Open Enrollment Thread: $6K in premiums for a $10K deductible. Thx Obama

The Something Awful Forums > Discussion > Ask/Tell > Business, Finance, and Careers > Open Enrollment Thread: $6K in premiums for a $10K deductible. Thx Obama

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TraderStav: May 19, 2006; It feels like I was standing my entire life and I just sat down

Lots of good discussion in the BWM and :zaurg:

threads about benefit selections and trying to navigate the ridiculously retarded landscape of health insurance in the US of A. This thread will be a resource for people to share their situations and plan options and get goons to analyze and criticize your life choices. I don't think we need to limit this exclusively to health insurance choices, but it's the most obvious.

Low effort OP to start, will add in stuff that's relevant or if others are more creative than I feel free to let me know and I'll update with your content.

I'll kick us off with the start of the discussion from the :zaurg:

thread:

Something Offal posted:

Information on comparing medical plans intended for SiGmA_X

HSA/HDHP---
Premium ($771.60/yr)
Deductible($1,500 Individual In-Network)
HSA contrib ($500/yr)
Co-Insurance (80%)
OPM ($9,000 Individual)

EPO (equiv. to a HMO)---
Premium ($840.72/yr)
Deductible($350 Individual)
Co-Insurance (80%)
OPM ($3,350 Individual)

SiGmA_X posted:

I realized I need another piece of info: what is your top tier tax rate (eg 22% fed, 9% state)?

And this is an individual plan, right? You say it a few times so I assume so. Changes how much you can stick into / wash through an HSA.

Ignoring tax effect of HSA payments, your EPO max billed medical procedures would be $16k with you paying $4.4k of premium+copay/deductible. For the HDHP with no tax impact, your max spend would be $9.3k at $39k billed procedures. Your break even between the two (where HDHP cash spend = EPO) for the HDHP would be $14.6k medical billing (at $4.4k cash spend).

Give me the plan type and tax rate and I'll re-run my maths and post up a crappy table.

SiGmA_X posted:

I'm an almost-CPA accountant, and a general numbers nerd. I wanted to make sure I was properly understanding and valuing my options when I first got to my company (HMO, PPO, HDHP options) so I did some learning. And then I generally love making things in Excel, its a problem...lol.

The math computes your responsibility for the given expense like this: deductible, computing coinsurance, computing HSA - which is IRS max less than ER contrib tax impact - less ER HSA contrib, plus premium.

I think you have a few considerations to make:
* Will you pay for your medical expenses post-tax and just use the HSA as an investment vehicle for medical expenses in retirement/later in life? This is always a good idea - no FICA on deposit or withdraw. I should have mentioned some states DO tax HSA contributions, but I would have to look it up for each state.
* Will you have under $3,450 in out of pocket expenses? If so, you can utilize the HSA tax diversion money as well as put a little bit into the HSA. I calculate that figure to be about $11k for you this year. If you had $6k in billed expenses, you could still get a grand into it.

I personally use my HSA for both investment savings (we have a handful of good Vanguard funds) as well as paying bills. As long as your total out of pocket will be less than the IRS max, you'll be able to put some amount into the HSA investment vehicle. I stick a few grand in a year as my expenses are pretty low. This year is looking to be a little more expensive but I'll still get a couple grand in.

If you expect a few grand in expenses, I'd definitely do the HSA option. I think I'd draw the line at somewhere in the $5-6k guesstimated expenses.

Your max spend under EPO is $4.4k @ 16.35k spend
Your break even under HDHP vs EPO ($4.4k) would be 14.5k spend (w/o tax effect)
Your break even under HDHP vs EPO ($4.4k) would be 20k spend (w/ tax effect)
Your max spend under HDHP is $9.3k @ 39k spend (w/o tax effect)
Your max spend under HDHP is $8.2k @ 39k spend (w/ tax effect)

SiGmA_X posted:

I just did a Googles for this, and the below sheet seems pretty good, minus the bad color scheme. It tax effects premiums - I don't. I removed the tax effect from premium and came up with the same value. I'd have to think about it a bit more to see if I think you should or shouldn't... I'm learning toward not, I think I played this logic game with myself 4yrs ago. I'll think on it.

https://docs.google.com/spreadsheet...hz2E/edit#gid=0
And the dudes post: https://www.reddit.com/r/personalfi...nsurance_plans/

E2: This calculator gets the same result as my spreadsheet, and does the premium without tax effect and does tax effect the HSA dollars. I think a spreadsheet is a lot better of a tool for analyzing this though.

https://www.mywealthcareonline.com/...Rightforme.aspx

TraderStav fucked around with this message at 13:27 on Aug 24, 2018

# ? Aug 23, 2018 13:49

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# ? May 8, 2024 12:47

SiGmA_X: May 3, 2004; SiGmA_X

Oh joy, I made it into an OP!

