Opinions about high-deductible health insurance plans?

[wendow]

My DH's employer switched to high deductible plans 5 years ago. That is all they offer. We put the max in the HSA from the first year. DH became ill, but no one knew what was wrong with him. We visited every specialist, and were still ok with the high deductible plan because everyone was in network. Then he was diagnosed, and the specialist we needed to see was not in network. We had a $6000 in network deductible, which we hit early every year until then between the two of us. But now, his specialist had a separate out of network $6000 deductible. So, we didn't hit either. Also, in 2017, he ended up needing to get IV treatments twice a week for 3 months. Didn't hit the $6000 until the end of November. There went the entire HSA buildup. So, basically, for the last 2 years we paid everything out of pocket because we just missed the deductible, and now we have no cushion in the HSA.

So, the high deductible plans are great unless someone suddenly becomes ill, there aren't many specialists in the field, and you're forced outside of the network. Then it gets pricey very fast!

This year, I'm going to check out options outside of his employer, while I can still get something that accepts preexisting conditions. Just in case.

This is pretty much our story with our dd18. She got sick 3+ years ago with a mystery illness, and we were on a HDHP. We ran through the max OOP (10k) in a year and ran through our maxed out HSA...the doctor who she ended up needing was not a doctor our health plan covered so we still have had to pay all bills OOP. It's crazy expensive and has really depleted what was a once healthy savings account. During the midst of all this, I was told the number one reason for bankruptcy is medical bills. I have no idea if that is true but I can believe it.

ETA: My dd still is in treatment and we pay OOP but the cost is not as bad now as she needs less care.

 

[tvguy]

During the midst of all this, I was told the number one reason for bankruptcy is medical bills. I have no idea if that is true but I can believe it..

Number one reason for bankruptcy is medical bills incurred by people with no health insurance. Most of our hospitals here are not for profits so most will set up a payment plan for any balance or forgive your portion in some cases. We've done stories on people who set up payment plans of like $25 a month for 40 years. IRS really keeps an eye on not for profits, so they have an incentive to be flexible.

 

[lanejudy]

someone suddenly becomes ill, there aren't many specialists in the field, and you're forced outside of the network.

Have you attempted to talk with the insurance company and/or the doctor's office about in-network? If the insurance company doesn't have an in-network alternative (another provider of the same specialty) you can appeal and ask for in-network coverage. Also, if you speak to the non-network provider and tell them of your challenge with coverage, they may be willing to join that network. We had to do that this year when the only options offered by my employer changed to an entirely different insurance/network and nearly all our providers were initially out-of-network. I thought we were going to have $20K+ as out-of-network medical expenses, but almost all are now in-network.


To answer the OPs question... we've had a high deductible health plan for several years now. At first it was an adjustment getting used to seeing the high amounts owed instead of a little co-pay. But a couple of years ago I switched back to a PPO and found that to be more expensive in the long run. I keep spreadsheets comparing the HDHP to the PPO, and nearly every year we have come out ahead with the HSA. We max out contributions to the HSA as well as a limited medical FSA (cannot be used to meet deductible), and most years have used both fully. It's a bonus when I have something to carry forward in the HSA.

But there are a LOT of differences, and simply saying HSA vs PPO doesn't really help. You'll need to crunch the numbers to see what works best for your family situation.

 

[kymom99]

There are many variations of high deductible plans. My work sent me a cost analysis based on my past activity and suggested the high CDHP as my best choice so I went with it. My husband also switched his and even though he has a thyroid issue and hbp, he has come out ahead so far. I realize that a major medical issue could cause the coverage to be insufficient but the out of pickets and deductibles are still in what I consider to be the reasonable side.

Several years when my husband had a kids deny stone thatcwoild not pass we had a couple thousand dollars in out of pocket expenses and that's when he was still in a higher level plan. I didn't have the funds at the time to pay all upfront do I asked for a payment plan. They set up $110 a month interest free. Had no problems paying it off.

The other good thing about any insurance now (and I hope they don't change it) is the rule about pre-existing conditions, and the one free well check a year that must be allowed.

