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Old 11-05-2012, 09:24 PM   #1
akshatp
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Default Confused about Health Plan choices -- HELP

Our northeast based company got bought by some backwards ass country bumpkin company from Missouri and with it come their midwestern values and policies.

We used to have a wide selection of great and simple healthplan choices, now we are faced with only two confusing choices. Both are WAY more expensive and both offer WAY less than what our current plan gives us, but nothing I can really do about that. Good thing we had our baby this year.

Can someone help me decipher them and pick one? I have a wife and newborn child that will be on the plan.

Incidentally, my wife works for the same company, so I need to know whether to have one plan with her and the kid on it, or for me to have my own and her to have her own, with the kid on one of ours.

Here are the two breakdowns:

Lower payroll deduction option
http://pics.bbzzdd.com/users/akshatp...icePlanHRA.jpg
$56.31 Self / $114.46 Self + Spouse / $102.92 Self + Child / $163.38 Family

Higher payroll deduction option
http://pics.bbzzdd.com/users/akshatp/BasicPlanPPO.jpg
$69.23 Self / $148.15 Self + Spouse / $126.92 Self + Child / $213.23 Family

Help me pick one. Im so confused.
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Old 11-05-2012, 10:00 PM   #2
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If you go to the doctor a lot, choose the higher deduction plan. If you only go for annual checkups, choose the lower deduction. The visits for the baby (every 3 months) will be considered wellness and covered at 100% so don't count those.

Can't really comment on whether to have one or two plans without seeing the costs. Usually less expensive having the plans separate in CA, however, you lose a few benefits. For instance, the family out of pocket max on the high deduction plan will be met when 2 indviduals meet their max.

Worst case scenario is that you use the plan for more than $3750 for all 3 of you in a year. If you're on the same plan, you could potentially save $3750 by being on the same plan. Separate plans and you will all pay the individual $3750.
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Old 11-05-2012, 10:57 PM   #3
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Will you have a flexible spending account or a health care spending account to go along with your medical plan?

You'll need to guesstimate how much you'll end up paying out of pocket under each plan, and add the annual premium to each figure. If the difference isn't that much, you might be better off with the more expensive plan.
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Old 11-05-2012, 11:01 PM   #4
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Need to know the payroll deductions for each plan and for individual, family and individual + child to make any real recommendations.

I know with our plans, the price difference that comes out of our paycheck to jump from the high deductible plan to the old school ppo is more than the deductible on the high ded plan. Right out of the gate you are very far behind with the pricier plans.
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Old 11-05-2012, 11:13 PM   #5
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yep as others said, we need to know premiums for each, or at least difference in premiums.
Both of these plans seem to be high deductible plans, so you will not get any coverage until you pay deductible. They better have low premiums.
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Old 11-05-2012, 11:20 PM   #6
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Consumer Choice $56.31 Self / $114.46 Self + Spouse / $102.92 Self + Child / $163.38 Family

Basic $69.23 Self / $148.15 Self + Spouse / $126.92 Self + Child / $213.23 Family

We get paid every two weeks so its essentially each of those numbers x26 for the year.

I will be contributing to an FSA to pay for medical expenses.

Still confused about the "HRA" plan -- Apparently my company contributes some money which I can use for medical expenses and after that runs out then it becomes "co-insurance"
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Old 11-05-2012, 11:25 PM   #7
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Go with the higher deductible plan that has the HRA reimbursement amount and supplement it with FSA or HSA.
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Old 11-06-2012, 01:08 AM   #8
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Go with the higher deductible plan that has the HRA reimbursement amount and supplement it with FSA or HSA.
I agree, high deductible plan should be less costly in most situations. Reimbursement will take care of the premiums. You'd want to put your wife with the child, that would be quickest way to get to use the benefit after deductible. Contrary to what I said before, second plan isn't high deductible plan, it would make sense to use if you or your family go to doctor very often. Even then, it would get pretty close to first plan, total cost wise.
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Old 11-06-2012, 06:44 AM   #9
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You are paying $56 for each body being covered, in any combination for the consumer choice and $70 per body in any combination for the basic.

If one gets Self+Child and the other gets self; you will save about $10-15 overall
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Old 11-06-2012, 07:06 AM   #10
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With the HRA plan it looks like the company will provide a $1,000 amount (single). Since you can use that amount to offset the deductible that plan is more like a $1,000 deductible plan.

