r/HealthInsurance • u/Substantial_Deer_678 • Jul 12 '25
Plan Choice Suggestions Starting my first job with benefits! Could use help picking insurance!
Hi everyone. In the past I've always had my insurance through state programs, but am now starting a job that provides insurance as a benefit. (Yay!!) I used to have BCBS, and currently have Kaiser. I didn't like BCBS very much. I don't smoke, don't drink. I care most about mental health services, but I know those are kinda shoddy no matter who my provider is. Definitely planning on seeing quite a few doctors, since I've avoided it financially in the past. My gut tells me the Cigna OAP Exclusive is the way to go since the max out of pocket is low. I am a bit worried about Tier 3 and 4 drugs costing more, though that's just because being limited in the kind of medication I can get sounds like a problem--I rather get whatever I need.
Income: 165k
State: California
Age: 28M
I've attached photos, but here's a table too with the same info for anyone using a screen-reader :)
Thank you so much.
| Feature | Cigna OAP $2,000 HDHP HSA | Cigna OAP Exclusive $0 | Cigna OAP Classic $500 |
|---|---|---|---|
| Monthly Premium (Company pays the rest) | $44.32 | $51.46 | $42.76 |
| Deductible (Individual / Family) | $2,000 / $4,000 | $0 / $0 | $500 / $1,000 |
| Max Out-of-Pocket (Indiv / Family) | $2,000 / $4,000 | $1,500 / $3,000 | $3,000 / $6,000 |
| Preventive Care | 0% after deductible | $0 | $0 |
| Primary Care Visit | 0% after deductible | $20 copay | $20 copay |
| Specialist Visit | 0% after deductible | $20 copay | $20 copay |
| Telehealth Visit | 0% after deductible | $20 copay | $20 copay |
| Diagnostic Labs/X-ray | 0% after deductible | $0 copay | $20 copay |
| MRI/CT Scan | 0% after deductible | $200 copay | 20% coinsurance |
| Urgent Care | 0% after deductible | $20 copay | $35 copay |
| Emergency Room | 0% after deductible | $100 copay | $100 copay + 20% after deductible |
| Inpatient Hospital | 0% after deductible | $100 copay | 20% coinsurance |
| Outpatient Surgery | 0% after deductible | $125 copay | 20% coinsurance |
| Tier 1 Rx (30-day) | $0 | $5 | $10 |
| Tier 2 Rx (30-day) | $0 | $25 | $25 |
| Tier 3 Rx (30-day) | $0 | $50 | $35 |
| Tier 4 Rx (30-day) | $0 | 20% up to $150 | Same as Tier 2/3 |
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u/Donut-sprinkle Jul 12 '25
What’s the HSA employer contribution?
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u/Substantial_Deer_678 Jul 12 '25
$1000/year. Thanks for asking, I didn't even know what this meant. ($2000 for family, but I'm single).
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u/Donut-sprinkle Jul 12 '25 edited Jul 12 '25
With the HSA contribution, I would go with HSA PLAN
You can use the employer contribution for the deductible then you will only be responsible for $1k.
You should also consider contributing to your HSA as welll. There’s a few tax advantages to it.
Drugs most likely are Tier 1 is generic brand drugs
2 is some brand name drugs
3 is all name brand
4 is specialty drug like chemo
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u/Substantial_Deer_678 Jul 12 '25
That makes sense. Since deductibles reset every 1st of January, does it make sense to start with the Exclusive $0 plan, and then switch to the HSA plan when the open enrollment period comes around for January 1st?
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u/Donut-sprinkle Jul 12 '25
Check to see if the employer HSA amount is prorated and if so what would it be.
If it’s not Prorated, then that’s even better bc you will get the full $1k. HSA will also roll over to the next year!
I would sit down and do the math to see which plan would come ahead. And if that difference is worth it.
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u/Substantial_Deer_678 Jul 12 '25
Yea I see what you're saying! I'll ask my employer about whether it's pro-rated. Thanks so much for taking the time to help me think through the considerations :)
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u/HopefulCat3558 Jul 12 '25
The HSA is a great way to build up another nest egg. You should max out your contributions each year if you are able to. Deductions are tax deductible. And you can invest the HSA funds which will earn interest/gains tax free. And then qualified deductions are also tax free. You’ll commonly hear the at HSAs are triple tax free.
Also, if you are financially able to, you should pay whatever medical expenses you have out of pocket. Let the money in your HSA grow and then reimburse yourself later. My HSA permits me to upload the expenses and receipts online and decide when I want to reimburse myself. So I’ve loaded up a few years worth of expenses and won’t reimburse until much later when hopefully the balance has seen significant appreciation.
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u/CascadiaRiot Jul 12 '25
What happens to those receipts if you change jobs and have to roll that HSA elsewhere to avoid fees?
May be okay to keep a copy of those scans for yourself.