I guess I should figure out how to get my HDHP v PPO/EPO spreadsheet into Google Sheets. It should all work right now, but I often change the visible rows and dollar breaks around the various max cash amounts as I think it makes it the most usable. That is likely able to be formula driven though.

# ? Aug 23, 2018 22:22

Fhqwhgads: Jul 18, 2003; I AM THE ONLY ONE IN THIS GAME WHO GETS LAID

SiGmA_X posted:

Oh joy, I made it into an OP!

I guess I should figure out how to get my HDHP v PPO/EPO spreadsheet into Google Sheets. It should all work right now, but I often change the visible rows and dollar breaks around the various max cash amounts as I think it makes it the most usable. That is likely able to be formula driven though.

If you do, I'd love to steal a copy to do this to my own options. My employer has two levels of PPO and an HSA and this year coming I really should do the math to see which one is better.

# ? Aug 24, 2018 01:23

TraderStav: May 19, 2006; It feels like I was standing my entire life and I just sat down

You mentioned tax benefits on the high deductible plans, can you explain a bit more how that needs to be considered as I don't think I knew of any different tax treatments on the different plans.

# ? Aug 24, 2018 01:50

SiGmA_X: May 3, 2004; SiGmA_X

TraderStav posted:

You mentioned tax benefits on the high deductible plans, can you explain a bit more how that needs to be considered as I don't think I knew of any different tax treatments on the different plans.

The tax treatment I mention is strictly on medical services, not premiums. You can effectively save your tax rate by paying for medical expenses with dollars washed through your HSA. FICA + top tier tax, providing you fall far enough into a tax bracket so all dollars are in the bracket, of course.

You have two choices when you pay an expense: pay cash and leave money invested in HSA, or pay cash and withdraw from the HSA immediately.

In my opinion, you will always want to pay for expenses with a rewards credit card, and then reimburse yourself if you choose to. You must keep all qualified receipts for seven years, OR until seven years after you "redeem" money from your HSA. This does not change if you pay out of the HSA - your HSA manager, coworkers, or HR department might tell you it does, it does not. The IRC, IRS pubs, and fine print on your providers site clearly states you must keep your own receipts.

Many BFC goons (myself included) would say you should keep as much in your HSA as possible as it is deposited pre-tax, including FICA (unlike 401k), and you never pay tax on withdrawal for qualified medical expenses. You can invest it in a 3 fund ish portfolio and let the money grow, and save receipts for redemption when you are retired. It also effectively converts into an IRA when you turn 65.

Many workplace HSA's are low cost (mine is free, it use to charge $2/mo, now it doesn't, but it does charge $25 to close the account after I leave the employer. Which is surely cheaper than $24/yr though!) and many have decent investment options, while some have poo poo investment options like 401k's.

I personally use HSA money to pay for expenses. I usually spend about a grand a year so I can build up another $2k or so pretty easily. I have it invested in Vanguard S&P500 & small caps, and I balance it as part of my overall long term portfolio. I would recommend you do the cash only and invest the annual max on the HSA, however, it's also nice to save 39% on my medical services.

Fhqwhgads posted:

If you do, I'd love to steal a copy to do this to my own options. My employer has two levels of PPO and an HSA and this year coming I really should do the math to see which one is better.