I *think* you're better off sticking with the same plan for the family. In addition to the slight premium savings, you also have family deductibles/out-of-pocket maximums that are only 2 times single for the whole family. If you pick separate plans I think you lose that advantage.

I think someone else mentioned this already, but I think it really comes down to doctor's visits. With the HRA you ahve to pay deductible/coinsurance, but on the PPO it's copay with no deductible. If you have a lot of (non preventive) office visits then you should go for the PPO.
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Old 11-06-2012, 07:33 AM   #11
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They seem so close in price overall id just go with the more expensive plan. Our 2 plans for one cost a lot more than either of those and the monitary gap between both is a lot larger than yours.

You lucky

Also self for you and self+child for her on the more expensive plan saves you $17/m

Edit. I was thinking those prices were monthly not bi-weekly. But overall i think id just do what i recommended before.
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Old 11-06-2012, 09:24 AM   #12
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I'd go with the HRA. I'm an advocate of PPO's, but damn that PPO plan is a pile of shit. 75% in network. That is a joke. And $7,500 out of pocket for the family is worse than the HRA.
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Old 11-06-2012, 09:39 AM   #13
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Wow, those area CHEAP

I'm paying $400 a month just for me and my wife (job plan)......with kids it would've been $900.....
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Old 11-06-2012, 10:48 AM   #14
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Quote:
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Wow, those area CHEAP

I'm paying $400 a month just for me and my wife (job plan)......with kids it would've been $900.....
It's likely a function that your company is subsidizing a lower % of the total cost. Starting in 2013 you should be able to see on your W-2 what the total cost of coverage is (required by health care reform) and figure out how much your company is picking up versus what your share is.
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Old 11-06-2012, 10:56 AM   #15
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It's likely a function that your company is subsidizing a lower % of the total cost. Starting in 2013 you should be able to see on your W-2 what the total cost of coverage is (required by health care reform) and figure out how much your company is picking up versus what your share is.
we are under 50 employees company, and lucky to even have ANY insurance

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Old 11-06-2012, 11:35 AM   #16
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Quote:
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Wow, those area CHEAP

I'm paying $400 a month just for me and my wife (job plan)......with kids it would've been $900.....
I'd assume that your deductibles, percent coverage, and out-of-pocket maximum are all much better than the OP's.
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Old 11-06-2012, 06:57 PM   #17
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Quote:
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Wow, those area CHEAP

I'm paying $400 a month just for me and my wife (job plan)......with kids it would've been $900.....
I've seen plans with single person cost about $500, so it could be that your company is not contributing much towards premium, if anything at all..
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Old 11-06-2012, 09:14 PM   #18
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So, plan A is 4247.88

Plan B is 5543.98

So plan A is starting out $1300 cheaper.

Sometimes an employer will subsidize the employees plan more than their dependents so that it might make sense for you and your wife to sign up separately. In this case the rate is pretty much the same across the board so you want to do a family plan so that your individual deductible and coinsurance will contribute to the family bucket to stop cost sharing sooner.

Well coverage is going to be paid at 100% for either plan, so free checkups, etc for everyone. What you will pay for will be sick care. I know our daughter 23 mos old used around $600 worth of care this year on our high deductible plan. If you track your medical expenses you can make a decent guess at where you will be next year, you can also usually log into your current plan and see where everyones usage is at.

Now if you are with the high deductible plan and you use up your $2k of free money, you will be on the hook for a decent chunk of deductible. Here it doesn't make a lot of sense to me, though it may be a product I'm not used to. It shows a deductible only for the EE(subscriber/emoloyee/main person on account). Usually each person has a separate deductible. After that you pay for 20% of everything until you hit the out of pocket max.

With the PPO, you have a small $400 deductible per person, and then have to pay 25% of each bill till you hit the 7500 oop max.

I'd honestly lean towards the HDHP. If you have mild usage and stay under the $2k in free cash it is a no brainer. The PPO for mild usage will hit you hard with the individual $400 deductibles. If

you have mid range usage with some ER visits or outpatient care it may be possible that the PPO comes out ahead, but I doubt it.

