HDHPs all basically the same?

[Sojourner]

So I've been looking into some different HDHPs in preparation for switching to one of them during open enrollment. As I mentioned in another thread, I'm leaning strongly in favor of opening up an HSA along with this.

My question is, do pretty much all HDHPs have essentially the same features and coverage limitations? For example, I found just three plans total on ehealthinsurance.com that are HSA eligible, and they all have $6,300 deductibles and basically cover 0% of health care costs until you reach that $6,300. They don't even have low copays for things like routine doctor's office visits. So it seems like every cent of health care bills I incur during the year would have to be paid out of pocket (from the HSA, primarily) until I reach the deductible. For those of you who've gone the HDHP / HSA route... does this sound right?

(FYI, my scenario is coverage just for me, mid-40s, non-smoker, living in Georgia, wanting a PPO or POS-type plan).

 

[athena53]

Read the fine print. I'm in MO and have Coventry. They sent me a letter telling me my current HDHP would no longer be available January 1 but they could switch me over to another policy I "might like" and gave me a link to look at it. Premium was 10-15% higher, of course. Thank heaven I looked at it. There is ZERO coverage out of network. There may have been an exception for emergency care but since they get to define "emergency" ("Well, since your severe abdominal pains were only gas and not peritonitis, the $15,000 in out-of-network ER charges aren't covered") that's not much comfort.


I consulted an insurance agent who said that half the policies he sees have no out-of-network coverage. Quality of the networks also vary. I'll be able to get one with a decent network and limited out-of-network coverage on 1/1 with anther company.

 

[Animorph]

The basics are all the same, that's why they're HDHP's with HSA's. I have a $5500 deductible, so there can be small differences. I had a small choice of deductibles last year from one company, with everything else about the same. I think co-pays are also possible with some plans. Of course you are restricted by what's offered in your area.

But their provider networks and drug formularies will probably be quite different between different insurance companies, and even for the same company. Pay a lot of attention to that.

 

[MBSC]

My question is, do pretty much all HDHPs have essentially the same features and coverage limitations? For example, I found just three plans total on ehealthinsurance.com that are HSA eligible, and they all have $6,300 deductibles and basically cover 0% of health care costs until you reach that $6,300. They don't even have low copays for things like routine doctor's office visits. So it seems like every cent of health care bills I incur during the year would have to be paid out of pocket (from the HSA, primarily) until I reach the deductible. For those of you who've gone the HDHP / HSA route... does this sound right?

(FYI, my scenario is coverage just for me, mid-40s, non-smoker, living in Georgia, wanting a PPO or POS-type plan).

To be HSA eligible, the HDHP cannot offer first dollar benefits, such as copays, before the deductible is met unless it's covered preventive. Office visits will be billed at the negotiated rate, not the "rack rate". The most distinguishing factor will be the size of the provider network. The same insurer can offer different plans with different networks.

With the Affordable Care Act’s third open enrollment season starting Nov. 1, new features of HealthCare.gov will allow consumers to type in the names of their doctors, prescription drugs and preferred hospitals, and see which plans cover them, administration officials said.

The new search tools are important for several reasons. Most insurers try to hold down costs by creating networks of selected doctors and hospitals, and patients typically face higher costs if they go outside the network.

Until now, people using HealthCare.gov generally had to visit the website of each insurer to see which doctors and hospitals were in its network and which drugs were on its list of preferred medications. That could be a cumbersome, time-consuming task.

Insurers said the new tools could be helpful, but had not been fully tested. In any event, they said, if consumers have any questions, they should call the doctor’s office and the insurance company to confirm if a particular provider is in its network.

Source: http://www.nytimes.com/2015/10/13/u...c=edit_tnt_20151012&nlid=58462464&tntemail0=y

 

[ziggy29]

My question is, do pretty much all HDHPs have essentially the same features and coverage limitations? For example, I found just three plans total on ehealthinsurance.com that are HSA eligible, and they all have $6,300 deductibles and basically cover 0% of health care costs until you reach that $6,300. They don't even have low copays for things like routine doctor's office visits. So it seems like every cent of health care bills I incur during the year would have to be paid out of pocket (from the HSA, primarily) until I reach the deductible. For those of you who've gone the HDHP / HSA route... does this sound right?