 

[smadath]

Have you attempted to talk with the insurance company and/or the doctor's office about in-network? If the insurance company doesn't have an in-network alternative (another provider of the same specialty) you can appeal and ask for in-network coverage. Also, if you speak to the non-network provider and tell them of your challenge with coverage, they may be willing to join that network. We had to do that this year when the only options offered by my employer changed to an entirely different insurance/network and nearly all our providers were initially out-of-network. I thought we were going to have $20K+ as out-of-network medical expenses, but almost all are now in-network.

I contacted them the first year, but ended up speaking with someone who just repeated over and over that there was nothing she could do. I then went up 2 additional levels of reps, who also said there was nothing they could do. Frustrating! As to the out of network doctor, he's actually not in a network at all, so there isn't another insurer to speak with.

Even though we pay him out of pocket, and even with depleting our HSA due to the extra treatments last year, I actually like the fact that he isn't associated with an insurance company. All of his costs are upfront, and we know exactly what we are paying for what we will get. He goes over all costs and options with us upfront and we choose what is best for my husband's care.

The reason I'm interested in changing insurers is that I will never reach the deductible on my own and with our combined prescriptions. Right now, we are basically throwing away the premiums for something we never get covered for. There has to be a better option for us out there!

 

[Patches Lee]

Number one reason for bankruptcy is medical bills incurred by people with no health insurance. Most of our hospitals here are not for profits so most will set up a payment plan for any balance or forgive your portion in some cases. We've done stories on people who set up payment plans of like $25 a month for 40 years. IRS really keeps an eye on not for profits, so they have an incentive to be flexible.

This was me 10 years ago. 35k in medical costs out of pocket after having first kid. Heard the whole "yeah you will still be covered at the single person deductible until you are discharged from the hospital". Reality was my single deductible of 5k was hit easily but the day she was born it went to family which meant 10k plan. The doc I'd used the whole pregnancy turned out not to have operating room privilege at the only hospital in town. Out of network people were brought in so then that went to 20k. 3 months later the 2008 layoffs hit and lost medical insurance completely. On top of the hospital refused to accept $300/month to combine the multiple bills from them, they wanted me to agree to pay $900. Or course couldn't do over half my pay a month, sent all to collections even with paying what I said I could, taken to court, wage garnishment forced me to file cause I couldn't pay the bills after they took their portion. It sucked but learned never to rely on medical insurance to help when you need it.

 

[LizzyS]

My husband and I have been on one for years and it's worked out fine for us, but we don't have any major health problems. Definitely be sure you can cover the out of pocket maximum and, if so, it might be a good option for you (in the grand scheme of things).

 

[wendow]

Number one reason for bankruptcy is medical bills incurred by people with no health insurance. Most of our hospitals here are not for profits so most will set up a payment plan for any balance or forgive your portion in some cases. We've done stories on people who set up payment plans of like $25 a month for 40 years. IRS really keeps an eye on not for profits, so they have an incentive to be flexible.

That’s what I meant. In our case, we did have medical insurance but they do not cover my dd’s illness so it was like having no insurance despite. All bills were on us and it was really hard financially. We had savings but blew through it in two years.

 

[Wish Upon A Starbucks]

Just one thought to add to all of this. We have a high deductible and from a financial standpoint it has been fine for us. But I do feel like there is a mental adjustment. I now often wait and see rather than running to the doctor. Twisted ankle, let’s give it a day before we X-ray. Sore throat, wait a day or two before making an appointment for strep test. It’s fine but it is an adjustment and you need to learn to find the right balance. It’s actually good and sort of the point of high deductible plans, to make consumers think about their choices but it does take some time to get used to.

 

[LadyD]

The HDHP my wife’s employer offers that we’re enrolled in is financially a much better idea with the spectrum of plans available to her. All of the plans have some form of a deductible, and the HDHP is not that much more than the next plan, particularly when the 1k her employer kicks in toward the HSA is factored in. The out of pocket maximum is not that high either (around 6k). It saves us a boatload, and it also lowers our tax liability because of the HSA while allowing us to essentially have a secondary 401k.