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u/HopefulCat3558 Jul 12 '25
I also have a separate copy but you’re entitled to keep your HSA if you leave. It’s your money forever.
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u/spiritofniter Jul 12 '25
Whoa, that’s a lot of contribution!
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u/Substantial_Deer_678 Jul 12 '25
I’m surprised too. They seem to really take care of their people :D
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u/Substantial_Deer_678 Jul 12 '25 edited Jul 12 '25
Edit: The premiums are biweekly, not monthly.
| Plan | Monthly Cost (≈) | Annual Cost |
|---|---|---|
| HSA | $92.55 | $1,111.76 |
| Classic $500 | $95.93 | $1,152.32 |
| Exclusive $0 | $111.48 | $1,337.96 |
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u/wishyouwould Jul 12 '25
OK, so first off, the Cigna OAP Exclusive $0 plan, in the middle there, is what I would describe as a "Cadillac Plan." This is extremely good coverage for extremely low premiums. Honestly, I had started to wonder if there were still employers offering this level of care and value any more. Further, I'd say that, for your described needs, I strongly believe that is the best choice. If you are going to see multiple physicians in the plan year, with each of them potentially needing to order attitional imaging and diagnostic testing, that is the option that will cost you the least. It also appears, to me, to be the option that will save you the most money if you were to have a major issue.
However, these are all SUPER interesting plans! And the premiums are all very low. So, usually a HDHP does not cover prescriptions until your deductible is met, which is one of the major drawbacks. This one DOES seem to cover prescriptions IN FULL without needing to meet deductible. I would be skeptical that this plan may be using a different formulary that may tier drugs differently than the other plan and/or exclude a large list of non-preventative medications, because if not, that *is* a pretty big value that is not normally seen in a HDHP. I would definitely check the formulary to make sure there are no excluded medications you think you might need BEFORE signing up for the HDHP, because if they are excluded, you will have to pay the FULL cash price with no contractual discounts. With that aside, though, for the HDHP, you will end up being responsible for a lot of costs, up to $2k, for physician services, labs, etc, so I still think, even with some potential prescription costs for the OAP Exclusive plan, you're more likely to save with that over the HDHP.
HSA accounts ARE incredible wealth-building vehicle, but I firmly believe that they are vehicles that are better to use/fund during years when you are not planning to *use* your healthcare much. That's kind of the point-- if you get the HDHP and then use a lot of healthcare, you have to pay for those expenses out-of-pocket, so the amount you're "saving" in your HSA is not as much. If you're planning on just having coverage in case the shit hits the fan, but not really seeing any doctors or getting many medications for the year, it's a great idea to get an HSA and fund it as much as you can for future expenses.
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u/Substantial_Deer_678 Jul 13 '25
Wow thanks for such a thoughtful response. Sounds like I really can’t go wrong either way. Maybe I’ll just track my healthcare expenditures this year and see if it makes sense to switch to the HSA after that.
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u/Magentacabinet Jul 12 '25
Questions:
How often do you go to the doctor?
Do you want to pay more for the coverage every month?
Or do you want to pay more when you go to the doctor?
Do you take any expensive medications that would be super expensive up front?
What network is your doctor in?
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u/Substantial_Deer_678 Jul 12 '25
I haven’t gone to the doctor much since I wasn’t well insured in the past, and am planning to do a bit of catch up. I also just moved to California, so I don’t have a doctor I specifically care about. But I assume the doctors with be the same in all plans since it’s Cigna. Feeling financially secure is definitely new to me, so i think my priority is just making sure I make the most of my finances and don’t squander it.
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u/MadeMeMeh Group Underwriter Jul 12 '25 edited Jul 12 '25
What is your standard or average healthcare usage in a year? Doctor appointments, blood work, pharmacy prescriptions, hospitals, etc? Is there something specific about this year that will change from what is normal?
I ask because if low the HSA is most likely the right decision. The HSA account is a pre-tax account (as in this money isn't taxed, so like a 401k). The goal is while young and healthy is to save up money in this account for the future. I for example have had an HSA for little over 10 years and even after a hospital visit last year I have near 20K in that account that I can use to cover healthcare expenses. There is a max you can put in the HSA per year which goes up slightly each year. It does suck when you go to the doctor and have to pay $150 or whatever because of the high deductible but when you have a hospital visit and you don't have to worry about the cost because you got it saved in the HSA is a weight off your mind.
However, if you are a frequent user then the exclusive $0 plan might be better. Since the copays will limit your costs throughout the year. Doing the math of benefit usage compared to premium will be important for this calculation.
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u/Substantial_Deer_678 Jul 12 '25
I haven’t gone to the doctor much in the past, and am hoping to catch up now. The HSA contribution max is more than the OOP max I think, so that’s good.
