Background: Wife and I both worked for large companies, but I switched jobs about 1.5 years ago to another large company.

We used my old employer's high deductible while I was there and it was the most cost effective except one year when we had a couple of ER trips and an unexpected surgery. Dental was similar and the vision was actually useful.

I assumed that my gig had the better benefits package, but we have not crossed shopped the companies policies in years.

I think they are going to be close and mine is likely better, but I really have no clue on how to actually cross shop all the numbers that the govt. has thrown into the mix.

Between deductibles, employer contributions to HSA, vision, dental and such I am not looking forward to this and do not know if there was an easy way to filter through the information when I get it all in.

Thank in advance.

There isn't an easy way IMHO. We sit with both plans in front of us, compare the monthly paycheck premiums and then compare that with what we get in benefits.

When my wife was pregnant and we had infants, we knew we would be at the doctor a lot and certain plans cover those prenatal and first two year health checkup things. This was a somewhat known quantity to help in all the analysis.

Now out of that and with kids approaching 8 and 10, the visits are far less but we are older and I find myself going to a doctor 2-3x per year rather than the once every 5 yrs I used to. Now it's for strange things so there usually is more cost there.

Compare the amount of premium savings with the higher deductible versus higher premiums lower deductible. You have to somewhat "guess" at what you think your doc visits will be and as you saw with your sample ER year sometimes stuff just happens.

So it's a lot of what ifs and some basic cost/benefit analysis. That doesn't mean it isn't totally confusing but if you have plan choices, price each out for a year and guess at whether or not you think you will hit your deductible and then if you do how much all that costs out of pocket.

Not sure this helped but that is a bit of my thought process...my company always provides a plan summary to allow for comparison if you wanted to post it I am sure people would have better advice.

Thanks, and that's what I was dreading. I was hoping for a magic wand of sorts, and frustrated that they are not as easy as they used to be.

1. How much is my premium?

2. How much is my Co-Pay?

3. What's my out of pocket before you pay for all of it.


It was so simple.

always assume it will be (much) more expensive than the year before

I have a buddy and we have a running list of yearly insurance plans and can model what you pay and what each plan will pay. Both of us have a varient of expensive, kinda expensive and cheap (with an HSA thrown into the mix as option #4).

We put salary, cost for each plan (family, individual, etc.) and then any contributions from the company (bonus cash, HSA inputs, etc.)

Look at total costs to you (premiums plus deductibles)

Look at after tax cash needed to fulfill things


Then the modeling; look at expected expenses (easy if having a kid, harder once they are born). Look at what is covered, what isn't (this is from the plan papers), maximum out of pocket, etc.

Final look is what all is coming out of your pocket. Look at what you have to cover with co-insurance, look at premiums and then look at HSA and bonus money from the company. Usually look at several cases and determine based upon what you think is happening this year.


For example:

Expected $25,000 in medical costs (having a kid and normal stuff). One plan is $3k deductible, one is $6k.

Total premiums are $18k or $10.3k (respectively). Employer gives $700 for doing fitness stuff on plan.

80% Co-insurance, so total out of pocket would be either $21.7k or $13.1k. There is also a tax shield on the income side that was not included.

For that scenario, if you go up to $50k in costs, the plans don't change much. But in the $10k range, things get more interesting.

But I have bad insurance....

~egon

Just wait until the 501E employer required coverage kicks in next year. To prepare you take whatever you pay in 4th quarter and add 40% for 2017. Thanks Obama!

We have three plans at my company, and I had to build a spreadsheet to compare the HDHP to the mid-level plan (the most expensive plan was discounted due to cost). I used my OOP health care costs from the previous years to help estimate (which for us never amounted to more than one extra doctor visit above and beyond our "well" visit and prescription costs)

My company offers a "calculator" where you put in a bunch of estimated health care costs and it tells you which plan is "best". The running joke last year was that, unless you are practically dying, the calculator will always tell you the HDHP is "best".

A couple of things to consider...my HDHP only covers minimal prescriptions. I didn't switch until one prescription we need moved to generic because the non-subsidized cost of the name brand was just too high. I have yet to find a calculator that adequately accounts for that. And insurance companies are horrible at estimating prescription drug costs, especially between plans. Mine gets it wrong every single time. Given my experience trying to get that info, I doubt they are much better at estimating actual health care costs.

Depending on how much your company contributes to the HSA, that might cover some or most of your regular OOP expenses. It does for us, although I haven't used it for any reimbursements. I want to let it grow to at least my max OOP. The other nice thing is the HSA gives you a nice tax shelter. I've been using a dependent care FSA, but my kid is getting close to aging out of that. The $3k I had been putting in that is going into the HSA next year (since I haven't maxed out the HSA, yet). It's nice to not lose that deduction.

For us it works out best for me to by on my company HDHP and my wife and kids to be on her $300 deductible PPO. They go to the doctor more often and my HDHP deductible is lower with single coverage than it would be with family coverage.