I just did a Googles for this, and the below sheet seems pretty good, minus the bad color scheme. It tax effects premiums - I don't. I removed the tax effect from premium and came up with the same value. I'd have to think about it a bit more to see if I think you should or shouldn't... I'm learning toward not, I think I played this logic game with myself 4yrs ago. I'll think on it.

https://docs.google.com/spreadsheets/d/1EzbKIbU5MGzevr6Rncp5UmFVzFjZIksNJJ3RGqEhz2E/edit#gid=0
And the dudes post: https://www.reddit.com/r/personalfinance/comments/2k3k78/trying_to_compare_health_insurance_plans/

E2: This calculator gets the same result as my spreadsheet, and does the premium without tax effect and does tax effect the HSA dollars. I think a spreadsheet is a lot better of a tool for analyzing this though.

https://www.mywealthcareonline.com/mvphealthcare/Resources/HSAResources/WhichHSAPlanisRightforme.aspx

SiGmA_X fucked around with this message at 02:29 on Aug 24, 2018

# ? Aug 24, 2018 02:08

TraderStav: May 19, 2006; It feels like I was standing my entire life and I just sat down

SiGmA_X posted:

The tax treatment I mention is strictly on medical services, not premiums. You can effectively save your tax rate by paying for medical expenses with dollars washed through your HSA. FICA + top tier tax, providing you fall far enough into a tax bracket so all dollars are in the bracket, of course.

You have two choices when you pay an expense: pay cash and leave money invested in HSA, or pay cash and withdraw from the HSA immediately.

In my opinion, you will always want to pay for expenses with a rewards credit card, and then reimburse yourself if you choose to. You must keep all qualified receipts for seven years, OR until seven years after you "redeem" money from your HSA. This does not change if you pay out of the HSA - your HSA manager, coworkers, or HR department might tell you it does, it does not. The IRC, IRS pubs, and fine print on your providers site clearly states you must keep your own receipts.

Many BFC goons (myself included) would say you should keep as much in your HSA as possible as it is deposited pre-tax, including FICA (unlike 401k), and you never pay tax on withdrawal for qualified medical expenses. You can invest it in a 3 fund ish portfolio and let the money grow, and save receipts for redemption when you are retired. It also effectively converts into an IRA when you turn 65.

Many workplace HSA's are low cost (mine is free, it use to charge $2/mo, now it doesn't, but it does charge $25 to close the account after I leave the employer. Which is surely cheaper than $24/yr though!) and many have decent investment options, while some have poo poo investment options like 401k's.

I personally use HSA money to pay for expenses. I usually spend about a grand a year so I can build up another $2k or so pretty easily. I have it invested in Vanguard S&P500 & small caps, and I balance it as part of my overall long term portfolio. I would recommend you do the cash only and invest the annual max on the HSA, however, it's also nice to save 39% on my medical services.
I just did a Googles for this, and the below sheet seems pretty good, minus the bad color scheme. It tax effects premiums - I don't. I removed the tax effect from premium and came up with the same value. I'd have to think about it a bit more to see if I think you should or shouldn't... I'm learning toward not, I think I played this logic game with myself 4yrs ago. I'll think on it.

https://docs.google.com/spreadsheets/d/1EzbKIbU5MGzevr6Rncp5UmFVzFjZIksNJJ3RGqEhz2E/edit#gid=0
And the dudes post: https://www.reddit.com/r/personalfinance/comments/2k3k78/trying_to_compare_health_insurance_plans/

E2: This calculator gets the same result as my spreadsheet, and does the premium without tax effect and does tax effect the HSA dollars. I think a spreadsheet is a lot better of a tool for analyzing this though.

https://www.mywealthcareonline.com/mvphealthcare/Resources/HSAResources/WhichHSAPlanisRightforme.aspx

Got it, I didn't realize you were referring to the HSA funding and awesome strategy of using that as another tax shelter. That is all predicated on your ability to fund that fully, so if you're savings rate isn't high enough to do so that math falls out of the equation.

I've been wanting to get in on the HSA train but as I said before in the other thread, I haven't been able to make the math work (cash flow hasn't been high enough to take meaningful advantage of the HSA in previous years) against the HMO my company offers. Every year the plan gets worse and the premiums get higher so I'm sure that tipping point is coming soon.

# ? Aug 24, 2018 13:26

Fhqwhgads: Jul 18, 2003; I AM THE ONLY ONE IN THIS GAME WHO GETS LAID

TraderStav posted:

I've been wanting to get in on the HSA train but as I said before in the other thread, I haven't been able to make the math work (cash flow hasn't been high enough to take meaningful advantage of the HSA in previous years) against the HMO my company offers. Every year the plan gets worse and the premiums get higher so I'm sure that tipping point is coming soon.