Any policy that is ACA-compliant should have preventative care visits covered 100% with no deductible... at least in-network.

 

[rodi]

The biggest thing a HDHP buys you is the negotiated rates.

We switched, for the first time, to a HSA qualified HDHP this year... Actually 2 plans, since DH wanted a different insurer than me and our kids. Of course this was the year that we had multiple sports injuries and their corresponding trips to the ER followed by orthopedic visits., a short in-patient hospital stay. Looking at the EOB - while I had significant sticker shock on what our out of pocket, to date, is... I also GREATLY appreciated seeing the "full price" followed by the "insurance price" (negotiated rate). The negotiated rate was often less than HALF the full price.

I'm treating the HSAs like Roth accounts. DH is also old enough to get catch up contributions. I've saved all our bills - so I can pull out our (maxed) contributions whenever I need to in the future.

 

[Animorph]

Any policy that is ACA-compliant should have preventative care visits covered 100% with no deductible... at least in-network.

Yep. I had a colonoscopy done within my HDHP network with very little out of pocket.

 

[Sue J]

We are on our second year of having an HDHP, with 2 different insurers. We switched for 2015 to get a lower premium even though we were just fine with our 2014 choice of insurers.

When we got the cards for 2015 I was surprised to see that it said first 3 PCP (primary care physician) visits are free! How can that be true if this is an HDHP where they are not allowed to pay anything except for the required preventative items (yearly physical, mammograms, flu shots, etc)? It's got to be a mistake, right?

I had a PCP office visit in January and when I saw the claim online I saw that it was billed at the full retail rate ($177), then reduced to the allowed amount of $128. I thought I'd have to pay the $128 but I owed nothing and the note on the claim said , "Service included under a special contract".

I paid nothing and my insurance paid nothing so it did not violate anything required of an HDHP. In other words, my doctor did not get paid anything for my visit. This happened the same way for a subsequent visit and I will have another visit handled this way if needed.

Looking back at my policy documents I saw that this is included but I didn't know how they would handled this with an HDHP. The in-network doctors must have all known about this when they contracted with this insurer.

I find it to be a very nice perk of being with this insurer. If their rates stay reasonable we will stay with them again for 2016.

This is a Bronze ACA HDHP ( $6450 deductible) with an HSA.

 

[MBSC]

When we got the cards for 2015 I was surprised to see that it said first 3 PCP (primary care physician) visits are free! How can that be true if this is an HDHP where they are not allowed to pay anything except for the required preventative items (yearly physical, mammograms, flu shots, etc)? It's got to be a mistake, right?

I had a PCP office visit in January and when I saw the claim online I saw that it was billed at the full retail rate ($177), then reduced to the allowed amount of $128. I thought I'd have to pay the $128 but I owed nothing and the note on the claim said , "Service included under a special contract"....

This is a Bronze ACA HDHP ( $6450 deductible) with an HSA.

This is known as a "value added benefit." It's interesting that your plan documents state it's an HSA plan when other plans remove HSA eligibility for the HDHP making it a non-HSA HDHP.

HSA Compatibility
We received guidance back on whether our plans are HSA eligible. This guidance confirms that the Oscar Standard Bronze Plan meets HSA requirements. A HDHP is defined as a health plan with (1) an annual deductible that is not less than $1,250 for an individual or $2,500 for a family AND (2) the annual out-of-pocket expenses does not exceed $6,350 for an individual or $12,700 for a family.

While some of our enhanced Oscar Edge plans meet these dollar thresholds, the 1-3 free PCP visits do not permit the plans to be HSA compatible. An HSA compatible HDHP requires that the only services that may be covered "pre-deductible" are preventive/wellness benefits. The additional PCP visits in the enhanced plans are not subject to a deductible and may be used for any purpose (sick or preventive). As a result, Oscar's enhanced plans do not meet the requirements of an HSA HDHP.

Source: http://static.hioscar.com/broker/Oscars Free PCP Visits and HSA Eligibility - 111813.pdf

Free doctor visits refers to primary care visits and is not available on HSA or catastrophic plans.

