Public School Teacher here.
For the first time, employer is offering a high deductible health insurance plan, therefore making me eligible for a HSA. Not very knowledgable about the subject, and looking for other's input and experiences to decide if that is the route to go. I may be mistaken, but I think my situation might be different than others in the private sector due to a relatively low insurance premium for current deductible as well as income level.
Comparison:
Regular PPO plan (With EPO OPTION)
Monthly Premium $100.14
PPO Deductible $800 (Blue Connect EPO option with EPO providers) $600 Out of Network Deductible $800
Coinsurance after Deductible PPO 90%/10% EPO providers 90%/10% Out of Network 70%/30%
NOTE:- Not sure why the info flyer presents the info in this particular format here "90%/10%" put lists it differently elsewhere. Is there something key to that?
Annual out of pocket max: PP0 -$2750 EPO Providers $2,500 Out of Network- $2750.
Lifetime Max- All Unlimited.
Preventative Care- PPO -100% EPO providers 100% Out of Network- Not Covered.
Office Visits- PPO $30-$50 EPO providers $25-$45 Out of Network 30% after deductible.
Emergency Room- All 10% after Deductible
Hospital Services PPO- 10% after Deductible EPO 10% after deductible Out of Network 30% after deductible.
Mental Health/Substance Abuse PPO- 10% after Deductible EPO 10% after deductible Out of Network 30% after deductible.
Prescription Drugs (No out of network option) Max Out of Pocket $5150
Generic Drugs /Tier 1 34 day supply Retail $15 90 Day Mail Order $30
Preferred Brand /Tier 2 34 day supply Retail $40 90 Day Mail Order$80
Non-Preferred Brand /Tier 3 34 day supply Retail $60 90 Day Mail Order$120
Multi-Source Brand 34 day supply Retail $7590 Day Mail Order $150
HIGH DEDUCTIBLE PLAN:
Monthly Premium $87.08
PPO Deductible $3000 (Blue Connect EPO option with EPO providers) $2,000 Out of Network Deductible $4,000
Coinsurance after Deductible PPO 20% EPO Providers 10% Out of Network 30%
NOTE:- Is there any significance to this being written differently than with the Regular plan above?
Annual out of pocket max: PP0 -$6000 EPO Providers $5000 Out of Network- $10,000.
Lifetime Max- All Unlimited.
Preventative Care- PPO -100% EPO providers 100% Out of Network- Not Covered.
Office Visits- PPO 20% coinsurance after deductible EPO providers 10% co insurance after deductible Out of Network 30% coinsurance after deductible.
Emergency Room- PPO 20% coinsurance after deductible EPO providers 10% co insurance after deductible Out of Network 30% coinsurance after deductible.
Hospital Services PPO 20% coinsurance after deductible EPO providers 10% co insurance after deductible Out of Network 30% coinsurance after deductible.
Mental Health/Substance Abuse PPO 20% coinsurance after deductible EPO providers 10% co insurance after deductible Out of Network 30% coinsurance after deductible.
Prescription Drugs (No out of network option) Max Out of Pocket "The medical and Pharmacy deductibles and out of pocket maxes are integrated"
All below are 34 day supply retail figures.
Generic Drugs /Tier 1 10% Coinsurance after deductible
Preferred Brand /Tier 2 20% Coinsurance after deductible
Non-Preferred Brand /Tier 3 20% Coinsurance after deductible
Multi-Source Brand 20% Coinsurance after deductible
Notes from Flyer on HSA- 1) Currently DO NOT HAVE payroll deduction for HSA
Max Contribution $4,300
Connect with Bank of Choice to set up account. Also mentions that "savvy" investors can set up a Health Savings Brokerage account. Does not mention an specific vendors.
MY Pertinent information
Age Jan 1 2025 49 & 7 months.
Single. No dependents.
Currently don't spend much on medical bills. Don't take prescription meds (used to take Statins, changed diet and do not take them anymore) Only current regular procedures- 5 year colonoscopy. Just had in summer. Next due in 2029.
Currently Max out 457b plan Roth 457b plans such that I am remain in the 12% bracket. This results in take home income of about $2,600 a month on average. In 2025, I will be eligible for the 50 year old 457b catch up contribution amount of $7,500.
Given that the premiums are fairly similar - $13.00 a month difference, and given the financial info given regarding retirement savings and additional savings capabilities, does it make sense to go to the High Deductible plan?
All thoughts welcome.
