Anyone else with a HDHSA insurance plan?

DH recently had to switch jobs (was in newspaper industry - position eliminated) and went with a much smaller company which does not provide health insurance, so I have been insurance shopping until my head spins, and boy, does it suck.

It is so hard to compare plans with the differing deductibles (per person, per family) and taking into account OOM and what is included in that, and the varying co-pays and RX deductibles. To top it off, since DH has had two serious spine surgeries in the last 3 years, we were very concerned he would be turned down and we would have to go to our state's high risk pool or even form a corporation of 2 people so we could get our own group plan.

He was approved for coverage, but, not surprisingly, at a high premium. After exhaustive spreadsheet analysis by yours truly, who was truly out of her depth ( I did get some help from an independent broker), the HDHSA account, and I'm talking high to the tune of $10,000 per family deductible high, turned out to be the best deal since we could come up with $10,000 if we had to. I compared a normal year for our family among 5 plans and then a year with a major surgery thrown in.

We are basically out of pocket unless catastrophe strikes, but at least the premiums are lower and we can put money into a HSA which carries over year to year, not that we expect to have any left in it to carry over.

Now, onto investigating ordering our drugs from Canada.

My employer has offered an HSA as one option for coverage for the past couple of years, and they really push it, so I assume it saves them money. I know some of my co-workers went for it because of the lower premiums, and I'm pretty sure some of them opted to stay with it again this year, so they must think it's okay.

We have an HSA and I rather like it. For one, I'm paying myself instead of an insurance agency. My employer covers the cost of Insurance if we choose an HSA ($10,000 per family) but if we choose traditional insurance coverage than we'd have a significant amount deducted from my paycheck each week.

Everyone is generally healthy in our family and we do not have regular prescriptions. We can use the HSA for vision and dental expenses as well.

I've had one prescription for DD that was over $100 out of pocket! That was hard to swallow, but nothing even close to that since. DS spent a week in the hospital. I thought that would be $10,000--but it was a small fraction of that. We didn't have enough money saved in the HSA to pay for it at the time so we arranged a zero interest payment plan with the hospital. The hospital let me pick how much we wanted to pay each month--as little or as much as I wanted, which was nice.

I'm also much more proactive in my healthcare since I'm now paying for a lot of it. I ask a lot more questions. What I've learned is that a lot of doctors have protocols that they follow--whether they are really necessary or not. . . . I could tell you stories that are surprising about how wasteful our healthcare system is. But, reality is, doctor's have to earn a living to and the more they prescribe and schedule the more they earn (I'm not saying ALL doctors are like that but it happens).

I've been using an HSA since the beginning.

First thing to understand is that you fund your HSA with PRE-TAX dollars. Meaning, you don't pay income tax on that money. Right now the limit for a family is $6250 at least in my state.
Second, you can use HSA funds for many things that your insurance will not cover. Besides the obvious, (co pays, the portion of your bill that you have pay towards the deductible) you can use it for vision, dental, massage, prescriptions, medical devices, and even certain over the counter products. The lists are available online, and documentation is the key. Our medical insurance does not cover prescriptions, period, so I use the HSA to pay for those.

In a perfect world, what you pay into and use with an HSA would exactly match your co pay and out of pocket expenses, but in reality, with the things that aren't covered, you will probably run out of HSA funds before you spend your plan out of pocket maximum.
I think the only people who have trouble seeing the tax benefit are those who've had the gold plated kind of plans where they've never had to actually pay for much of the actual cost of medical care ( $5 dollar office visits, no copay, minimum deductible.

With our plan, you pay 100% of all medical costs until you reach your deductible, then the plan is supposed to pay 100% of costs after that. There are no co-pays.

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Originally Posted by ny biker

With our plan, you pay 100% of all medical costs until you reach your deductible, then the plan is supposed to pay 100% of costs after that. There are no co-pays.

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All plans are different. We have an 80/20 high deductible plan that on the one hand covers certain wellness things ( mammograms etc) 100% with no deductible, and other things not at all. The rest goes to the deductible. So we use our hsa for all sorts of things.

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Originally Posted by Irulan

We have an 80/20 high deductible plan that on the one hand covers certain wellness things ( mammograms etc) 100% with no deductible ...

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This might be OT but aren't mammograms, PAP smears and such supposed to be covered by all plans as of Aug 1 per the latest provisions of the Affordable Care Act?

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Originally Posted by jobob

This might be OT but aren't mammograms, PAP smears and such supposed to be covered by all plans as of Aug 1 per the latest provisions of the Affordable Care Act?

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probably, but we've had "wellness" provisions for a few years. I pay close attention because the trade off is zero prescription drug coverge.

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Originally Posted by jobob

This might be OT but aren't mammograms, PAP smears and such supposed to be covered by all plans as of Aug 1 per the latest provisions of the Affordable Care Act?

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The plan does cover preventive care, so there is that going for it :)

OK, our HSA has a limit of 3500. That would pay for like maybe 2 months of DH's prescriptions (Zetia, Crestor, Plavix). We only use it for contacts and glasses and the deductible for pharmaceuticals. It used to be 5K, but it was lowered a couple of years ago. We have a fabulous insurance plan; no deductibles, reasonable prescription prices (10.00- 50.00), no referrals. I have seen several specialists at the Brigham, with no questions asked. They pay for my Prolia, which is not the first line of treatment for osteoporosis. I have a 20.00 copay for office visits, and as Oak mentioned, wellness care is now covered for physicals under the new health care law. We also have unlimited mental health coverage, as Massachusetts has had mental health parity laws for quite awhile. We do pay a decent sized premium each month (through DH's company), but my employer offers the same plan for like 3X the cost. They want people to use the tiered plan where you get more if you use crappy doctors. Sorry, I was very happy to be able to not have to think about going into Boston for specialists in rheumatology and neurology a couple of years ago. They even paid for DS to have experimental surgery to cure his Raynoud's, in 2003 (which involved flying to Texas).
I've had enough weird medical things to shudder at the thought of a 10K deductible. Even as a younger person, I had asthma, bouts of bronchitis, etc. and my kids were always at the pediatrician. We live a healthy lifestyle, but I can't imagine if we had had to pay for DH's stents, etc. That bill was hundreds of thousands of dollars, and we paid about 200.00. No amount of healthy living could fight DH's genetics.

