Hi all,
I recently started a new job and need to select a health plan. I’m having a hard time figuring out which one will end up being the least expensive and could use some advice. My employer offers a substantial number of options, but I’ve pretty much narrowed it down to three.
Option 1 (CDHP w/ HSA):
Monthly premium: $24
Deductible: $1400 (combined)
Out-of-pocket max: $4200 (combined)
HSA comes with $700/yr contribution before my own
Network: Regence
Co-insurance: 15% in-network | 40% participating provider (cannot be balance-billed) | 40% out-of-network (can be balance-billed)
Prescriptions: 15% after deductible (100% before)
Inpatient: Standard rates
Preventative care and drugs are covered 100% (regardless of deductible) unless OON
Massage therapy: $15 co-pay IN after deductible, 24 visits/yr
Option 2 (Classic):
Monthly premium: $110
Deductible: $250 (medical) | $100 (prescription – Tier 2 only)
Out-of-pocket max: $2000 (medical) | $2000 (prescription)
Network: Regence
Co-insurance: 15% in-network | 40% participating provider (cannot be balance-billed) | 40% out-of-network (can be balance-billed)
Prescriptions: Value Tier: Up to $10/30 days | Tier 1: Up to $25/30 days | Tier 2: Up to $75/30 days
Inpatient: $200/day IN ($600 max), 40% OON + provider charges at standard rates
Preventative care and drugs are covered 100% (regardless of deductible) unless OON
Massage therapy: $15 co-pay IN, does not count toward deductible but does count toward OOP max, 24 visits/yr
Option 3 (Value):
Monthly premium: $78
Deductible: $125 (medical) | No prescription deductible
Out-of-pocket max: $2000 (medical) | $2000 (prescription)
Network: Limited
Co-insurance: PCP visits are $0 | 15% in-network | 50% out-of-network (can be balance-billed)
Prescriptions: Value Tier: Up to $10/30 days | Tier 1: Up to $25/30 days | Tier 2: Up to $75/30 days
Inpatient: $200/day IN ($600 max), 50% OON + provider charges at standard rates
Preventative care and drugs are covered 100% (regardless of deductible) unless OON
Massage therapy: $15 co-pay IN, does not count toward deductible but does count toward OOP max, 24 visits/yr
For all plans, OON costs/co-insurance doesn’t count toward the deductible or OOP max. All plans have the same vision benefits (1 exam/year, $100 toward glasses every 2 years). My preferred clinic to receive healthcare services is in-network under all plans, as is my preferred pharmacy. For the Classic and Value plans, I have the option of funding an FSA but don’t get an external contribution. As far as I can tell, the HSA and FSA cover the same things but the HSA rolls over while I lose whatever I don’t use in my FSA. Other considerations:
I have to see a psychiatrist at least 4x/year, sometimes more. My psychiatrist is OON on my current insurance, so I pay $100/visit at the self-pay rate. I think (not 100% sure) that my psychiatrist would be in-network under the CDHP and Classic plans, but I am not sure if this would actually save me money since they might bill more to insurance.
I am on multiple prescription medications that I take daily. Two are inexpensive Tier 1 drugs, the other is a Tier 2 that costs $300-$500/month on average without insurance depending on whether or not the authorized generic is available (they will not substitute a bioequivalent generic because there is poor QC on other generics for this particular medication). The brand name is not covered by the new plan at all unless I get a PA (possible, my current Medicaid plan approved it) – in which case it will be Tier 2. The manufacturer has a discount program for up to $150 off each fill. Also, my psych wants to potentially switch me to a different drug that is not covered since it has no generic equivalent (new to market). The manufacturer of this drug has a discount program that would make it $25 a fill if I could get a PA, or $75 a fill otherwise (equivalent to Tier 2 price, anyway). I am not clear on whether or not I can use my HSA/FSA for these prescriptions if I use a discount card.
