It's open enrollment time...anyone making changes?

formerlyGDaisy09 · September 2015

Xstatic3333 said:

This has been interesting reading. Most financial stuff doesn't confuse me too badly but healthcare math completely makes my head spin!

I'm pretty sure H's open enrollment was earlier this year. We only have two options since we live in a different state then where he works, and both are relatively pricey PPOs. I wish we had the option of taking advantage of an HSA! That said, we'll be TTC next year, and even if the math worked in favor of the HDHP I'm not sure I'd have the guts to pull the trigger. We go with the cheapest of the two plans, and it significantly declined in quality and value last year. Our family OOP max actually doubled, and we now need referrals for everything. H's union is up in arms. Still, I know that since I'm pro-ACA I'm not allowed to complain about it :-) I'm assuming I'll need to have the family OOP max on hand during the year in which I give birth.

I just spent a few minutes Googling to finally understand the difference between coinsurance and the OOP max. If anyone else shares my bewilderment there, this page was sure helpful:

http://www.cigna.com/individuals-families/copays-deductibles-and-coinsurance-explained

if you have an HSA already, you could potentially wait until you have the family deductible for the HDHP in your HSA to pull the triggor.

in reality the ACA is the first step in moving us closer to a single payer-ACO based model. Really i think in the future ACOs are going to become the "insurance companies"...as in employers or individuals will pay into a health system and basically say "OK, you take care of me" and it becomes that health systems job to either 1. keep you healthy and make money off of you or 2. take care of you when you are sick and use the money they make from the healthy population to supplement your care.

that is grossely simplified, but is ultimately going to be how we reign in healthcare spending and force hospitals to give the right care at the right time, opposed to their current fee-for-service model where they win when they do more (and more care is not the answer).

jessica490 · September 2015

Luckily we keep everything the same and we hardly have to pay anything out of pocket all year since the company starts us off with $1100 in an account to use first.

Xstatic3333 · September 2015

formerlyGDaisy09 said:

Xstatic3333 said:

This has been interesting reading. Most financial stuff doesn't confuse me too badly but healthcare math completely makes my head spin!

I'm pretty sure H's open enrollment was earlier this year. We only have two options since we live in a different state then where he works, and both are relatively pricey PPOs. I wish we had the option of taking advantage of an HSA! That said, we'll be TTC next year, and even if the math worked in favor of the HDHP I'm not sure I'd have the guts to pull the trigger. We go with the cheapest of the two plans, and it significantly declined in quality and value last year. Our family OOP max actually doubled, and we now need referrals for everything. H's union is up in arms. Still, I know that since I'm pro-ACA I'm not allowed to complain about it :-) I'm assuming I'll need to have the family OOP max on hand during the year in which I give birth.

I just spent a few minutes Googling to finally understand the difference between coinsurance and the OOP max. If anyone else shares my bewilderment there, this page was sure helpful:

http://www.cigna.com/individuals-families/copays-deductibles-and-coinsurance-explained

if you have an HSA already, you could potentially wait until you have the family deductible for the HDHP in your HSA to pull the triggor.

in reality the ACA is the first step in moving us closer to a single payer-ACO based model. Really i think in the future ACOs are going to become the "insurance companies"...as in employers or individuals will pay into a health system and basically say "OK, you take care of me" and it becomes that health systems job to either 1. keep you healthy and make money off of you or 2. take care of you when you are sick and use the money they make from the healthy population to supplement your care.
that is grossely simplified, but is ultimately going to be how we reign in healthcare spending and force hospitals to give the right care at the right time, opposed to their current fee-for-service model where they win when they do more (and more care is not the answer).

I could get behind that model. The one thing that really grinds my gears about our current health plan is that it doesn't allow us to use urgent care centers. H came down with horrible, stabbing stomach pains on July 4th this year that he wanted to see someone for. We went to a local urgent care that I have used in the past, and when they got his insurance information they told him they could not see him without a referral from his primary care doctor. Not only that, but they would not allow us to pay out of pocket for the visit.

His choices at that point were 1) Go to the ER, pay $250 out of pocket and waste everyone's time and resources, or 2) Tough it out until Monday. We went with 2) and luckily it turned out to not be anything serious. Really though, why on earth should our insurance discourage us from using the most cost efficient option? I'm glad there are people like you working on getting health care costs down, and give you a lot of credit for what you do. It can't be easy.

cupcait927 · September 2015

julieanne912 said:

hoffse said:

The really compelling thing about HSAs for me is that you get reimbursed for current healthcare costrs decades later. So if you document things properly, your HSA can essentially be a super tax-friendly retirement vehicle, because you get to double dip by not paying taxes on the contributions OR the withdrawals, as long as there is some health expense you can match it with.

I'm pretty sure you can also use HSAs to pay for your spouse's OOP health costs, even if they are on a different plan. So @Julieann912, by maxing out an HSA (or at least up to your husband's deductible), you could lower your household's OOP costs for your husband's treatments.

I have maxed out mine the last couple of years just because I like the retirement aspect to it. I don't really consume healthcare, and neither does H. But that money sure is nice to have as a back-up. I am sure we will consume more healthcare as we age.

Hmmm that's interesting. He has his own HSA that he and his employer contributes to... would that affect what I can do with mine?

It can in the sense that between your HSA and your H's HSA, you can't go above and beyond the family annual maximum. So keep that in mind when your allocating funds to your HSA.

formerlyGDaisy09 · September 2015

Xstatic3333 said:

formerlyGDaisy09 said:

Xstatic3333 said:

This has been interesting reading. Most financial stuff doesn't confuse me too badly but healthcare math completely makes my head spin!