If you have a major unexpected catastrophic event, you will probably be paying the full out of pocket max for either policy. But it is lower on the HRA/HDHP at 7k with the free 2k vs the full 7500k for the ppo. '

Something that isn't in all this is the pharmacy benefits on the plans. Sometimes they fall under the same deductible as the medical plan, but it is probably a copy situation if it wasn't listed on each summary.

The deductible plans tend to work out cheaper for most people, but are different and some will avoid them. If you can, try and take the time going forward to track your annual expenses(I never use medical care, wife always has a few hundred of misc usage, and kids always get sick) and then you can test future plans against what you can reasonably expect to happen. Of course its also always worth considering the catastrophic case, but most years will be humdrum.

I think I rambled, feel free to PM with specific questions, this kind of thing has a lot of caveats and usually works better as a phone or in person conversation.



With Plan A, you are going to be given a fund to pay for your first $2k of care. If you don't think you will go over that, you are golden.
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Old 11-06-2012, 09:24 PM   #19
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Quote:
Originally Posted by Turin39789 View Post
So, plan A is 4247.88

Plan B is 5543.98

So plan A is starting out $1300 cheaper.

Sometimes an employer will subsidize the employees plan more than their dependents so that it might make sense for you and your wife to sign up separately. In this case the rate is pretty much the same across the board so you want to do a family plan so that your individual deductible and coinsurance will contribute to the family bucket to stop cost sharing sooner.

Well coverage is going to be paid at 100% for either plan, so free checkups, etc for everyone. What you will pay for will be sick care. I know our daughter 23 mos old used around $600 worth of care this year on our high deductible plan. If you track your medical expenses you can make a decent guess at where you will be next year, you can also usually log into your current plan and see where everyones usage is at.

Now if you are with the high deductible plan and you use up your $2k of free money, you will be on the hook for a decent chunk of deductible. Here it doesn't make a lot of sense to me, though it may be a product I'm not used to. It shows a deductible only for the EE(subscriber/emoloyee/main person on account). Usually each person has a separate deductible. After that you pay for 20% of everything until you hit the out of pocket max.

With the PPO, you have a small $400 deductible per person, and then have to pay 25% of each bill till you hit the 7500 oop max.

I'd honestly lean towards the HDHP. If you have mild usage and stay under the $2k in free cash it is a no brainer. The PPO for mild usage will hit you hard with the individual $400 deductibles. If

you have mid range usage with some ER visits or outpatient care it may be possible that the PPO comes out ahead, but I doubt it.

If you have a major unexpected catastrophic event, you will probably be paying the full out of pocket max for either policy. But it is lower on the HRA/HDHP at 7k with the free 2k vs the full 7500k for the ppo. '

Something that isn't in all this is the pharmacy benefits on the plans. Sometimes they fall under the same deductible as the medical plan, but it is probably a copy situation if it wasn't listed on each summary.

The deductible plans tend to work out cheaper for most people, but are different and some will avoid them. If you can, try and take the time going forward to track your annual expenses(I never use medical care, wife always has a few hundred of misc usage, and kids always get sick) and then you can test future plans against what you can reasonably expect to happen. Of course its also always worth considering the catastrophic case, but most years will be humdrum.

I think I rambled, feel free to PM with specific questions, this kind of thing has a lot of caveats and usually works better as a phone or in person conversation.



With Plan A, you are going to be given a fund to pay for your first $2k of care. If you don't think you will go over that, you are golden.
Wow thanks for the detailed reply. It cleared up some questions. I may take you up on your offer of PMing some other questions.

As for RX benefits, the company we work for is a PBM and those benefits are the same regardless of which medical plan we choose.

I think I am leaning towards the HRA plan. I hardly ever go to the doc, and I think between my wife and son we should be able to stay under the $2000 cap. Also, if I sign her up on her own plan, she also gets the free $1000 from the HRA right?

One thing I am confused about is the annual deductible of $2000 EE. I just dont understand how this comes into play in accordance with the HRA.

Another thing I just found out is that if either of us add the other on their plan, and we have insurance available ourselves (through our employer), there is a $100 surcharge per month to add the spouse lol. So it looks like I will have my own plan and she will have hers. Since the company charges for insurance based on salary, I will put the kid on hers because she makes less and her premiums will be slightly less.
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Old 11-07-2012, 09:11 AM   #20
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Wow thanks for the detailed reply. It cleared up some questions. I may take you up on your offer of PMing some other questions.