I am near-sighted and spend about $200 on a pair of glasses. I usually buy a pair every 2 years, but my vision gets worse every year so would prefer to be able to do this every year (at least lenses) especially because I don’t have a pair of backup frames. I also need prescription sunglasses which cost about the same and am overdue for a new pair.
I have a prescription for massage therapy from my ortho that I would like to use. My current insurance plan doesn’t cover massage therapy at all but I would like to max this benefit on my new insurance.
I possibly have some sort of endocrine or autoimmune disorder but no one has figured it out yet – the last doctor who saw me for it wanted to check my adrenal function but I haven’t been able to get in to see him again and it’s sort of an obscure thing to run diagnostics on so I haven’t tried to get anyone else to do it yet.
I have a bunch of other “mild” chronic conditions, like eczema and dry eye. I don’t usually need to see doctors about these but I do have expenditures related to them that I can use HSA/FSA money on.
I am a woman of child-bearing age. I don’t plan to have children, and am going to pursue sterilization. This and my birth control needs are covered 100% under the preventative care benefit on all plans.
I would like to say I’m fairly healthy but I have been to the doctor a lot this past year (worsening mystery illness symptoms 2x that led to lots of blood tests and an ECG, shoulder injury that led to an urgent care visit + ortho visit + imaging (u/s and rad) + a loooot of PT (insurance stopped paying for it), accidental pregnancy that came with a chronic UTI that I had to be seen 3x for, etc). Normally, I’d say I average like 3 clinic visits/year (for acute issues or mystery illness stuff) + maybe 2 urgent care visits (usually for an ear infection or BV). I’ve literally never been to the ER in my life (but it’s a possibility if I do have an adrenal problem) and haven’t ever broken a bone.
Obviously, managing my prescription costs is the big concern since those are guaranteed medical expenses. I’ve given this a ton of thought, as you can see, but I’m still not sure which option will be the most affordable for me so I would appreciate any advice! Thanks so much!
submitted by /u/fernxqueen
[link] [comments]Hi all, I recently started a new job and need to select a health plan. I’m having a hard time figuring out which one will end up being the least expensive and could use some advice. My employer offers a substantial number of options, but I’ve pretty much narrowed it down to three. Option 1 (CDHP w/ HSA): Monthly premium: $24 Deductible: $1400 (combined) Out-of-pocket max: $4200 (combined) HSA comes with $700/yr contribution before my own Network: Regence Co-insurance: 15% in-network | 40% participating provider (cannot be balance-billed) | 40% out-of-network (can be balance-billed) Prescriptions: 15% after deductible (100% before) Inpatient: Standard rates Preventative care and drugs are covered 100% (regardless of deductible) unless OON Massage therapy: $15 co-pay IN after deductible, 24 visits/yr Option 2 (Classic): Monthly premium: $110 Deductible: $250 (medical) | $100 (prescription – Tier 2 only) Out-of-pocket max: $2000 (medical) | $2000 (prescription) Network: Regence Co-insurance: 15% in-network | 40% participating provider (cannot be balance-billed) | 40% out-of-network (can be balance-billed) Prescriptions: Value Tier: Up to $10/30 days | Tier 1: Up to $25/30 days | Tier 2: Up to $75/30 days Inpatient: $200/day IN ($600 max), 40% OON + provider charges at standard rates Preventative care and drugs are covered 100% (regardless of deductible) unless OON Massage therapy: $15 co-pay IN, does not count toward deductible but does count toward OOP max, 24 visits/yr Option 3 (Value): Monthly premium: $78 Deductible: $125 (medical) | No prescription deductible Out-of-pocket max: $2000 (medical) | $2000 (prescription) Network: Limited Co-insurance: PCP visits are $0 | 15% in-network | 50% out-of-network (can be balance-billed) Prescriptions: Value Tier: Up to $10/30 days | Tier 1: Up to $25/30 days | Tier 2: Up to $75/30 days Inpatient: $200/day IN ($600 max), 50% OON + provider charges at standard rates Preventative care and drugs are covered 100% (regardless of deductible) unless OON