I'm pretty sure H's open enrollment was earlier this year. We only have two options since we live in a different state then where he works, and both are relatively pricey PPOs. I wish we had the option of taking advantage of an HSA! That said, we'll be TTC next year, and even if the math worked in favor of the HDHP I'm not sure I'd have the guts to pull the trigger. We go with the cheapest of the two plans, and it significantly declined in quality and value last year. Our family OOP max actually doubled, and we now need referrals for everything. H's union is up in arms. Still, I know that since I'm pro-ACA I'm not allowed to complain about it :-) I'm assuming I'll need to have the family OOP max on hand during the year in which I give birth.

I just spent a few minutes Googling to finally understand the difference between coinsurance and the OOP max. If anyone else shares my bewilderment there, this page was sure helpful:

http://www.cigna.com/individuals-families/copays-deductibles-and-coinsurance-explained

if you have an HSA already, you could potentially wait until you have the family deductible for the HDHP in your HSA to pull the triggor.

in reality the ACA is the first step in moving us closer to a single payer-ACO based model. Really i think in the future ACOs are going to become the "insurance companies"...as in employers or individuals will pay into a health system and basically say "OK, you take care of me" and it becomes that health systems job to either 1. keep you healthy and make money off of you or 2. take care of you when you are sick and use the money they make from the healthy population to supplement your care.
that is grossely simplified, but is ultimately going to be how we reign in healthcare spending and force hospitals to give the right care at the right time, opposed to their current fee-for-service model where they win when they do more (and more care is not the answer).

I could get behind that model. The one thing that really grinds my gears about our current health plan is that it doesn't allow us to use urgent care centers. H came down with horrible, stabbing stomach pains on July 4th this year that he wanted to see someone for. We went to a local urgent care that I have used in the past, and when they got his insurance information they told him they could not see him without a referral from his primary care doctor. Not only that, but they would not allow us to pay out of pocket for the visit.

His choices at that point were 1) Go to the ER, pay $250 out of pocket and waste everyone's time and resources, or 2) Tough it out until Monday. We went with 2) and luckily it turned out to not be anything serious. Really though, why on earth should our insurance discourage us from using the most cost efficient option? I'm glad there are people like you working on getting health care costs down, and give you a lot of credit for what you do. It can't be easy.

the trick with that model is going to be how to transition from fee-for-service to that model...especially during the interrum time when there is still a mixture of payers and service models.

That's ridiculous that they wouldn't let you pay out of pocket. It seems odd that an insurance company would require a refferal for an urgent care visit. granted there are tons of things I see at work that insurance companies do that make absolutely no sense to me.

blondie42107 · September 2015

formerlyGDaisy09 said:

blondie42107 said:

formerlyGDaisy09 said:

for those thinking about TTC in the future, look into whether your hospital does global billing or not. If they do Global billing all your office visits (regular OB visits) get billed after the baby is born, along with all the L&D charges. you will get charged for things like labs and ultrasounds along the way, but it *may* pay to be in a lower deductible plan the year you deliver...but not necessarily the year you're pregnant, if your pregnancy will span two years.

@formerlyGDaisy09
I'm not familiar with this. My OB is in private practice and has rights at the hospital we use. It's the same for all the OB's that have rights at that hospital. The hospital has no control over what the OB's charge for pre/post natal care or the L&D charges. The hospital only bills for use of hospital and nursing staff. Even my anesthesiologist bill came from his office not the hospital. Same with our pediatrician visits - I think we had three visits from the ped while in the hospital (day born, day after, day of discharge), which our ped billed our insurance for, not the hospital. They were covered in full, no copay, same as wellness visits.

some offices still bill for individual visits, like I said, just something to look in on....if you're not on global billing everything gets spread out, and it might pay to be on a HDHP both years, if they do do global billing it *Might* be worth it to be on a PPO plan with a higher premium for the year when the baby is born, you'll likely meet your deductible/OOP max quickly. just something to consider.

again, in all cases you would have to do the math out, in my case I think I would have been better on the even higher premium PPO plan my company offers ($250 deductible, 90/10 coinsurance, $2,250 OOP max) versus the plan I chose ($500 deductible, 80/20 coinsurance, $3,400 OOP max), Live and learn...I'm thinking HDHPs are the way of the future, so we may not have a choice next time we TTC.

I guess I'm just confused and that's okay.

My OB submitted everything to my insurance at once: prenatal care, L&D and post natal care. There's a separate bill from the hospital, seperate bill for the anesthesiologist, etc. I just know my hospital doesn't do one bill for all of that - each provider bills separately for their services.

short+sassy · September 2015

I guess I'm just confused and that's okay. My OB submitted everything to my insurance at once: prenatal care, L&D and post natal care. There's a separate bill from the hospital, seperate bill for the anesthesiologist, etc. I just know my hospital doesn't do one bill for all of that - each provider bills separately for their services.

I find this super aggravating. I mean, I understand why it happens, but its still annoying. I had an ER visit a few years ago. Wasn't even admitted to the hospital, was treated and left within a couple hours. FOUR different bills. It was just ridiculous.

formerlyGDaisy09 · September 2015

@blondie42017, I guess I live in an area where most all midwives and OB/GYNs work at hospitals, so all the billing is under the hospital's umbrella. I can't think of any OB/GYN private practices in the area. so global billing where everything, prenatal-L&D-postnatal, hospital, anesthesiology...is billed from the same place is common practice here.

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