This is where I am right now. I live in a high COL area and am not yet able to max out my 401k, so an HSA for tax sheltering purposes is not high on the priority list yet. But I'm generally healthy and rarely go to the doctor outside of the usual checkups so it still might work in my favor to at least get one started?

# ? Aug 24, 2018 13:54

TraderStav: May 19, 2006; It feels like I was standing my entire life and I just sat down

Fhqwhgads posted:

This is where I am right now. I live in a high COL area and am not yet able to max out my 401k, so an HSA for tax sheltering purposes is not high on the priority list yet. But I'm generally healthy and rarely go to the doctor outside of the usual checkups so it still might work in my favor to at least get one started?

My excuse is that I�m on a single income family with 3 kids.

Given the HSA features, I imagine it�s preferable to contribute to that first ahead of a traditional IRA, isn�t it? Since there�s tax free dollars when offset by medical expenses (that were incurred years prior with out of pocket dollars)?

# ? Aug 24, 2018 13:58

SiGmA_X: May 3, 2004; SiGmA_X

TraderStav posted:

My excuse is that I�m on a single income family with 3 kids.

Given the HSA features, I imagine it�s preferable to contribute to that first ahead of a traditional IRA, isn�t it? Since there�s tax free dollars when offset by medical expenses (that were incurred years prior with out of pocket dollars)?

You'd really want to analyze your plans, and expected medical expenses. HDHP could work out better, or not. PPO usually *feels better* but isn't always the most efficient. As with most things ~it depends~ applies.

If you want to provide your Fed tax rate, state tax rate (except CA, AL, or NJ), and various plans premiums, deductibles, out of pocket max, co-insurance %, and ER HSA contrib amounts, I can give it a try.

Fhqwhgads posted:

This is where I am right now. I live in a high COL area and am not yet able to max out my 401k, so an HSA for tax sheltering purposes is not high on the priority list yet. But I'm generally healthy and rarely go to the doctor outside of the usual checkups so it still might work in my favor to at least get one started?

I would say you should do the HDHP (provide your plan infos, I can maths them and we can all discuss - or you can use that calculator linked in the OP, I have yet to upload mine to gDrive) and stick at least enough to cover your deductible into the HSA per year. If not max it. I'd reduce your 401k/Roth IRA contributions slightly to be able to max the HSA, as long as you're still maxing your employer match. Eg if you're at 15% to 401k, match is maxed at 5%, I'd drop you 401k to ~10% (whatever it works math wise) to be able to max the HSA.

For me, it was super simple. My first year with the HDHP I was paying $357 per year for the HDHP, and the Company was giving me $750 a year into the HSA. PPO would have been $1,059 a year. My income was not so high at the time and I knew my medical expenses would be pretty low, so what I did was put the $700 difference into the HSA (I think I did a little more, maybe it was a grand over the year? I am not going to look it up, I'm lazy). I had a couple hundred in expenses in 2014, it worked out quite well.

Something Offal posted:

Thanks for this. The OPM on the HDHP is incorrect, I quoted the out-of-network figure by mistake. The HDHP in-network OPM is $4,500 for individual.

Sigma would have to redo his chart to correct the difference

Oh that makes a lot more sense. Always make sure you're going to in-network docs! I would suggest knowing which hospitals are primarily in-network vs out in your city, too, just in case... American insurance is a loving scam!

I think I got these updated correctly...

I would strongly lean toward the HDHP. And max out your HSA.

SiGmA_X fucked around with this message at 01:40 on Aug 31, 2018

# ? Aug 31, 2018 01:28

SiGmA_X: May 3, 2004; SiGmA_X

Original post content from the BFC Newbies Thread, I thought this would be a good home for the discussion.

Untagged posted:

Any word on that legislation to allow a spouse to have an HSA if the other spouse has an FSA? From what I've seen it looks like a related bill was passed in the House, but no updates on if it has a chance of going further. That specific topic seems to get buried in the broader discussion.

Untagged posted:

It is my understanding that this is currently a no no under IRS regulations because most medical FSA's funds can still be used for a spouse, even if that spouse works for another employer and/or has their own independent plan.

