bow-tie said:
Justin,
It sounds like your plan is an HSA for a family. Is that correct? If so, I believe you have a youngin', if memory serves me. I'm trying to figure out if having an HSA with a new family addition would prove cost effective, or if I should ditch the HSA and go with the more traditional employer health insurance.
Care to share your opinion/assumptions for your case that I might be able to use for my own?
Sure.
So far we've had very healthy babies (2 of em under age 2 right now). That tainted my decision. We also don't run to the doc at every snivel and we take advantage of calling the nurse hotline and the doc's clinical assistant if it is a questionable illness/malady that we aren't sure needs medical attention.
With our High Deductible plan, preventative care is 100% covered w/ no copay, so the half dozen or so well-baby visits the first 1-2 years won't cost us anything, versus a $25 copay per visit (at least) under the full insurance $0 deductible plan. That's $150 for the newborn that we'll save. If the baby is sick, we can potentially squeeze in a well-baby visit at the same time as the sick visit and have it covered as a well-baby visit. If/when we make a sick visit, it usually runs $50-80 after the ins. co. discount. But that is only $25-55 more than what we would have paid with the $25 copay from the full insurance $0 deductible plan. So throw in a few sick visits per kid per year (that may or may not happen) and the occasional prescription out-of-pocket, and you have a couple hundred dollars extra per year under the high ded. plan above the full insurance $0 deductible plan.
The big unknown is an unexpected accident, injury or illness. If one kid incurs a large medical bill, as long as the negotiated rate of all medical expenses for that kid are $9400 or less, then the High Ded. plan is cheaper. A couple days in the hospital, a minor surgery, etc. might fit within the $9400. If two kids have serious medical bills of $1200 each (the deductible amount), then we lose $177 from having chosen the high ded. plan.
Our max out of pocket under the plan is $3500 per kid or $7000 per family. If something catastrophic were to occur (cancer, heart attack, major car wreck, brain injuries, etc), we'd be out either $3500 or $7000 versus $1500 or $3000 under the full insurance $0 deductible plan. That extra risk of $2000-4000 isn't going to hurt us too bad, given that we are saving $1800 by choosing the high ded. plan. To reach $3500 out of our pocket, we would have to have incurred a medical bill of $12,700 (negotiated rate).
Plus DW and I get free physicals, and she gets free "female" doc visits (pap, mammogram, whatever else?). I take a generic maintenance drug - it's $4/month at Walmart now (although I still have my own insurance through my employer).
We figured we're saving $1800 by choosing the high ded. plan, and have access to the Health savings account to boot (which we will end up funding mostly with the savings of choosing the high ded. plan). A scenario where our incremental cost due to choosing the high ded. plan is greater than $1800 is a low probability event. And our maximum incremental loss is capped at $4000 no matter what.
We just observed that we are atypical medical consumers it seems these days. We can use resources to figure out if we really need medical attention for ourselves or our kids, and don't go to the emergency room/doctor otherwise. Nothin worse than hearing the doc say "it's fine, let the little one get some rest, drink plenty of fluids, give her children's tylenol for the fever, and call us back if the fever goes over 10x degrees. It should clear up in a few days, call us if it doesn't."
