Hello, I am hoping somebody can assist with my medical insurance question as I am not the greatest at understanding the system. I was under the belief that HSA (HDHP) health plans typically have cheaper premiums, but a higher deductible and out-of-pocket max. However, my employer offers both plans at the same deductible and OOPM, but the HSA plan with cheaper premiums. The breakdown of coverage follows (sorry for the formatting):
PPO PLAN COSTS Deductible $4000 Out of Pocket Max $5000 Coinsurance 20% Primary Care Visits $20 copay Preventative Care No charge Specialist Care $40 copay Inpatient Visit 20% after deductible Outpatient Services 20% after deductible Emergency Room $300 copay Urgent Care $75 copay HSA PLAN COSTS Deductible $4000 Out of Pocket Max $5000 Coinsurance 0% Primary Care Visits 0% coinsurance Preventative Care No charge Specialist Care 0% coinsurance Inpatient Visit 0% coinsurance Outpatient Services 0% coinsurance Emergency Room 0% coinsurance Urgent Care 0% coinsurance
Like I said, I am not an expert on health insurance. However, my gut feeling is that the HSA plan is a clearly better plan. The premiums are lower but they have the same deductible. The coinsurances are also zero, which unless I’m missing something, would be better to pay zero than 20% after the deductible? I guess my questions are the following:
What happens before the deductible? I have always been under the assumption that no benefits apply until the deductible has been met, so with the HSA plan that means I pay the full (negotiated) costs until the deductible kicks in. But what about the PPO plan? Do I pay the copay before the deductible has been met, or am I responsible for the full costs and only pay the copay amount after the deductible has been met?
If the HSA plan has 0% coinsurance (I pay 0% of the costs after the deductible has been met), then what is the difference between the deductible and out-of-pocket max? I understand the plan only covers “covered” services, but still, what would be the difference?
Typically I hit the deductible for my plan every year and have a lot of medical expenses each year. I just feel like I am not understanding which plan would be better for me. It’s very possible I do not understand everything, but it just seems like the HSA plan would be a clear-cut choice for anyone due to the reduced premiums, the ability to open an HSA, and having better coinsurance that kicks in with the same deductible. Please help, thank you.
submitted by /u/rentAbuddy
[link] [comments]Hello, I am hoping somebody can assist with my medical insurance question as I am not the greatest at understanding the system. I was under the belief that HSA (HDHP) health plans typically have cheaper premiums, but a higher deductible and out-of-pocket max. However, my employer offers both plans at the same deductible and OOPM, but the HSA plan with cheaper premiums. The breakdown of coverage follows (sorry for the formatting): PPO PLAN COSTS Deductible $4000 Out of Pocket Max $5000 Coinsurance 20% Primary Care Visits $20 copay Preventative Care No charge Specialist Care $40 copay Inpatient Visit 20% after deductible Outpatient Services 20% after deductible Emergency Room $300 copay Urgent Care $75 copay HSA PLAN COSTS Deductible $4000 Out of Pocket Max $5000 Coinsurance 0% Primary Care Visits 0% coinsurance Preventative Care No charge Specialist Care 0% coinsurance Inpatient Visit 0% coinsurance Outpatient Services 0% coinsurance Emergency Room 0% coinsurance Urgent Care 0% coinsurance Like I said, I am not an expert on health insurance. However, my gut feeling is that the HSA plan is a clearly better plan. The premiums are lower but they have the same deductible. The coinsurances are also zero, which unless I’m missing something, would be better to pay zero than 20% after the deductible? I guess my questions are the following: What happens before the deductible? I have always been under the assumption that no benefits apply until the deductible has been met, so with the HSA plan that means I pay the full (negotiated) costs until the deductible kicks in. But what about the PPO plan? Do I pay the copay before the deductible has been met, or am I responsible for the full costs and only pay the copay amount after the deductible has been met? If the HSA plan has 0% coinsurance (I pay 0% of the costs after the deductible has been met), then what is the difference between the deductible and out-of-pocket max? I understand the plan only covers “covered” services, but still, what would be the difference? Typically I hit the deductible for my plan every year and have a lot of medical expenses each year. I just feel like I am not understanding which plan would be better for me. It’s very possible I do not understand everything, but it just seems like the HSA plan would be a clear-cut choice for anyone due to the reduced premiums, the ability to open an HSA, and having better coinsurance that kicks in with the same deductible. Please help, thank you. submitted by /u/rentAbuddy [link] [comments]Read Morer/HealthInsurance