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u/NaiomiXLT Jul 13 '25
HSA all the way. Even if you have high utilization, the max you pay for healthcare is $2000. That’s good. Start contributing to the HSA if you can do not pay bills with the HSA account. When you’re older you can withdraw all the money you spent on healthcare tax free, while now it has Roth like growth potetional, while also being an income deduction for taxes now.
It’s the bees knees
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u/OldDude2551 Jul 12 '25
I’d get the OAP. Since you’re planning to see some doctors, the low deductible will serve you better, especially with low premium difference. If you’re only planning annual checkups then get the HDHP plan and try to maximize and keep your HSA.
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u/milster706 Jul 15 '25
For the Hospital rates….arent the % ones coinsursnce? I think that means you pay a % of the total amount instead of capped dollar amount. That can be a big risk.
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u/Donut-sprinkle Jul 15 '25
What did you end up going with?
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u/Substantial_Deer_678 22d ago
I ended up going with the 0 deductible plan for the time being since I'm expecting quite a few medical bills, and then planning to switch to the HSA during open enrollment :) Thank you so much for your insight.
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u/showtime013 Jul 12 '25
It kind of depends on your health status. IF you are a pretty healthy person where you expect to mostly see a primary care doc yearly and maybe have 1-2 sick visits then the exclusive plan seems to make most sense. You are unlikely to need tier 3-4 drugs (unless you wanted to use the weight loss drugs which could be in that tier)
If you have a few medical problems you have been putting off and would expect to see a pcp along with a few specialists, a few tests (MRIs, CT scans) and a few chronic medications the OAP 2000 or 500 would make more sense. The OAP 2000 makes the most sense if you have a few chronic conditions with historically expensive meds (Ulcerative Colitis, severe migraines, etc)
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u/AnotherNoether Jul 12 '25
High tier drugs are often going to be brand names with copay cards available
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u/loftychicago Jul 12 '25
I would check out how many restrictions are involved with your choice of doctors and hospitals for each plan. Don't just look at the dollars (unless they all have the same doctors and hospitals, then the dollars are the primary consideration. )
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u/SeaweedWeird7705 Jul 12 '25
If you go with Plan 1, it has a $2000 deductible. That means you pay your own care for the first $2000. It’s kind of like having no insurance at all. You pay your own doctor bills. Only if you are using lots of care will you get past the $2k deductible.
Plan 2 has a zero deductible. I think Plan 2 works better for many young people for this reason.
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u/Brethgyk Jul 12 '25
Plan 2... I hate having a HDHP and having a fear of going to the doc because of how much it costs (yay america) Plus the premium for your HDHP is really high for that type of plan. Your net pay will differ by a few bucks in the end... Plan 2 all the way.
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u/eyeiscauseiam Jul 12 '25
I’d go with either the HSA or the Exclusive. The plan I’m currently on through Amazon seems kind of like a mixture of both and I wouldn’t trade it for anything. I have a $3000 individual deductible but it’s almost impossible to meet because Cigna damn near fully covers everything and whatever minimal copay they don’t I just pay with my HSA (basically free money, the way I see it I was gonna pay it in taxes anyway). I get multiple medications fully covered (one of which is $3k without and was like $950 when I was on Aetna) and last year I had an unexpected health scare that resulted in several hospital stays and about $250k worth of medical bills, I was only liable for like $2k and they gave me access to a medical concierge and a dietician while I recovered.
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u/Substantial_Deer_678 Jul 12 '25
Wow I’m so glad that worked out for you, that must have been so stressful!
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u/eyeiscauseiam Jul 13 '25
Thank you, the health stuff was but i at least had the clarity at the time to make sure i went to an in network hospital and I didn’t have to worry much about the bills, I knew I had decent copays and money in my hsa so I was able to just focus on my recovery the whole time.
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u/Bogg99 Jul 13 '25
The first 2 are both really good plans but with different strengths. 3rd plan is not worth considering.
If employer is contributing significantly to HSA and you think you'll use a decent amount of insurance I'd go with first plan but understand that you'll be paying for everything until deductible, so the bill will be higher. There's also the benefit of free prescription coverage with this plan If you don't think you'll hit your out of pocket max but expect to have a few Dr appointments the second plan is the better value because you'll just have copays but there will be copays on prescriptions and you doing get HSA savings
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u/mattyofurniture Jul 13 '25
I compare the Out of Pocket Max for the year versus the annual premium and use that to help me decide. Assuming I have some crazy medical event, what’s the most amount of money coming out of my pocket that year? I’m a big fan of low OOPmax but if it’s at the expense of a doubling or even tripling in premium, I’d think long and hard about it.
These seem to be some excellent plans presented here. Personally, I’d go with the “Exclusive”.
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u/boosayrian Jul 12 '25
The healthcare savings account (that comes with an HSA) is one of the greatest individual wealth-building tools in the modern era. Start contributing the max now when you’re young and invest it. By the time you’re mid-40s you’ll have a massive healthcare nest egg.