Her HDHP is one of the lowest deductibles I’ve ever seen on one though (2.5k for the family). The HDHP offered through my work is not even close to that.

 

[dhardawa]

Have you attempted to talk with the insurance company and/or the doctor's office about in-network? If the insurance company doesn't have an in-network alternative (another provider of the same specialty) you can appeal and ask for in-network coverage. Also, if you speak to the non-network provider and tell them of your challenge with coverage, they may be willing to join that network. We had to do that this year when the only options offered by my employer changed to an entirely different insurance/network and nearly all our providers were initially out-of-network. I thought we were going to have $20K+ as out-of-network medical expenses, but almost all are now in-network.


To answer the OPs question... we've had a high deductible health plan for several years now. At first it was an adjustment getting used to seeing the high amounts owed instead of a little co-pay. But a couple of years ago I switched back to a PPO and found that to be more expensive in the long run. I keep spreadsheets comparing the HDHP to the PPO, and nearly every year we have come out ahead with the HSA. We max out contributions to the HSA as well as a limited medical FSA (cannot be used to meet deductible), and most years have used both fully. It's a bonus when I have something to carry forward in the HSA.

But there are a LOT of differences, and simply saying HSA vs PPO doesn't really help. You'll need to crunch the numbers to see what works best for your family situation.

This is what I was going to say. Call the office insurance and ask for a waiver if there are in in network specialists. If the insurance company won’t help, check with your state department of insurance. There are rules around network adequately to sell plans.

 

[wendow]

This is what I was going to say. Call the office insurance and ask for a waiver if there are in in network specialists. If the insurance company won’t help, check with your state department of insurance. There are rules around network adequately to sell plans.

Unfortunately, there are just some illnesses that insurance will not cover. Regardless of the doctor being in network or not. My dd18 has chronic lyme. We know when she was bit but symptoms did not show up for about 3 years. At that time we didn't know what it was that was slowly beginning to show itself. It wasn't until years later that it came to a head and she was almost disabled. CDC says long term lyme disease does not exist. So insurance says we do not treat for long term lyme no matter what our own testing says My guess is there are a fair amount of people in positions like us. We pay OOP for everything even though we also pay $900 a month for health insurance that we never use...

 

[2China2009]

I am currently on the marketplace. I have been for the last 2 years. I pay $300/mos for our entire family. Our OOP deductible for 1 person is $4900. For the rest of the family another $5,000. So a total of about $10,000. What I love about our plan is that we have co pays of $30 or $60 depending on who you are seeing. After the co pay the entire visit is paid for. I have an internist that codes for $250 visit at times. All of our yearly stuff is included. So for us it is a win win. The other thing I like about it is I always will have the policy even if I am not employed or become sick and can not work. That is the biggest issue that millions of americans are in. They loose their job and the health insurance that goes with it and they are sunk. I am now at a job that offers health insurance for $225/mos and the deductible is $2700. Not bad at all, but like others have said I would have to pay out that $2700 if we have an emergency before anything was paid. I think for 2019 I will stay on the marketplace if it continues to be affordable for us. I make less than $50,000 year so I am in a great position for a substantial subsidy and I qualify for financial assistance at the 2 hospitals that we would choose to go. I can also write off all my medical expenses and my premium every year. Best yet I can pat my premium with my CC so I get FF miles on SW airlines.

 

[tvguy]

I am currently on the marketplace. I have been for the last 2 years. I pay $300/mos for our entire family. Our OOP deductible for 1 person is $4900. For the rest of the family another $5,000. So a total of about $10,000. What I love about our plan is that we have co pays of $30 or $60 depending on who you are seeing. After the co pay the entire visit is paid for. I have an internist that codes for $250 visit at times. All of our yearly stuff is included. So for us it is a win win. The other thing I like about it is I always will have the policy even if I am not employed or become sick and can not work. That is the biggest issue that millions of americans are in. They loose their job and the health insurance that goes with it and they are sunk. I am now at a job that offers health insurance for $225/mos and the deductible is $2700. Not bad at all, but like others have said I would have to pay out that $2700 if we have an emergency before anything was paid. I think for 2019 I will stay on the marketplace if it continues to be affordable for us. I make less than $50,000 year so I am in a great position for a substantial subsidy and I qualify for financial assistance at the 2 hospitals that we would choose to go. I can also write off all my medical expenses and my premium every year. Best yet I can pat my premium with my CC so I get FF miles on SW airlines.