Can you cite something on this? I am not aware of this being an issue... Benefits websites explain that it's not a problem. Pub 969 says you're disallowed from making contributions into both a HSA and FSA but that doesn't apply because (as I understand) the tax payer is bifurcated into two if they have Individual plans. Now, if the tax payer still has a family plan (eg Initio's spouse has a Family FSA-eligible plan and Initio has an HSA Individual plan) on either side, that may be (probably is) a problem. Likewise if the FSA allows reimbursements to anyone in the family unit, that too is an issue...

Initio posted:

Crap. We�re not allowed to do this? What are my options?

My wife got a job earlier in the year and moved to her own plan with a FSA. I dropped her from my plan and reduced my HSA contributions to the single limit.

My not-tax-advice opinion on this is that you just have to back-test your prior year contributions to the HSA under the last-month rule and testing period. This is because the testing period goes from later of Jan 1, 2017 or first date of Family HDHP in 2017 through December 31, 2018.

If you want to confirm dates of eligibility in 2017 and 2018, date of change (trying to make it more clear, this is technically just date of eligibility) and amounts contributed in total (EE+ER) into your HSA in 2017 and 2018. I don't think I care about the dates of contributions, just net amount.

SiGmA_X fucked around with this message at 02:31 on Aug 31, 2018

# ? Aug 31, 2018 02:05

Untagged: Mar 29, 2004; Hey, does your planet have wiper fluid yet or you gonna freak out and start worshiping us?

SiGmA_X posted:

Original post content from the BFC Newbies Thread, I thought this would be a good home for the discussion.

Can you cite something on this? I am not aware of this being an issue... Benefits websites explain that it's not a problem. Pub 969 says you're disallowed from making contributions into both a HSA and FSA but that doesn't apply because (as I understand) the tax payer is bifurcated into two if they have Individual plans. Now, if the tax payer still has a family plan (eg Initio's spouse has a Family FSA-eligible plan and Initio has an HSA Individual plan) on either side, that may be (probably is) a problem. Likewise if the FSA allows reimbursements to anyone in the family unit, that too is an issue...

My understanding is that because a spouse having a medical FSA is considered "other coverage" to the HSA. So even if it's never used by the one spouse for the other, it could potentially cause an issue. This does not include dependent care or specialized FSA's, as long as the other person isn't covered.

This OPM's take on the matter...

OPM.gov posted:

HSA: Eligibility

Who is eligible for an HSA?

You must participate in a High Deductible Health Plan, have no other insurance coverage other than those specifically allowed, and not be claimed as a dependent on someone else's tax return in order to be eligible for an HSA.

Some examples of other coverage that would cause ineligibility are: a health care flexible spending account (HCFSA), a spouse's FSA, a spouse's family enrollment in an HMO, other non-high deductible health insurance coverage, TRICARE, Medicare, or receipt of VA or IHS benefits within the previous three months. You can still have other disability, dental, vision and long-term care insurance policies.

Also, from the synopsis of the bill I was asking about.

HR 6199 posted:

�Restoring Access to Medication Act of 2018,� would [...]

Permit individuals with HSA-qualifying family coverage to contribute to an HSA if their spouse is enrolled in a medical flexible spending account (FSA), currently a disqualifying scenario.

# ? Aug 31, 2018 05:01

SiGmA_X: May 3, 2004; SiGmA_X

Untagged posted:

My understanding is that because a spouse having a medical FSA is considered "other coverage" to the HSA. So even if it's never used by the one spouse for the other, it could potentially cause an issue. This does not include dependent care or specialized FSA's, as long as the other person isn't covered.

This OPM's take on the matter...

Also, from the synopsis of the bill I was asking about.

I think the language of the FSA matters. My company set ours up to allow this distinction, it does not cover non-PPO insured parties (eg, spouses, dependents). I did a bit of Googlin' and it seems like that is NOT a normal thing.

I'm guessing you're right and this is going to cause Initio issues.

I imagine that bill will die in the Senate...

# ? Aug 31, 2018 05:34

Bugamol: Aug 2, 2006

I guess *humble brag*, but this thread and anytime anyone complains about horrible medical insurance makes me more and more thankful that my employer has amazing medical benefits.