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For us it works out best for me to by on my company HDHP and my wife and kids to be on her $300 deductible PPO. They go to the doctor more often and my HDHP deductible is lower with single coverage than it would be with family coverage.

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This is the other possibility that I hope to not deal with.

Surely your plan has a cap on out of pocket, right?

Your math above basically assumed expenses were Total Out of Pocket = Deductible + (1-Coinsurance rate) x Expenses above Deductible, with no possible cap.

$10k is normal? Man...

Ive started selecting the HDHP due to HSA contributions. Major medical event would be a huge expense though.

if you can afford to do it, go with the HSA. invest everything you contribute and cash flow your healthcare expenses.

Yeah, it does.

My OoP max I think is $26k or something. I think it is across the board, regardless of plan.

~egon

Dang that seems high, maybe it's family plan? My wife and I have separate individual plans that both cap OOP at ~$7500, but these aren't high-deductible plans (not sure if that matters, would think OOP would be same regardless of deductible).

Well the wife's company is rolling out something very similar to mine. Looks like it will be a ton of work to review them both, and maybe save a few bucks.

I am so glad the government got involved and made this so much better.

Another thing to consider and look out for is that many plans/companies are now charging a premium if your spouse could be covered under another plan and you opt to put them on your plan.

My company has been doing that for a while. And if they can prove you could have put your spouse out on their own sooner, they will come back at your for premiums.

My OoP is high because you have to hit it for everyone. For example:

Had a kid and the wife was on plan before. So I had to pay max OoP for both her AND the kid. Even though I maxed her out before with pre-natal care. Luckily it was in the same year. But if have the care one year and the kid is born the next year, you get to pay 3 OoP max (2 for wife, 1 for kid).

It doesn't help that everyone at work is either 20-something young or 70-something with 3 pages of health issue and 2 gallon bags of medicine.

~egon

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My company has been doing that for a while. And if they can prove you could have put your spouse out on their own sooner, they will come back at your for premiums.

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At my employer, you just get fired if you do this.

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My company has been doing that for a while. And if they can prove you could have put your spouse out on their own sooner, they will come back at your for premiums.

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At my employer, you just get fired if you do this.

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this is why my wife is on the school district plan and I am in my company plan. Too risky over insurance.

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Yeah, it does.

My OoP max I think is $26k or something. I think it is across the board, regardless of plan.

~egon

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This is becoming the basis for all plan costs whether your employer shares some of the expense or not. That is enough to buy a small new car every year. Every year! This is breaking the middle class - by design and intentionally.

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Yeah, it does.

My OoP max I think is $26k or something. I think it is across the board, regardless of plan.

~egon

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Dang. Our family OOP max is something like $4200, and our deductible is $1200 I think.

We are lucky. Our premiums didn't go up a dollar. $340/month for family PPO. $500 in network deductible, $1,000 out of network, 90/10 coinsurance, $5 co-pay, $2,000 max OOP family regardless of network.

I honestly can't believe there are still plans out there like you have. I would sign up in a heart beat, though I would miss the tax advantage of the HSA.

On my HDHP, my premiums for a family are moving to $450/mth from $350. The deductible is staying the same at $1,300/$2,600. And the OOP increased to $10,000 from $8,000. Ugh...

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I honestly can't believe there are still plans out there like you have. I would sign up in a heart beat, though I would miss the tax advantage of the HSA.

On my HDHP, my premiums for a family are moving to $450/mth from $350. The deductible is staying the same at $1,300/$2,600. And the OOP increased to $10,000 from $8,000. Ugh...

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Wow...that's about the same plan I have - $2600 deductible and max $9k OOP. But it's free (for me, including one dependent). My company pays 100% of the premium and puts $1k in my HSA. And they still can't convice most employees to opt for it (we have two other plans to choose from that cost the employee a few hundred a month, depending on which plan and how many dependents)

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I honestly can't believe there are still plans out there like you have. I would sign up in a heart beat, though I would miss the tax advantage of the HSA.

On my HDHP, my premiums for a family are moving to $450/mth from $350. The deductible is staying the same at $1,300/$2,600. And the OOP increased to $10,000 from $8,000. Ugh...

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Here is ours based on what I can remember:

My husband is covered for free, premium/month for me and child is something like $150 I think. Deductible is around 2k for family, oop max is around 4k. 80/20 after deductible to include emergency room visits. We do not have co pays. Company puts 2200 each year into a HSA that auto reimburses our checking account once BCBS generates an EOB (auto files with our HSA).

Yep, it's not going to get any better I don't think. The employer does put $1,140 in the HSA for families ($570 for just the employee), so that's a nice benefit. I'm 80/20 after deductible, no copays either. I usually cash pay doctors/prescriptions, unless there is a larger expense. Then I will use the HSA for that.