gsasquatch t1_iui2zen wrote on October 31, 2022 at 2:31 PM

What's the difference in premium? It's easier to compare when you look at the premium from a yearly instead of a monthly cost.

$500 difference in deductible, is worth $41/month in premium. For the out of pocket, that's worth $83/month in premium.

What's the coinsurance with the PPO? Deductible is $1000, but somehow you're getting to an out of pocket of $4000? How about with the high deductible? Is that max out of pocket $1500x2, like they pay 100% after the deductible is met?

Was the last kid c-section? What did it cost to hatch that one? Are you expecting $10k or $50k? Is that going to be $4000 out of pocket max on PPO, or $1500 for just your wife's deductible?

When looking at this stuff, I find it almost always pays to go for whichever has less premium. They will find ways not to pay, or you might get lucky and not even need them to pay. So, it is best not to give them your money up front. At most if not all the plans I've looked at, lower deductible is always more than made up for in premium.

Does the high deductible plan qualify for an HSA? It's $1400/$2800 for the deductible to qualify, but even with that not all plans do. An HSA can give you a (tax rate) discount on what you spend on health care by using pre-tax money that could nearly overcome the lower deductible on the PPO.

HandyManPat t1_iui4cnz wrote on October 31, 2022 at 2:41 PM

"The High Deductible is max deductible of 1,500 but max out of pocket of 3,000."

>Does the high deductible plan qualify for an HSA? It's $1400/$2800 for the deductible to qualify, but even with that not all plans do.

You have highlighted an important point... If the High Deductible plan has "only" $3000 max out-of-pocket then although it is within limits for a qualifying HDHP for HSA contribution purposes, it might warrant further investigation since the OOP is less than 1/2 the max limit allowable. There are other factors that could make it disqualifying such as office or prescription co-pays, for example.

https://www.uhc.com/broker-consultant/news-strategies/resources/2023-health-savings-account-and-high-deductible-health-plan-limits-announced

These IRS changes are effective on customers’ renewal dates beginning Jan. 1, 2023, or later:Minimum deductible$1,500 for self-only coverage ($100 increase from 2022)$3,000 for family coverage ($200 increase from 2022)$3,000 for embedded individual deductible ($100 increase from 2022)

Out-of-pocket maximum** $7,500 for self-only coverage ($450 increase from 2022) **$15,000 for family coverage ($900 increase from 2022)

HSA contribution limits$3,850 for self-only coverage$7,750 for family coverageIndividuals 55 and over may contribute an extra $1,000 to their HSA

gsasquatch t1_iui5iru wrote on October 31, 2022 at 2:49 PM

I was looking at this: https://www.healthcare.gov/glossary/high-deductible-health-plan/

That says $1400 individual, $2800 family, which might cover OP's $1500/$3000

When I was looking at plans for my family, even with the deductible much higher than $1500/$3000, some plans specifically said "not qualified for HSA". There might be other qualifications in the plans.

trilliumsummer t1_iui7z1a wrote on October 31, 2022 at 3:06 PM

I believe that means the OOP Max can't being HIGHER than 7,500 to qualify - not that it has to be at least 7,500.

Source - I have an HSA this year and the OOP max is $7000 which is less than the current max amount set for this year and it was $6000 in 2021.

HandyManPat t1_iuijztn wrote on October 31, 2022 at 4:28 PM

You're correct. I'll edit my posting.

rockysworld OP t1_iui5mmz wrote on October 31, 2022 at 2:50 PM

The high deductible is $1740 a year, the PPO is 2100. Coinsurance for both is 80/20.

Last kid was c section, I literally just paid copays, we were under my insurance at a different job that had really good insurance and didn't have to go through this.

HSA is available through her employer with employer contribution of up to $750

gsasquatch t1_iui8cym wrote on October 31, 2022 at 3:09 PM

Does the HSA work with the PPO? I'd doubt it. Paying an extra $140 ($360 premium-$500 deductible) to get $750 is a no brainer.

Plus, the HSA can be treated as a tax-free retirement account as it is funded with pre-tax money, and grows tax free like a 401k. It can be used as an emergency fund, if you just pay the bills, and not submit them until such time as you need the money, even years down the line. There is something to be said for maxing that out at the $7300 per year, which only reduces your paycheck like $5000 per year.

In light of the c-section, where 20% of $50k is $10k, so you'll hit the out of pocket max on either. The lower max, means the high deductible plan is going to be $1340 cheaper.

I'm having a hard time finding a scenario where the PPO is the better way to go.

I'm on the ACA now, my premiums are going to be $1480/month for 5 with $7500/$15000. To me, your plan looks really good, very generous. Your employer would seem to be contributing 80% or more of your premium. The high deductible plan in that case would be that much cheaper for them, making the $750 HSA contribution for them worth while to push you toward the high deductible.