HDHP or PPO

livingalmostlarge

Recycles dryer sheets
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Okay I need help deciding if this is worth it. I am unsure exactly if the benefits make sense to switch from the PPO to the HMO. The problem is these sentences. Is this normal? we've never had a hdhp offer before. It's always been just PPO

Only for HSA

1. If you enroll one or more family members, you must meet the full Family Deductible before the plan starts to pay expenses for any one individual.
2. If you enroll one or more family members, you must meet the full Family Out of Pocket maximum before the plan starts to pay eligible covered services for at 100% for any one individual.

So this is our two options 2 adults and 2 kids

HSA
Premium $137.02 per month month
Deductible $3400 Individual/$6800 Family
Max OOP $6000 Individual? / $12000 Family
Company HSA contribution $400/month ($4800 for the year)
Covered Services
Office Visits 20%
Virtual Visits 20%
ER 20%
Urgent Car 20%
Hospital Stay 20%
Pharmacy 20%

Medical PPO
Premium $312.75 per month
Deductible $200 individual / $600 Family
Max OOP $1500 individual / $4500 Family
Covered Services
Office Visits $15
Virtual Visits $15
ER $200
Urgent Car $15
Hospital Stay $0
Pharmacy $5, $25, $50, 30% - require deductible to met then plan pays

So my DK2 has pretty expensive treatments and hits the maximum OOP. DK1 uses mental health and maxes out the deductible. DH and I only use routine preventative.

So is it worth switching?
 
back of the napkin math you save $2,100 in premiums with the hdp plus the company giving you $4,800, so $6,900 essentially in your pocket.

double check your medical expense history to see if the savings offset deductibles and out of pocket exposure.

hdp's don't seem to always work with high utilizers of coverage.
 
An additional benefit with the HSA is you can contribute up to $8550 in 2025 and, similar to an IRA, reduce your taxable income by that amount. Depending on your marginal tax rate that can produce substantial savings. If you’re over age 55 you can contribute an additional $1000.
 
the problem I have to ask users doesn't it mean that we have to hit the family deductible and max OOP before they cover my DK2?

She uses max OOP and Max everything in and out of network.

Thanks! I'm trying the health plan worksheet so much
 
From that worksheet the PPO works out better for us. Ut says that the max we will pay is $8853 per year with premium and max OOP for family.

For the HSA the max is $1644 premium + $7200 = $8844 max OOP but there is tax savings, But I'm confused if based on the two lines above if I would keep paying until one of us hit the max OOP for the max $12k per family max out of pocket
 
We had an HMO once, I called it Horrible Medical Option... , highly restricted in Dr to see, pre-approval by $20/hr clerk questioning Dr directions..

So glad I didn't have any serious issue.
 
An HDHP can be a PPO or HMO or probably something else.

For the HDHP you pay everything (excluding annual physicals) until you hit the deductible. Then you will pay 20% until you hit the max OOP. Then insurance pays everything. There are per person and per family limits.

For low medical expenses, the HDHP will be cheaper. For really high medical expenses, it will be pretty close especially if you max your HSA. Your HSA contributions are pre-tax and pre-FICA. An HSA can be a great retirement account.

If you are trying to eke out every dollar, then plot the two plans (your cost vs medical expenses). You will see the regions where one plan is better than the other. You can then look at what you think your 2025 medical expenses will be to see which plan is better.

You would also need to make sure that the HDHP network covers your doctors and services.
 
Okay I need help deciding if this is worth it. I am unsure exactly if the benefits make sense to switch from the PPO to the HMO. The problem is these sentences. Is this normal? we've never had a hdhp offer before. It's always been just PPO

Only for HSA

1. If you enroll one or more family members, you must meet the full Family Deductible before the plan starts to pay expenses for any one individual.
2. If you enroll one or more family members, you must meet the full Family Out of Pocket maximum before the plan starts to pay eligible covered services for at 100% for any one individual.

So this is our two options 2 adults and 2 kids

HSA
Premium $137.02 per month month
Deductible $3400 Individual/$6800 Family
Max OOP $6000 Individual? / $12000 Family
Company HSA contribution $400/month ($4800 for the year)
Covered Services
Office Visits 20%
Virtual Visits 20%
ER 20%
Urgent Car 20%
Hospital Stay 20%
Pharmacy 20%

Medical PPO
Premium $312.75 per month
Deductible $200 individual / $600 Family
Max OOP $1500 individual / $4500 Family
Covered Services
Office Visits $15
Virtual Visits $15
ER $200
Urgent Car $15
Hospital Stay $0
Pharmacy $5, $25, $50, 30% - require deductible to met then plan pays

So my DK2 has pretty expensive treatments and hits the maximum OOP. DK1 uses mental health and maxes out the deductible. DH and I only use routine preventative.