HSA (Kaiser or Cigna)
Premium ($0/yr single, +1, or family all $0)
Deductible($1,350 or $2,700 family Individual In-Network)
HSA contrib ($600/yr or $1,200/yr family)
OPM ($3,000 Individual / $6,000 family)
Co-Insurance (80%)

Dental
Premium ($0)

Vision
Premium ($0)

# ? Aug 31, 2018 18:32

Initio: Oct 29, 2007; !

From everything I�ve read so far, it sounds like I�ve messed up a little.

So even though my wife and I have two different individual insurance plan, I�m �covered� by her FSA because she can use money from it to pay for my medical expenses. And that coverage makes me ineligible to further contribute towards my HSA.

My options this point look like
1. Remove any excess contributions from my HSA and pay tax on that amount
2. Keep the contributions in the HSA, Pay taxes + a 6% tax on the contributions (and their earnings?)
3. My wife quits her job, and I adjust my remaining contributions for the rest of the year.

Then next year I can either
A. Contribute towards a FSA myself
B. Have my wife use all funds in her FSA to eliminate any carryover, not re-enroll in it, and I then contribute to my HSA

Personally, I�m leaning towards 1 and B. I�m also planning to delay removing the contributions since she�s actually looking to :toot:

The other factor that makes this a little odd is that her plan year starts in July while mine starts in January. I think I�d be able to make a full contribution to the HSA next year based on the last month rule.

Can anyone help me confirm that last piece? Or tell me if I�m completely off base somewhere else?

Edit: I�d also appreciate some help on understanding how much I�m allowed to contribute this year to my HSA. My wife was on my HDHP plan until mid March when she then got a new job and insurance, I dropped her from my coverage then. Her FSA was funded in early April. My guess is that I can contribute $2012. 575 each month from for Jan - Mar while she was on my plan. Then another $287 in April since her FSA wasn�t opened until after the 3rd.

Initio fucked around with this message at 19:11 on Aug 31, 2018

# ? Aug 31, 2018 18:53

TraderStav: May 19, 2006; It feels like I was standing my entire life and I just sat down

Sigma: my open enrollment is coming up in a month or so, I�ll post then and we�ll analyze the poo poo out of it.

# ? Sep 1, 2018 21:04

SiGmA_X: May 3, 2004; SiGmA_X

Bugamol posted:

I guess *humble brag*, but this thread and anytime anyone complains about horrible medical insurance makes me more and more thankful that my employer has amazing medical benefits.

HSA (Kaiser or Cigna)
Premium ($0/yr single, +1, or family all $0)
Deductible($1,350 or $2,700 family Individual In-Network)
HSA contrib ($600/yr or $1,200/yr family)
OPM ($3,000 Individual / $6,000 family)
Co-Insurance (80%)

Goddamn, that's awesome.

TraderStav posted:

Sigma: my open enrollment is coming up in a month or so, I�ll post then and we�ll analyze the poo poo out of it.

Lookin' forward to it!

Initio posted:

From everything I�ve read so far, it sounds like I�ve messed up a little.

So even though my wife and I have two different individual insurance plan, I�m �covered� by her FSA because she can use money from it to pay for my medical expenses. And that coverage makes me ineligible to further contribute towards my HSA.

My options this point look like
1. Remove any excess contributions from my HSA and pay tax on that amount
2. Keep the contributions in the HSA, Pay taxes + a 6% tax on the contributions (and their earnings?)
3. My wife quits her job, and I adjust my remaining contributions for the rest of the year.

Then next year I can either
A. Contribute towards a FSA myself
B. Have my wife use all funds in her FSA to eliminate any carryover, not re-enroll in it, and I then contribute to my HSA

Personally, I�m leaning towards 1 and B. I�m also planning to delay removing the contributions since she�s actually looking to

The other factor that makes this a little odd is that her plan year starts in July while mine starts in January. I think I�d be able to make a full contribution to the HSA next year based on the last month rule.

Can anyone help me confirm that last piece? Or tell me if I�m completely off base somewhere else?

