r/HealthInsurance • u/AutistOctavius • Dec 04 '24

Plan Choice Suggestions But seriously, where do you get the "good" health insurance? Who's getting the "good" healthcare?

What I'm told is, the working class are the ones who struggle with healthcare/insurance. If that's so, what are the well-to-do doing for health insurance?

Suppose I had an enlarged prostate and wanted a laser prostatectomy. And I don't want a long wait or for my insurance to labor over whether I've had too many prostate procedures this year to approve the surgery. How do I get that?

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u/vin_nm Dec 04 '24

High deductible + HSA all the way! We spend less doing it this way.

9

u/dopamaxxed Dec 05 '24 edited Dec 05 '24

this is what my entire family does, can confirm its the best way

plus we usually hit out of pocket max bc of health issues which "helps" (lol) & right after we do we try to cram every appointment, treatment, & med refill in before the end of the year

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u/Bobzyouruncle Dec 05 '24

The year my wife gave birth I went to every doctor under the sun to take advantage of that family OOPmax. Thanks, kid!

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u/j2thebees Dec 06 '24

Our daughter was born in a hospital years ago, when my wife worked there. We literally got an itemized statement with $0.00 about a month after her birth. We were young. It was glorious. That was their policy.

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u/tothepointe Dec 09 '24

One year I got surgery on Xmas Eve because by then it was free. Was checked out of the hospital and followups done by New Years. Of course that was in the good old days of $2k max out of pocket.

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u/[deleted] Dec 06 '24

This is my strategy also lol. I plan births around this strategy.

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u/stripmallbars Dec 08 '24

Exactly what I do

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u/CommanderMandalore Dec 05 '24

Only works if you don’t have expensive prescriptions. If you have cheap or generic prescriptions it would work. My math.

Cost for 2 people with low deductible. $290/biweekly: $7,540 a year. Deductiable $1500. Prescriptions $10 to $40 unless it’s like some high end expensive when there is a generic available. Cost to me/wife: $30/month. 360

Total: $7,900

High deductible: No prescription coverage before deductable. Company contributes $1,500 to HSA annually. $7,500 deductible and max out of pocket

Prescription cost: $200-700 a month. Could hit $7,500 then have to pay for health insurance premium at $1,200 a year. So no High deductible would be much worse for me and wife.

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u/[deleted] Dec 08 '24

[deleted]

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u/tothepointe Dec 09 '24

If you use a high deductible with an HSA properly it won't

With a HSA you can contribute $4150 a year as an individual tax free but then you can invest that money while your not using it for expenses so it can grow tax free. A year or two of doing this enables you to have more than enough to cover a bad health year. If your bad luck still continues then you can switch to a different plan the next year.

HSA isn't a use or lose it thing either.

An HSA can also be used as a regular retirement account when your 65.

HDHPs often still cover preventative medicine and some televisits.

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u/klsklsklsklsklskls Dec 05 '24

Obviously there are scenarios where it's not a better option.

But in your HDHP scenario you're paying 7500 OOP max and then 1200/ year worst case scenario? So 8700 total. I dont know if I'd call 8700 which us basically 10% higher "much worse" than 7900. And Ilyour prescriptions have a huge range- 200 to 700 a month? You might not even hit the 7500 OOPM. Also- have you looked at ways to get your medication cheaper outside of insurance? Goodrx, costplusdrugs, etc?

Also if you have other costs in scenario 1 (Dr's apps, etc) you still have a deductible in addition to you 7900 insurance cost and 360 prescriptions for another 1500 in costs possible, whereas if you do hit the OOPM on option 2, those contribute to it.

Obviously you know your situation better than I do, so I'm not arguing its better for the more expensive plan in your case, just that it's closer than you think probably.

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u/pterencephalon Dec 06 '24

One medication alone for me costs over $3000 per month. There are no generics or alternatives. Same for me husband. We would 100% hit the OOP on a HDHP before the end of January. It would cost us a lot more money overall, too, but I'm sure for everyone it depends on the particulars of the premiums and the deductibles.

But it's also absurd that we have to worry about this at all. No other developed country has such a fucked up health insurance system.

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u/silasmoeckel Dec 09 '24

Hate to break to to you but as somebody that also has a 4k a month med it's simply not covered in many government run healthcare systems like NZ.

T1D and they wont cover CGM or modern pumps because those cost more.

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u/Itchy_Appeal_9020 Dec 05 '24

Yes, but if you’re rich/financially comfortable, a couple thousand dollars doesn’t really make a difference. One plan might be a few thousand dollars more expensive, but that’s not going to impact your life if you have a high income. Tens of thousands of dollars might hurt more, but a few thousand won’t.