So is it worth switching?
I'm having trouble following your posts.

HSA = $1,644.24 in premium plus $12,000 max OOP for the FAMILY less $4,800 in HSA gift from the company, net cost exposure $8,844.24 assuming everyone utilizes coverage and you max out your out of pocket expenses.

PPO = $3,753 in premium plus $4,500 max OOP for the FAMILY giving you next cost exposure of $8,253 max net cost exposure.

2 covered participants can satisfy the family out of pocket expense limit.

If I were in your shoes I would look at every explanation of benefits issued for the last 2 or 3 years and see who is driving your health care costs and by how much and with that information you'll be in a better position to decide. Your health insurance carrier likely can even give them to you in a worksheet saving you time.

My personal opinion is that I'd rather keep the money in my pocket for as long as possible and take advantage of the HSA account for the future.
 
OP,

it seems like you are trying to figure out how a HDHP works. I would think your company or insurance provider should have people that can explain it to you. Otherwise, find a really smart co-worker that has been using the HDHP and ask that person. This way you can ask questions until you understand.

It is unfortunate that medical insurance has to be so complicated, especially when we have loved ones that really need medical care.
 
So I know who is driving the costs my DK2. She had $20k shots per month that was covered by our insurance after 1 shot. She's the primary driver. DK1 has some costs and usually she maxes out the in network Max OOP of $1500. She's got medical issues that are pricey and we are trying a lot of different stuff.

But DH and I are minimal users where we may hit our deductible.

So the plan is a HDHP plan with HSA versus a PPO plan. I sent DH a text I want to chat with the representative. My fear about the HDHP is that DK2 will max out $6k OOP but then DK1 won't max out the OOP so we are $6k plus it keeps rising because of this sentence.

2. If you enroll one or more family members, you must meet the full Family Out of Pocket maximum before the plan starts to pay eligible covered services for at 100% for any one individual.

So we will continue paying DK2 bills because none of the 3 of us will hit the other $6k max OOP for the HDHP/HSA.

Everyone talks about how great an HSA/HDHP but are there times it doesn't make sense? I feel so frustrated because we try to do everything right and i'm not even sure I fully understand our own current insurance and i have to track everything based on what's submitted to insurance.

I just wait often times and have been told by Drs to not pay and see what goes through our insurance because I know we hit the maximum. I received a bill for $1200 from a dr and then when I called to ask for it to be itemized they said it wasn't processed through our insurance correctly so don't pay it. Then called me back and said we owed $0 because it was DK2 and she hit her $1500 max OOP in and out of network so we owe nothing. I knew that which is why I called.

Blogs, forums all say the HSA is the triple win. Best thing, but I can't seem to get the numbers to work I think. I think i'm right in keeping our PPO but i'm just not sure. We went to retire early and will but we'll retire without ever having an HSA and not ever having put money in an HSA.

Our kids have had a lot of medical issues since birth. It's been very expensive and without employer provided coverage it would have been exobitant.
 
Let us know what the plan rep has to say, it's a very important discussion and you've provided really helpful information.
 
I know medical insurance is important to your family. You have two choices. If you choose wrongly, the most you are out is $2-3k. I don't know how important $2-3k is to you, but don't destroy your health and sanity over $2-3k. Make sure the plan you choose will cover the doctors and services your family needs. Then, decide how optimal of a choice you are willing to make. We all leave money on the table here and there because we can only deal with so many things at once.
 
I know medical insurance is important to your family. You have two choices. If you choose wrongly, the most you are out is $2-3k. I don't know how important $2-3k is to you, but don't destroy your health and sanity over $2-3k. Make sure the plan you choose will cover the doctors and services your family needs. Then, decide how optimal of a choice you are willing to make. We all leave money on the table here and there because we can only deal with so many things at once.
I'm also frustrated because our network changed last year and so much went out of network. It's a terrible network now so then we maxed out the in and out of network PPO costs for the DK2. I just figured okay for DK2 $3k. Then we had the rest of us who did not max out the OOP.

So then it seemed like the HDHP/HSA seemed smart for us. But not reading the fine print. Since it's DH's plan I have to wait for him to get home and talk to me or hope I can talk the plan representative without him being on with me.
 
We had an HMO once, I called it Horrible Medical Option... , highly restricted in Dr to see, pre-approval by $20/hr clerk questioning Dr directions..

So glad I didn't have any serious issue.
I don't see it mentioned by others, but on the marketplace, I purchase a POS plan, which is a combination of a HMO plan and an indemnity plan. I haven't had any problems with it and have only used the HMO part because all services have come from in-network providers. I was even able to try a $500+/mo medication without having to jump any hoops that some people do to get approved through it. The indemnity plan part is for coverage outside of the network, but I haven't had to use it, which is good since the coverage isn't nearly as good.
 
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