That is amazing coverage. Cheaper than most employer plans I have seen.

 

[AmyAnne]

OP here -- thanks to everyone for sharing your experiences. I hadn't paid much attention to these types of plans because this is the first year I've had the option to choose one. Looking at the specific numbers for the two choices I have, the maximum out-of-pocket for the traditional PPO plan is $3000 and for the high deductible plan is $4000. The savings in premiums is more than $1000, so if I needed $3000+ in health care, the HD plan would actually be better. Where the PPO plan would be better is if I needed between $750 (the deductible) and $3000 (the OOP maximum).

I am going to check with HR this week to make sure certain preventive testing things are covered -- I have a family history of several unpleasant things that so far I have not developed but I do get tested for every year. If those things are covered, I think I will give the HD plan a try next year. I actually think it might make me go to the doctor more, to catch things early. I have ended up with bronchitis turning into pneumonia twice because I just kept putting off going in. If I know delaying (and getting worse) could cost a lot more, I might not delay so long. Or I could, as someone experienced, dislike having to think about cost and whether to get something checked out.

 

[DreamIsaWish]

The HDHP my wife’s employer offers that we’re enrolled in is financially a much better idea with the spectrum of plans available to her. All of the plans have some form of a deductible, and the HDHP is not that much more than the next plan, particularly when the 1k her employer kicks in toward the HSA is factored in. The out of pocket maximum is not that high either (around 6k). It saves us a boatload, and it also lowers our tax liability because of the HSA while allowing us to essentially have a secondary 401k.

Her HDHP is one of the lowest deductibles I’ve ever seen on one though (2.5k for the family). The HDHP offered through my work is not even close to that.

Mine is similar to yours in deductibles and OOP, and it works great for us. But those key numbers make a huge difference in why the HD plan is a no-brainer for us.

 

[Hikergirl]

Just one thought to add to all of this. We have a high deductible and from a financial standpoint it has been fine for us. But I do feel like there is a mental adjustment. I now often wait and see rather than running to the doctor. Twisted ankle, let’s give it a day before we X-ray. Sore throat, wait a day or two before making an appointment for strep test. It’s fine but it is an adjustment and you need to learn to find the right balance. It’s actually good and sort of the point of high deductible plans, to make consumers think about their choices but it does take some time to get used to.

On the flip side of this is that people put off going when they really shouldn't. I have never been one to rush to the doctors, or rush my kids to them but now I hold off even longer waiting (and hoping) that the issue "heals" itself. Sometimes that is the right thing to do, but other times it isn't. My ds had some issues that didn't seem serious enough to see the doctor, and we thought we knew why he was having them. So we waited a couple months and then other issues popped up but again they didn't seem serious or related since we thought we knew why he was having them. Turns out it was kind of serious (not life threatening or anything) and because it wasn't treated right away could have long term effects that won't be known until he's older. I feel so guilty for not taking him in right away because I wanted to save the money in case we need it for a big medical issue.

We have a similar story to some of the pp's when using our HDHP.
Dh got sick, started with an emergency room visit, hospital stay, tons of tests, then tons of specialists in and out of network (with no real diagnosis). We met the deductible for him but blew through the HSA to cover the OOP costs, so we didn't have a cushion when the next year started and he was still seeing doctors and getting tests done. We were literally spending the money from the HSA as fast as it was being put in.
If you could plan an illness and when it occurs in a calendar year HDHP with HSA's would be great, but since you can't you need to be prepared with a healthy bank account to cover your OOP costs when you spend all of your HSA. With the cost or medical care that is easy to do in a short amount of time. You can be reimbursed but if you don't have the money there at the time the bills will pile up and that isn't a good situation to be in.