As for RX benefits, the company we work for is a PBM and those benefits are the same regardless of which medical plan we choose.

I think I am leaning towards the HRA plan. I hardly ever go to the doc, and I think between my wife and son we should be able to stay under the $2000 cap. Also, if I sign her up on her own plan, she also gets the free $1000 from the HRA right?

One thing I am confused about is the annual deductible of $2000 EE. I just dont understand how this comes into play in accordance with the HRA.

Another thing I just found out is that if either of us add the other on their plan, and we have insurance available ourselves (through our employer), there is a $100 surcharge per month to add the spouse lol. So it looks like I will have my own plan and she will have hers. Since the company charges for insurance based on salary, I will put the kid on hers because she makes less and her premiums will be slightly less.
It would probably be worthwhile to call or email a few questions to HR to clear up anything you are unsure on.

As I said, I'm still a bit unclear on if the deductible is only for the policy holder or if all members have some deductible. I know with our HRA plan, we go to the Dr for the first time in the year, and the allowed cost is $70. The bill gets paid by the HRA account, so our HRA balance goes down $70 and the payment also fulfills $70 of deductible. You don't pay anything when you go to the doc, they bill insurance, the bill gets reduced by the contract and then the insurance company pays the bill out of your HRA. Typically with HRA there is no card or anything for you to do, ins makes a little bank account for you and pays for your portion of the bill until it is used up. Whatever they pay applies to your ded or coinsurance max amounts, so whatever HRA funds you use for medical care(you may be able to spend the money for your scripts, and this wouldn't hit deductible) effectively lowers the deductible by the hra amount.

My wife's work just instituted the $100 surcharge this year as well(she doesn't work for a PBM company though). The idea behind it is that your company doesn't want to subsidize your spouses insurance if they can instead push her to get her own insurance through her own company. This shouldn't apply if you both work for the same company, as they are helping with the bill regardless, but you might want to double check.

As far as separate policies, a joint policy is usually better since you can cap out your Family Out of pocket(OOP) usually with 2 peoples deductibles, but there are always exceptions.

You would get extra HRA money with two accounts, as she would carry the kid and they would have $1500 to use, and you would get your own separate $1000. but you would also get more deductible to pay before the plan starts chipping in. The HRA money wouldn't travel from plan to plan, so while you get extra money total, this might not work out if we assume that you won't use any care. You are getting 1k just for yourself and they would get 1500, while with a single plan you would have less total free money but all 2k of it would be usable for spouse and child. It really depends on your personal situation but this is getting fairly nitpicky and you would probably be fine either way.

But this gets me back to your info sheet's odd 1 person deductible. Assuming this is true you get into all kinds of weird scenarios. If you are all covered under your name, then the ded only applies to you and you would only have to pay 20% of their costs. So you would want to put the policy in the name of the healthiest person, so that you get that instant 80% reduction of everyone elses costs.

If there is just one deductible, I think it would make more sense to get a single plan(possibly in your name if you are mr healthy, depending on how much extra your rate will be compared to hers).

If she will also have a deductible regardless, it may make sense to split the plans, but you would need to at least guess at what everyone's costs will be for the year and play the scenario out. The extra $500 in HRA may not make up for extra deductible and it would probably just sit in your account anyway. This all assumes(correctly I hope) that the $100 surcharge doesn't apply for spouses who work for the same company.
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Old 11-07-2012, 09:45 AM   #21
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The deductible thing is really weird - I highly doubt that the deductible only applies to the primary account holder, with no deductible for dependents. That would not make any sense in my mind. Much more likely is that there are deductibles for everyone (it looks like information probably got cut off in the plan summary)

Another thing you may want to find out is whether you are allowed to carry HRA money over to the next plan year if you have money left. This may make that plan more attractive over the longer term.

Remember one thing though, that HRA is really just a notional account and not a real bank account. If you leave your job, then you will lose any HRA account balance remaining.
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Old 11-15-2012, 11:40 PM   #22
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I went with the HRA plan for myself, and the Basic plan for the wife and kid.

Makes more sense since I hardly go to the Dr. and even this year (2012) when I had an ER visit I stayed well under the $1000 I will get from the HRA.

yuchai - any unused HRA funds roll over to the next year, to a max of $8000

Thanks everyone for your input.. Esp. Turin
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