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u/tothepointe Dec 09 '24

The best time to start with the HDHP is when your young and not using your healthcare anyway and when your employer kicks in some towards a HSA. That's like free money to tuck away for the future.

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u/No-Specific1858 Dec 06 '24

$7,500 deductible and max out of pocket

This sounds pretty high for an HSA eligible plan. My deductible is $2,500 and I get a similar seed contribution to the HSA.

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u/CommanderMandalore Dec 06 '24

I thought the IRS minimum was 5K.

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u/No-Specific1858 Dec 07 '24

It was $1,600 for individuals and $3,200 for family coverage in 2024.

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u/tothepointe Dec 09 '24

Yeah mine is $4k deductible (combined medical/pharmacy) and $8k for family with a $2k HSA contribution. So sounds right if its a family deductible but probably has a lower individual deductible to hit. The premiums are really low though $800 a year. So the lower premiums plus the HSA contribution make up for it.

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u/tothepointe Dec 09 '24

A lot of high deductible plans cover everything at 100% once you've hit the deductible as long as it's in network. They also have a combined medical/pharmacy deductible.

I think your only coming out slightly ahead with the non high deductible if HDHP is only $1200 in premiums per year for only a $6k increase in deductibles plus $1500 towards your HSA. Then you could contribute another $2500 tax free on your own.

HSA's are triple taxed advantaged. Being able to invest your HSAs funds is on of the biggest advantages.

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u/CommanderMandalore Dec 09 '24

I’m going to double check my math later but I think I would save $3000 a year by switching to High deductible plan. I would also get like $1600 a year in a HSA. Nice savings

I would be spending $500 a month or more on prescriptions. I take one expensive prescription and my wife takes 3.

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u/tothepointe Dec 09 '24

Yeah and if you put that $3k in your HSA at least for the first year or two until you've built up a buffer you'll be sweet.

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u/CommanderMandalore Dec 09 '24

No I won’t because all the money would be used on prescriptions…..

edit: If I use all the money I get from my employer in HSA plus difference in lpremiums it will be less than the deductible for HDHP and I expect I would meet it due to prescription cost. Otherwise prescriptions are like $20 for a 90 day supply.

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u/tothepointe Dec 10 '24

Well the real advantage of the HSA is to not to have to take it out so it can be invested and grown. If your going to take the HSA out in the same year then you might as well go for the other plan.

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u/tothepointe Dec 10 '24

Definately for young workers I would always say take the HSA option and let your HSA build up an invest and then by the time health problems kick in you might have $50-100k stashed away so you don't have to stress. Why I wish I'd known about it earlier

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u/CommanderMandalore Dec 10 '24

I’m fairly young. So is my wife. The problem is you only need to take 1 or 2 expensive pills and suddenly like you said might as well as go with the more expensive option.

ADHD meds for example are often $300 or more per month even with generics. Zofram which is a common anti-nausea med is $500 for 30 days. That is the generic. I’m sure others can point other common meds younger people take and how expensive they can be.

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u/tothepointe Dec 10 '24

With my current plan they are exactly the same except for the deductibles so I go with the HSA one to get access to HSA. Employer kicks in $2k into it each year which is the difference between the 2 deductibles but the premium is 1/2 the cost.

I haven't used my insurance for anything other than a checkup in 4 years but have been maxing out the HSA every year while I can.

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u/remainderrejoinder Dec 05 '24

If I was an employer this would be my goto. High deductible and pay into HSA for the employee.

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u/FinishExtension3652 Dec 05 '24

I worked for a startup that provided an HDHP with  no HSA contribution,  but you could expense costs up to your deductible. 

I now work at a US office of a European tech company and it's fantastic.  Family HDHP with $3600 HSA contribution, $3200 deductible, and $5k out of pocket max costs me $244/month.  Also, 30 sick days in addition to PTO.  

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u/No_Pen_6932 Dec 05 '24

Are they hiring?

1

u/wolfmann99 Dec 05 '24

Federal govt has very european like benefits.

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u/Specialist_Crab_8616 Dec 06 '24

Nothing that good!

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u/remainderrejoinder Dec 05 '24

Yeah, I should have specified the HSA needs to largely cover the deductible.

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u/Bobzyouruncle Dec 05 '24

I worked for a startup that provided an HDHP with  no HSA contribution,  but you could expense costs up to your deductible. 

Are you talking about some sort of QSEHRA? Because most HDHP are eligible for HSA accounts even if your employer doesn't set one up or contribute to it for you. As long as it qualifies for an HSA you can open an HSA account anywhere you want and fund it; then deduct it on your tax return (1040). Unless you're talking about some sort of special health reimbursement arrangement you cannot just deduct medical expenses (at least not federally) until they exceed like 7.5% of your AGI. And even then it's just the excess over that amount (and premiums don't count as expenses unless it's cobra).