Edit: I�d also appreciate some help on understanding how much I�m allowed to contribute this year to my HSA. My wife was on my HDHP plan until mid March when she then got a new job and insurance, I dropped her from my coverage then. Her FSA was funded in early April. My guess is that I can contribute $2012. 575 each month from for Jan - Mar while she was on my plan. Then another $287 in April since her FSA wasn�t opened until after the 3rd.

*Not tax or other formal advice, I'm going off some articles I dug up about having two plans due to marriage, basically the same..basically.*

I think 1-B is the right option. I am really unsure about the overlapping dates of FSA enrollment (1/1/2019-6/30/2019), maybe your or her HR person would know..but probably not. I *think* the last month rule applies next year, as you become re-eligible for HSA as of 7/1/2019 if the FSA is no longer available. I do have minor concerns about the last month rule impacting your 2017 eligibility, and I have no opinions on that. Re-reading the IRS publication probably would help clear it up, or muddy the water, either or.

When did her new plan and FSA coverage start? Sounds like it was 4/1/2018, and she was on the family HDHP through 3/31/2018? That means you should be able to make 3/12 of the annual Family amount, or $1,725. The IRS often rounds dates to full months, so I'm not sure you could "use" any of the April Individual amount ($287) but I am really unsure there.

This could all change in the Senate takes up the House resolution, but let's not hold our breaths...

# ? Sep 1, 2018 22:12

Initio: Oct 29, 2007; !

I think I�ve got it mostly figured out.

The IRS instructions for form 8889 give a lot of answers. https://www.irs.gov/instructions/i8889

Basically if you�re eligible on the first of any month, you can contribute that month. So I can contribute for 3 months even though my wife�s plan started mid March. Unfortunately her FSA was also back dated to her start date rather than the day we elected it, so April contributions are out.

And you�re right about the last year rule. I�m not invoking it to cover this year, since as of April I�m not eligible. But in 2019, I can invoke it since I plan to be eligible in December 2019 and through the entire year in 2020.

I�m just glad I caught this when I did and before I already spent the money. Now to see if the senate fixes it.

Initio fucked around with this message at 17:20 on Sep 3, 2018

# ? Sep 3, 2018 17:12

ChickenOfTomorrow: Nov 11, 2012; god damn it, you've got to be kind

Please help.

I have to choose between four bad insurance options for myself and my just laid-off spouse, in the next week. Our current insurance only runs through the end of this month. COBRA is available but the cost would eat up all of my spouse's UI.

We're pretty broke (but not broke enough to qualify for medi-cal), I have pre-existing conditions for which i need to see a specialist at least once every three months and to take daily medication (thankfully all generic). I thought I understood this stuff but it turns out that's not true.

All the options beyond COBRA are through Kaiser Permanante but I don't have the SBC for all of them yet.

Once I get more information may I crowdsource some help for choosing the "best" option? What information should I provide?

For now, question about an "HSA-qualified HMO."
Will the amount I pay for an out-of-network provider cost apply towards my deductible?

From the SBC:
What is the overall deductible?
$2,700 for any one member within a Family enrollment
Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay. If you have other family members on the plan, each family member must meet their own individual deductible until the total amount of deductible expenses paid by all family members meets the overall family deductible.

What is the out-of-pocket limit for this plan?
$3,000 for any one member within a Family enrollment
The out-of-pocket limit is the most you could pay in a year for covered services. If you have other family members in this plan, they have to meet their own out-of- pocket limits until the overall family out-of-pocket limit has been met.

What is not included in the out-of-pocket limit?
Premiums, health care this plan doesn't cover, and services indicated in chart starting on page 2.
Even though you pay these expenses, they don't count toward the out-of-pocket limit.

Will you pay less if you use a network provider?
This plan uses a provider network. You will pay less if you use a provider in the plan�s network. You will pay the most if you use an out-of-network provider, and you might receive a bill from a provider for the difference between the provider�s charge and what your plan pays (balance billing).

Services You May Need: Primary care visit to treat an injury or illness
What You Will Pay Plan Provider (You will pay the least): 10% coinsurance after deductible
What You Will Pay Non-Plan Provider (You will pay the most): Not Covered

Services You May Need: Specialist visit
What You Will Pay Plan Provider (You will pay the least): 10% coinsurance after deductible
What You Will Pay Non-Plan Provider (You will pay the most): Not Covered

ChickenOfTomorrow fucked around with this message at 18:23 on Sep 22, 2018

# ? Sep 22, 2018 18:20

Zauper: Aug 21, 2008

Yes and no.