I work for a major insurance company and frankly I consider the plans given to employees to be pretty poor. Is 10K your ded or is it also your OOP? If it's your OOP and you have that on hand it's not too bad. I always sock money away in my HSA each year. My son sees a counselor that is not covered by insurance so I use it for that. I also use it for glasses, contacts and the occasional prescription.

Crankin, from what I've seen, the better featured a plan correlates with a lesser HSA limit. We self insure (both self employed) and plans with "fabulous" benefits are not even an option unless we pay outrageous premium with no HSA: a traditional 80/20 plan that is horribly expensive is the only choice is that if what we want.The higher limit is associated with higher deductible plans. Plans with the higher HSA amount might be available but just not offered through the employers broker.

I'm not going to venture into how screwed up our system is here in the US.

I researched getting Rx med from Canada and found out:

1. I can reimburse myself from the HSA (but no one really knows what would happen if I ever got audited.)

2. The cost of Rx meds from Canada would not apply to my deductible or out-of-pocket maximum.

I hate my ins. company.

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Originally Posted by malkin

I researched getting Rx med from Canada and found out:

1. I can reimburse myself from the HSA (but no one really knows what would happen if I ever got audited.)

2. The cost of Rx meds from Canada would not apply to my deductible or out-of-pocket maximum.

I hate my ins. company.

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I did exactly this for years with my prescription. The price savings was unbelievable, something along the line of several hundred dollars per refill. Medicine Shoppe is a very reputable chain and the service was excellent. Once I did have it confiscated via mail inspection ( wtf?) and I got an empty envelope with a big neon sticker on it.

If you do not have prescription coverage, it pays to shop around. My formulation got changed, and this is what I found. I hadn't shopped around for several years after getting the price from Canada.
Fred Meyer 305 per month
Rite Aid, Savon, same.
Walmart, same within a few bucks.
Costco, 112 for 3 months. No kidding. Costco give an additional 10% discount if you do not have prescription coverage. So now I am getting it from Costco instead of Canada

Wow, that's a huge difference.

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Originally Posted by thekarens

Is 10K your ded or is it also your OOP? If it's your OOP and you have that on hand it's not too bad.

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Yes, $10,000 is the total family OOP maximum. If we meet that, and I surely hope we don't, then everything in network is covered at 100%. Preventive care is covered from day one. The maximum HSA contribution for us is $6,250 for 2012 which increases next year to $6450.

With the extreme difference in premiums, even if we did blow through the whole $10,000 deductible, it was the best plan financially for us, but it is hard to break away from the mindset of having a co-pay and good RX plan to paying for most everything out of pocket. I really had to break down the numbers to convince myself it was the way to go.

For mine the deductible is 3k. Before that, they don't pay anything, but we do get to pay the "negotiated rate." So, like some simple visit or procedure will be billed at $900.00 and the negotiated rate is $75.00, so that's what we pay.

I believe this works to the insurance company's benefit because it makes it less likely that basically healthy people will ever meet the deductible.

After the deductible they pay 80% and we still pay 20%.

The out of pocket maximum is unthinkable; I don't remember how much--it is astronomical. At that point, the insurance company will only one more horror to deal with.

I understand that, Irulan. I am happy to use the $ for my eye related things. A couple of years ago, I used it for acupuncture, after I negotiated the price down with the practitioner, and then I got the $ back from the HSA. My Blue Cross only pays for acupuncture if it's done by an MD and I was too lazy to research the approved people, so I went with a regular acupuncturist. I know I'm lucky in that DH's company has these great benefits, but I also feel safe that there's a safety net in my state. It's not perfect, but all of the clients I see have our state mandated insurance for low income people and they get good benefits. In fact, I wouldn't have a job if it wasn't for the behavioral health initiative that's specifically part of this plan, for this population.

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Originally Posted by malkin

[B]F" So, like some simple visit or procedure will be billed at $900.00 and the negotiated rate is $75.00, so that's what we pay.

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That's pretty standard, you pay the rate contracted with the plan. Every plan I've ever had has worked that way. Yet another thing wrong with the ins. in the country. Every one gets a different contracted rate, and heaven forbid you are paying cash w/o a plan...

Just like air travel, except that air travel used to be fun.

Trying to get my first Canadian RX filled. We'll see how it goes.

They are going to contact the MD (via faxed form, I assume) for the RX. I'm not sure how obvious it is going to be to the physician's office that it is a Canadian company. If there is any trouble, I guess I'll just get a paper prescription that I can mail in. So far the pharmacy itself has been very good to work with. They confirm and re-confirm that everything is correct and you do want them to proceed with the order. They also tell you exactly what is being shipped, who manufactures it and where. This particular prescription (Restasis for dry eyes) is less than half what I would pay here. My husband has a prescription for Diovan HCT that, generic, will be about a fourth of what we are paying for brand name here.

It's not illegal to do it. There should not be issues. I routinely had my MD fax renewals etc to the Canadian pharmacy.