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Medical Insurance - CDHP vs PPO Sanity Check Request
Old 10-25-2013, 05:01 PM   #1
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Medical Insurance - CDHP vs PPO Sanity Check Request

I just received my retirement healthcare renewal material. I retired almost almost 3 years ago at age 55 so now at 58. I have always selected the PPO option vs. the CDHP option and have no complaints The past 3 years I opted out of the prescription coverage since it seemed way too expensive at ~2K/year and not very good IMO. My health is very good and up until now anyway and have only needed preventive care.

The basic info on each plan is below, I am now debating on whether to go with the PPO given the price is about the same and the deductible and max out of pocket expenses are somewhat lower, or the CDHP that has the $1,000/year carryover. However it is not an HSA fund so if I don't use it before I turn 65 or if I switch plans again, I lose whatever has accumulated. Actually the two choices look kind of like a "wash" now.

Any comments would be appreciated. (FYI - my megacorp pension plan pays ~$400/month of the monthly cost listed below ).



Anthem CDHP – (Myself only)
Premium - $845/mo (no option to opt out of prescription coverage)
Deductible - $800
In Network Out of pocket Max - $5,000
PDOC office visit – 80% covered after deductible is met
Specialist office visit – 80% covered after deductible is met
Carryover - $1,000/year (not an HSA - funds are forfeited when plan ends which by definition will be NLT when I turn 65).


Anthem PPO – (Myself only)
Premium - $860/mo ($700/month if I don’t select prescription coverage which is not a very good plan IMO…I know I am not supposed to do this for 2014 per new ACA law, but I opted out the last 3 years since I am on no maintenance meds and saved an estimated $5,000 the last 3 years - still debating for 2014).
Deductible - $500
In Network Out of Pocket Max - $3,000
PDOC office visit – $20 copay
Specialist office visit – $40 copay
Carryover – n/a
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Old 10-26-2013, 09:56 AM   #2
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So for $180 more a year, the PPO w/Rx coverage gets you a $300 reduction in deductible, a lower out of pocket maximum and a flat rate on co-pays.

Stay with the PPO, yes, I know you would be buying prescription coverage. The CDHP price looks to be attractive, but the $1000 to cover copays/deductibles needs to be higher to sweeten the deal. They really want you to buy the PPO, and without the Rx coverage. Buy the PPO with the Rx coverage: drugs, even maintenance drugs for most common issues are not cheap without insurance.

Do either of these plans have a statement in the brochure that says they meet the basic requirements of the ACA? Actually, it really doesn't matter, just buy the PPO.

-- Rita
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Old 10-26-2013, 03:10 PM   #3
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Thanks, Looked at all this again this morning and decided to stick with the PPO. Was wondering if I had missed something, but couldn't find anything. Seems like the CDHP should have been a lot less expensive or had a true HSA attched (or so I read in my research) given the $1K/year max you can build up per year if you have limited medical expenses is a "use it or loose it before you turn 65" bucket of money.

Both plans do meet 2014 ACA regulations.

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Originally Posted by Gotadimple View Post
So for $180 more a year, the PPO w/Rx coverage gets you a $300 reduction in deductible, a lower out of pocket maximum and a flat rate on co-pays.

Stay with the PPO, yes, I know you would be buying prescription coverage. The CDHP price looks to be attractive, but the $1000 to cover copays/deductibles needs to be higher to sweeten the deal. They really want you to buy the PPO, and without the Rx coverage. Buy the PPO with the Rx coverage: drugs, even maintenance drugs for most common issues are not cheap without insurance.

Do either of these plans have a statement in the brochure that says they meet the basic requirements of the ACA? Actually, it really doesn't matter, just buy the PPO.

-- Rita
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