Massage therapy: $15 co-pay IN, does not count toward deductible but does count toward OOP max, 24 visits/yr For all plans, OON costs/co-insurance doesn’t count toward the deductible or OOP max. All plans have the same vision benefits (1 exam/year, $100 toward glasses every 2 years). My preferred clinic to receive healthcare services is in-network under all plans, as is my preferred pharmacy. For the Classic and Value plans, I have the option of funding an FSA but don’t get an external contribution. As far as I can tell, the HSA and FSA cover the same things but the HSA rolls over while I lose whatever I don’t use in my FSA. Other considerations: I have to see a psychiatrist at least 4x/year, sometimes more. My psychiatrist is OON on my current insurance, so I pay $100/visit at the self-pay rate. I think (not 100% sure) that my psychiatrist would be in-network under the CDHP and Classic plans, but I am not sure if this would actually save me money since they might bill more to insurance. I am on multiple prescription medications that I take daily. Two are inexpensive Tier 1 drugs, the other is a Tier 2 that costs $300-$500/month on average without insurance depending on whether or not the authorized generic is available (they will not substitute a bioequivalent generic because there is poor QC on other generics for this particular medication). The brand name is not covered by the new plan at all unless I get a PA (possible, my current Medicaid plan approved it) – in which case it will be Tier 2. The manufacturer has a discount program for up to $150 off each fill. Also, my psych wants to potentially switch me to a different drug that is not covered since it has no generic equivalent (new to market). The manufacturer of this drug has a discount program that would make it $25 a fill if I could get a PA, or $75 a fill otherwise (equivalent to Tier 2 price, anyway). I am not clear on whether or not I can use my HSA/FSA for these prescriptions if I use a discount card. I am near-sighted and spend about $200 on a pair of glasses. I usually buy a pair every 2 years, but my vision gets worse every year so would prefer to be able to do this every year (at least lenses) especially because I don’t have a pair of backup frames. I also need prescription sunglasses which cost about the same and am overdue for a new pair. I have a prescription for massage therapy from my ortho that I would like to use. My current insurance plan doesn’t cover massage therapy at all but I would like to max this benefit on my new insurance. I possibly have some sort of endocrine or autoimmune disorder but no one has figured it out yet – the last doctor who saw me for it wanted to check my adrenal function but I haven’t been able to get in to see him again and it’s sort of an obscure thing to run diagnostics on so I haven’t tried to get anyone else to do it yet. I have a bunch of other “mild” chronic conditions, like eczema and dry eye. I don’t usually need to see doctors about these but I do have expenditures related to them that I can use HSA/FSA money on. I am a woman of child-bearing age. I don’t plan to have children, and am going to pursue sterilization. This and my birth control needs are covered 100% under the preventative care benefit on all plans. I would like to say I’m fairly healthy but I have been to the doctor a lot this past year (worsening mystery illness symptoms 2x that led to lots of blood tests and an ECG, shoulder injury that led to an urgent care visit + ortho visit + imaging (u/s and rad) + a loooot of PT (insurance stopped paying for it), accidental pregnancy that came with a chronic UTI that I had to be seen 3x for, etc). Normally, I’d say I average like 3 clinic visits/year (for acute issues or mystery illness stuff) + maybe 2 urgent care visits (usually for an ear infection or BV). I’ve literally never been to the ER in my life (but it’s a possibility if I do have an adrenal problem) and haven’t ever broken a bone. Obviously, managing my prescription costs is the big concern since those are guaranteed medical expenses. I’ve given this a ton of thought, as you can see, but I’m still not sure which option will be the most affordable for me so I would appreciate any advice! Thanks so much! submitted by /u/fernxqueen [link] [comments]Read Morer/HealthInsurance