Source: https://cohealthop.org/our-plans/

 

[Sue J]

This is known as a "value added benefit." It's interesting that your plan documents state it's an HSA plan when other plans remove HSA eligibility for the HDHP making it a non-HSA HDHP.

Source: http://static.hioscar.com/broker/Oscars%20Free%20PCP%20Visits%20and%20HSA%20Eligibility%20-%20111813.pdf

Source: https://cohealthop.org/our-plans/

Our plan definately says it's HSA compatible. I even called to verify because I questioned the 3 free PCP visits. They can still be HSA compatible because they don't pay the PCP. If they paid for the visit then it would not be HSA compatible.

In your link https://cohealthop.org/our-plans/ the chart shows the BEAR Bronze plan that has the 3 free PCP visits but is still HSA compatible.

In your other example http://static.hioscar.com/broker/Oscars Free PCP Visits and HSA Eligibility - 111813.pdf it gets confusing..... they say the OSCAR STANDARD BRONZE has the 3 PCP visits and is HSA compatible while the Oscar Enhanced Edge plans are not.

Just in case, I did save all my plan documentation, including the page from HealthCare.gov that shows that it's HSA compatible.

I did think it was odd, because I know the requirements for an HSA. The only difference is that they do not pay the doctor. Nice perk for the patient.

 

[Sue J]

Here's a link to our plan at HealthCare.gov
https://www.healthcare.gov/see-plan...fad6ba3cd4635e7cbbc&issuer=SummaCare&state=OH

It says HSA eligible - yes

If you click on Plan Brochure you can see in the Office Services section - Primary Office Visit -
$0 copay for first three visits then
$0% (Subject to deductible)

I'm hoping this plan is still offered for 2016. If it is, I will carefully check these features!

 

[athena53]

Hmmm. The new policy my agent proposed has a provision for 3 PCP visits at no charge. I don't consider that a big benefit because in a given year I typically go for an annual physical (covered anyway) and maybe one doc-in-the-box for poison ivy. I'll have him do some digging. HSAs are a great tax break and I was hoping to continue to max out mine till I hit Medicare age in 3 years.

 

[gauss]

Can you get both HMO and PPO versions of HDHPs?

If so, it seems that these would be quite different.

 

[pb4uski]

....My question is, do pretty much all HDHPs have essentially the same features and coverage limitations? For example, I found just three plans total on ehealthinsurance.com that are HSA eligible, and they all have $6,300 deductibles and basically cover 0% of health care costs until you reach that $6,300. They don't even have low copays for things like routine doctor's office visits. So it seems like every cent of health care bills I incur during the year would have to be paid out of pocket (from the HSA, primarily) until I reach the deductible. For those of you who've gone the HDHP / HSA route... does this sound right?...

Sounds right except our HDHP plans (we have had several over the years) allow for some free preventative visits (annual physical, eye exam). Mine also gives me up to $300 a year back (on a debit card) if I get an annual physical, eye exam, dental exam, etc.

...Certain preventive care is covered at 100 percent before the deductible in all plans... 3-6-9 benefits allow coverage at 100 percent of our allowed amount for a certain number of visits with a primary care physicians or mental health professionals before you meet deductibles. You get three if you have a single plan, six visits (combined) with a two-person plan or nine with a family plan.

I think if it as two major benefits. First, I get negotiated rates with health care providers which is typically 25-50% off the "rack" rates for such services. Second, I am financially protected if one of us has a major illness... we pay the first $6,600 and then the insurance covers the rest.

Another angle to explore is catastrophic coverage. If your unsubsidized health insurance premiums exceed 8.05% of your modified AGI you can buy catastrophic coverage even if you are over 30. In our case, the benefits are slightly less than a HDHP plan (same max OOP though) but the premiums are about 35% less but from what I understand in other states the difference in premium is minor so YMMV.

 

[Animorph]

Can you get both HMO and PPO versions of HDHPs?

If so, it seems that these would be quite different.

My insurer used to have both. I'm in the PPO HDHP with HSA now. Looks like 2016 will be HMO only (still HSA eligible), as many others seem to be discovering. The only big difference in my brief scan is the much smaller network. No PCP referrals to a specialist are required, even though they call it an HMO. Not like the old HMO I had decades ago.