For the first time, employer is offering a high deductible health insurance plan, therefore making me eligible for a HSA. Not very knowledgable about the subject, and looking for other's input and experiences to decide if that is the route to go. I may be mistaken, but I think my situation might be different than others in the private sector due to a relatively low insurance premium for current deductible as well as income level.
Comparison:
Regular PPO plan (With EPO OPTION)
Monthly Premium $100.14
PPO Deductible $800 (Blue Connect EPO option with EPO providers) $600 Out of Network Deductible $800
Coinsurance after Deductible PPO 90%/10% EPO providers 90%/10% Out of Network 70%/30%
NOTE:- Not sure why the info flyer presents the info in this particular format here "90%/10%" put lists it differently elsewhere. Is there something key to that?
Annual out of pocket max: PP0 -$2750 EPO Providers $2,500 Out of Network- $2750.
Lifetime Max- All Unlimited.
Preventative Care- PPO -100% EPO providers 100% Out of Network- Not Covered.
Office Visits- PPO $30-$50 EPO providers $25-$45 Out of Network 30% after deductible.
Emergency Room- All 10% after Deductible
Hospital Services PPO- 10% after Deductible EPO 10% after deductible Out of Network 30% after deductible.
Mental Health/Substance Abuse PPO- 10% after Deductible EPO 10% after deductible Out of Network 30% after deductible.
Prescription Drugs (No out of network option) Max Out of Pocket $5150
Generic Drugs /Tier 1 34 day supply Retail $15 90 Day Mail Order $30
Preferred Brand /Tier 2 34 day supply Retail $40 90 Day Mail Order$80
Non-Preferred Brand /Tier 3 34 day supply Retail $60 90 Day Mail Order$120
Multi-Source Brand 34 day supply Retail $7590 Day Mail Order $150
HIGH DEDUCTIBLE PLAN:
Monthly Premium $87.08
PPO Deductible $3000 (Blue Connect EPO option with EPO providers) $2,000 Out of Network Deductible $4,000
Coinsurance after Deductible PPO 20% EPO Providers 10% Out of Network 30%
NOTE:- Is there any significance to this being written differently than with the Regular plan above?
Annual out of pocket max: PP0 -$6000 EPO Providers $5000 Out of Network- $10,000.
Lifetime Max- All Unlimited.
Preventative Care- PPO -100% EPO providers 100% Out of Network- Not Covered.
Office Visits- PPO 20% coinsurance after deductible EPO providers 10% co insurance after deductible Out of Network 30% coinsurance after deductible.
Emergency Room- PPO 20% coinsurance after deductible EPO providers 10% co insurance after deductible Out of Network 30% coinsurance after deductible.
Hospital Services PPO 20% coinsurance after deductible EPO providers 10% co insurance after deductible Out of Network 30% coinsurance after deductible.
Mental Health/Substance Abuse PPO 20% coinsurance after deductible EPO providers 10% co insurance after deductible Out of Network 30% coinsurance after deductible.
Prescription Drugs (No out of network option) Max Out of Pocket "The medical and Pharmacy deductibles and out of pocket maxes are integrated"
All below are 34 day supply retail figures.
Generic Drugs /Tier 1 10% Coinsurance after deductible
Preferred Brand /Tier 2 20% Coinsurance after deductible
Non-Preferred Brand /Tier 3 20% Coinsurance after deductible
Multi-Source Brand 20% Coinsurance after deductible
Notes from Flyer on HSA- 1) Currently DO NOT HAVE payroll deduction for HSA
Max Contribution $4,300
Connect with Bank of Choice to set up account. Also mentions that "savvy" investors can set up a Health Savings Brokerage account. Does not mention an specific vendors.
MY Pertinent information
Age Jan 1 2025 49 & 7 months.
Single. No dependents.
Currently don't spend much on medical bills. Don't take prescription meds (used to take Statins, changed diet and do not take them anymore) Only current regular procedures- 5 year colonoscopy. Just had in summer. Next due in 2029.
Currently Max out 457b plan Roth 457b plans such that I am remain in the 12% bracket. This results in take home income of about $2,600 a month on average. In 2025, I will be eligible for the 50 year old 457b catch up contribution amount of $7,500.
Given that the premiums are fairly similar - $13.00 a month difference, and given the financial info given regarding retirement savings and additional savings capabilities, does it make sense to go to the High Deductible plan?
All thoughts welcome.
Statistics: Posted by coachd50 — Sat Oct 26, 2024 12:07 am