation: the MERP pays for our first $10K of medical expenses, then we pay for the next $4K, and the our insurer picks up everything after that.
Two questions on this. The first: since our health insurance plan is an HDHP, can we set up an HSA to potentially cover the $4K in that donut hole? The second is related to the first. How can we find out in advance the “retail” costs of the services we get from our insurer, so we have a sense of whether we’re going to burn through that $10K in a year or not? We have Kaiser, which means that almost everything is done in-house, so you’d think this would be simple, but it appears not. Mostly I’m trying to track down the cost of a particularly pricey migraine med by wife is on, which we now pay a $20/month copay for but I’m sure that’ll go up. Any advice on tracking this information down would be appreciated. America’s health care system remains good and cool and easy to navigate!
submitted by /u/frooboy
[link] [comments]We have health insurance through my wife’s work, and previously had a platinum plan with no deductible. For next year, we are being moved to a combination of a high-deductible plan and a Section 105 Medical Expense Reimbursement Plan (MERP), which is a new one on me. From what I can tell, on our new health insurance plan we now have a $7K individual/$14K family deductible/out of pocket max (I know these are sometimes different but they seem to be the same on this plan). However, the MERP, which is administered by yet another company separate from our health insurer, will pay for the first $10K of that deductable; that money is not deducted from her paycheck or anything, we just will have a Visa card for the MERP and they’ll pay directly to the provider. So basically as near as I can tell we have a “donut hole” situation: the MERP pays for our first $10K of medical expenses, then we pay for the next $4K, and the our insurer picks up everything after that. Two questions on this. The first: since our health insurance plan is an HDHP, can we set up an HSA to potentially cover the $4K in that donut hole? The second is related to the first. How can we find out in advance the “retail” costs of the services we get from our insurer, so we have a sense of whether we’re going to burn through that $10K in a year or not? We have Kaiser, which means that almost everything is done in-house, so you’d think this would be simple, but it appears not. Mostly I’m trying to track down the cost of a particularly pricey migraine med by wife is on, which we now pay a $20/month copay for but I’m sure that’ll go up. Any advice on tracking this information down would be appreciated. America’s health care system remains good and cool and easy to navigate! submitted by /u/frooboy [link] [comments]Read Morer/HealthInsurance