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u/FinishExtension3652 Dec 05 '24

There was an HSA, but there was no employer contribution of money into it. Instead the employer would reimburse you directly for costs up to the deductible    IIRC, it counted as regular income so it was still taxed. 

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u/carolinababy2 Dec 05 '24

I work for a municipality and my plan is very similar.

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u/Specialist_Crab_8616 Dec 06 '24

That’s incredible

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u/FinishExtension3652 Dec 06 '24

Yeah, I didn't even believe it at first. 

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u/FuckinHighGuy Dec 06 '24

3200 is not a high deductible plan. My PPO has the same deductible and oop max (family plan)

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u/FinishExtension3652 Dec 06 '24

It technically is, though it's the minimum possible allowed while legally being considered an HDHP.

At my previous company,  it was $7k for the family deductible. 

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u/JThereseD Dec 05 '24

When my dad owned his company, his priority was providing great insurance for his employees because he viewed it as an effective way to keep good employees. He provided a comprehensive Blue Cross health plan with no deductible or coinsurance and no payroll deduction for premium. As soon as he retired in 2000, his replacement eliminated that plan and offered an HMO with copays and employee contributions to payroll. It did not go over well with employees.

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u/remainderrejoinder Dec 05 '24

That's too bad. Yeah, HMOs in particular are really unpopular.

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u/bs2k2_point_0 Dec 09 '24

One place I’ve worked at did a hdhp with no hsa. In lieu of an hsa they did an hra. The annual deductible on a family plan was awful, like $12k. However, we’d only be responsible for the first thousand, and the last thousand. Anything over the first grand up to the last was either reimbursed or paid directly by the company.

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u/shmuey Dec 05 '24

As a small business employer, offering an HDHP doesn't really save us money if we also are contributing into the HSA.

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u/remainderrejoinder Dec 05 '24

Obviously you could save more by contributing less, but by giving them the ability to reap the rewards of saving you will change behavior. The coupon clippers will start shopping around - which is great because prices are sharply different from doctor to doctor.

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u/shmuey Dec 05 '24 edited Dec 05 '24

I think the average person doesn't know or care about that though. They want an affordable rate (which is achieved with a healthy company subsidy) and to minimize their costs when they use providers, which high premium plans offer. This group obviously has a very different mindset and it's far from mainstream. FWIW we offer a mid deductible HDHP ($2500) and have had zero takers. They all go for the $1000 deductible plan with minimal costs to them.

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u/remainderrejoinder Dec 05 '24

That's good feedback thanks. Hdhp w/ HSA should appeal to young people especially but I guess it's a mindset -- gold star plan means low copay low coinsurance to most people.

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u/Dazzling_Pen6868 Dec 05 '24

It pisses me off to no end than my workplace doesn't offer an HSA, and that their lowest cost plan is $500 off from qualifying for an HSA I could open on my own 

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u/Karen125 Dec 05 '24

Me too. I only fund the HSA for $3,000 a year and I hardly use any of it. It just feels good to know it's there.

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u/[deleted] Dec 05 '24

Do you invest it? Because I think investment gains on it are also tax free

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u/klsklsklsklsklskls Dec 05 '24

They are. Furthermore you can "Save" your medical expenses if you pay out of pocket, so keep receipts. Have $2k in expenses per year you can afford? Pay that out of pocket, keep money in HSA, keep receipts. Money grows tax free. 10 years later you need 2k for something? Reimburse yourself with your receipt, you can withdraw the money tax free.

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u/miffrose99 Dec 05 '24

Genius-I thought it had to be same year! Redditing pays off for me today. Ty!

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u/klsklsklsklsklskls Dec 05 '24

Yeah, it's the most tax advantaged account- tax free contributions AND tax free growth/withdrawals. So it makes sense if it's in an account with good investment options and low costs to just contribute and pay your expenses out of pocket until you need the money later. Create a folder on a Google drive or something and just upload receipts every year or as you get them.

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u/tothepointe Dec 09 '24

Nope! Save your receipts and use it as another retirement account.

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u/Karen125 Dec 05 '24

I didn't know that, but there have been times when I've had the funds available to pay the bill, so I added extra to the HSA and then paid the bill.

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u/HaymakerGirl2025 Dec 05 '24

This is the answer. I have catastrophic only.

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u/newintown11 Dec 06 '24

High deductible HSA plan and I cash pay. Procedure in a couple months will cost me $1400 as cash pay, would cost more with insurance to meet my $7000 deductible lol. Basically the insurance is useless unless there was a catastrophe or hospital stay

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u/nfg-status-alpha9 Dec 07 '24

This. As a single person, I save more than $5,000 a year in premium plus out of pocket costs.

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u/[deleted] Dec 10 '24

HSA confused me , dam it. How Does it work