CDHP vs PPO, likely to hit OOP maximum on either plan

I’ve had PPO plans for several years. My yearly costs are high and will likely continue to be. 36M, single, NY.

This year my company’s CDHP plan premiums are going up 9% and the PPO premiums are going up 29%. I’m wondering if that tilts the scales toward CDHP.

CDHP: $580 yearly premium. $2000 deductible, $4000 OOP maximum. Company seeds HSA $700 spread over 26 paychecks. I could contribute up to $2900 pretax money to the HSA to hit the IRS $3600 maximum.

PPO: $3000 yearly premium. $500 deductible, $2500 OOP maximum. Company funds a $500 HRA.

CDHP premiums are $2400 lower. Factoring HSA/HRA company seeds, my OOP would be $1300 higher with CDHP (3300 vs 2000).

I am administered an expensive drug via IV (Remicade) once every four weeks. I’ve had the PPO for several years- the first treatment hits the $500 deductible, which uses up the $500 HRA. After that the treatments and office visits chip away at the $2500 OOP. I usually hit that in the third quarter. I make use of the drug maker’s patient assistance program- that reduces my drug cost to $5, but because it’s an IV administered at an office my PPO OOP for each treatment is around $350.

If I were to choose CDHP I am allowed to change contributions during 2022. I would pull $500 from each of my first 5 paychecks to HSA, then drop to a number that gets me to the IRS maximum by year end. The Jan/Feb treatments, billed in Mar/Apr, would drain my early HSA contributions plus about $1000, but they’d hit deductible and OOP maximum. The rest of the year will be fully covered. The company HSA contributions throughout the rest of the year give 2023 a head start.

CDHP premiums $2400 less than PPO. CDHP OOP $1300 more than PPO, though a lot of that would have HSA tax advantages. I’m leaning CDHP. Is my thinking right here? Thanks for your input.

submitted by /u/AwixaManifest
[link] [comments]I’ve had PPO plans for several years. My yearly costs are high and will likely continue to be. 36M, single, NY. This year my company’s CDHP plan premiums are going up 9% and the PPO premiums are going up 29%. I’m wondering if that tilts the scales toward CDHP. CDHP: $580 yearly premium. $2000 deductible, $4000 OOP maximum. Company seeds HSA $700 spread over 26 paychecks. I could contribute up to $2900 pretax money to the HSA to hit the IRS $3600 maximum. PPO: $3000 yearly premium. $500 deductible, $2500 OOP maximum. Company funds a $500 HRA. CDHP premiums are $2400 lower. Factoring HSA/HRA company seeds, my OOP would be $1300 higher with CDHP (3300 vs 2000). I am administered an expensive drug via IV (Remicade) once every four weeks. I’ve had the PPO for several years- the first treatment hits the $500 deductible, which uses up the $500 HRA. After that the treatments and office visits chip away at the $2500 OOP. I usually hit that in the third quarter. I make use of the drug maker’s patient assistance program- that reduces my drug cost to $5, but because it’s an IV administered at an office my PPO OOP for each treatment is around $350. If I were to choose CDHP I am allowed to change contributions during 2022. I would pull $500 from each of my first 5 paychecks to HSA, then drop to a number that gets me to the IRS maximum by year end. The Jan/Feb treatments, billed in Mar/Apr, would drain my early HSA contributions plus about $1000, but they’d hit deductible and OOP maximum. The rest of the year will be fully covered. The company HSA contributions throughout the rest of the year give 2023 a head start. CDHP premiums $2400 less than PPO. CDHP OOP $1300 more than PPO, though a lot of that would have HSA tax advantages. I’m leaning CDHP. Is my thinking right here? Thanks for your input. submitted by /u/AwixaManifest [link] [comments]Read Morer/HealthInsurance

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