Another open enrollment insurance question

smerka · October 2015

I read through the other post, but we are in a different situation so I need some opinions. We are a family of four and would probably be considered heavy users of insurance. One son has autism and another has speech issues so we spend a lot of time in the therapy office. We are currently on a PPO plan, but I am considering switching to the high deductible plan. Here are the numbers. PPO - deductible 300 individual/600 family. 20% coinsurance until the OOP max of $2,000 (ind)/$4,000 (family). This year we reached our OOP for my son in June and we are about to hit the family max. Premiums are about $40 more per month than the HD plan HD Plan - 2600 ind/5,200 family deductible. Employer will put $2,000 into HSA. Monthly premiums are about $40 less per month than PPO. We should stick with the PPO, right? I mean the HSA is attractive, but since we will blow throw that money very quickly there isn't much of an advantage. TIA.

kmurphy2131 · October 2015

What is the OOP max for the HD plan? Is it the $5200? If so, that would be a better plan I think because you would save essentially 2,480 (the HSA contribution plus savings for the cheaper plan) but only pay 1200 more. But if there is a co-insurance/copay after the deductible is met then I'm not sure it would be cheaper.

brij2006 · October 2015

The HD plan actually sounds like a better deal. You would be paying less in premiums, and having the employer cover $2k of the deductible since it will be in the HSA.

formerlyGDaisy09 · October 2015

I would do the math out. it sounds like as a heavy user you're likely to hit the family out of pocket max on either plan, as long as the out of pocket max is the individual max x2.

multiply out the monthly premiums to get the annual premium cost then add that to the Max out of pocket. then go with whichever plan is less.

cupcait927 · October 2015

The big question here is what is the coinsurance on the HDHP plan after you hit the deductible and what is your OOP max? Typically on the 2600/5200 plans, it's either 20% coinsurance or or covered in full with prescriptions going to a copay structure. The OOP max on these plans that I've seen are $5500/$11,000. If your HDHP option follow a similar structure to that, it actually might make more sense for you to stay in the PPO.

vlagrl29 · October 2015

Personally if I was a heavy user of health insurance I would stay with the PPO lower deductible.

Another open enrollment insurance question

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