The covered plan amount counts towards your deductible. The rest does not.

# ? Sep 22, 2018 19:44

ChickenOfTomorrow: Nov 11, 2012; god damn it, you've got to be kind

What does "covered plan amount" mean?

Am I understanding correctly that if I see an out of network provider, who is "Not Covered," I'll pay 100% of the cost as if i were a cash pay client, and none of that cost would count towards my deductible?

ETA: destroy capitalism, single-payer healthcare now, guillotine health insurance CEOs :thermidor:

# ? Sep 22, 2018 21:01

Zauper: Aug 21, 2008

ChickenOfTomorrow posted:

What does "covered plan amount" mean?

Am I understanding correctly that if I see an out of network provider, who is "Not Covered," I'll pay 100% of the cost as if i were a cash pay client, and none of that cost would count towards my deductible?

ETA: destroy capitalism, single-payer healthcare now, guillotine health insurance CEOs

I don't have an out of network bill in front of me.

Let's say you see a doc for an office visit. That visit may be $1000. Now, if it were in network, it would be $100 - with you paying 20 and the plan paying 80. Of your $1000 bill, you would get something saying the allowed amount is $100, so that $100 would count towards your deductible (and out of pocket max).

Essentially. Sometimes that number is different from the actual total that would have been paid if in network. But some - small fraction - of it will count towards your deductible. Assuming the procedure in question is covered at all by the plan.

# ? Sep 22, 2018 22:17

Ancillary Character: Jul 25, 2007; Going about life as if I were a third-tier ancillary character

ChickenOfTomorrow posted:

What does "covered plan amount" mean?

Am I understanding correctly that if I see an out of network provider, who is "Not Covered," I'll pay 100% of the cost as if i were a cash pay client, and none of that cost would count towards my deductible?

ETA: destroy capitalism, single-payer healthcare now, guillotine health insurance CEOs

Your plan does not cover seeing out-of-network providers as indicated by:

quote:

Services You May Need: Primary care visit to treat an injury or illness
What You Will Pay Plan Provider (You will pay the least): 10% coinsurance after deductible
What You Will Pay Non-Plan Provider (You will pay the most): Not Covered

Services You May Need: Specialist visit
What You Will Pay Plan Provider (You will pay the least): 10% coinsurance after deductible
What You Will Pay Non-Plan Provider (You will pay the most): Not Covered

So that means anything you pay to an out-of-network provider would not count towards your deductible nor your out-of-pocket annual max. Are you broke enough to get subsidies for the premiums?

# ? Sep 22, 2018 23:07

ChickenOfTomorrow: Nov 11, 2012; god damn it, you've got to be kind

Thanks, I understand that now. It doesn't make sense, but i understand it.

# ? Sep 22, 2018 23:10

TraderStav: May 19, 2006; It feels like I was standing my entire life and I just sat down

Got my summary plans today for next year, but not plan costs so I imagine that as well as my expected costs for next year (based on history? best way to capture this) are the missing pieces to get a recommendation.

Google Doc located here, what's the best way to post this? Should I screenshot each plan separately and post? Do a code bracket? Thoughts?

https://docs.google.com/spreadsheets/d/1W4edCU4sHRIs3q6RaD5QU6tATAmALP_ZX8BZ-x220Rg/edit?usp=sharing

# ? Oct 7, 2018 14:27

ChickenOfTomorrow: Nov 11, 2012; god damn it, you've got to be kind

What's the best provider for an HSA? My employer doesn't contribute.

# ? Oct 20, 2018 01:40

EugeneJ: Feb 5, 2012; by FactsAreUseless

ChickenOfTomorrow posted:

What's the best provider for an HSA? My employer doesn't contribute.

https://livelyme.com/

# ? Oct 20, 2018 05:36

TraderStav: May 19, 2006; It feels like I was standing my entire life and I just sat down

My open enrollment starts Monday so I'll have numbers to post. Looking forward to seeing another perspective!

# ? Oct 20, 2018 13:13

TraderStav: May 19, 2006; It feels like I was standing my entire life and I just sat down

Updated with Premiums! What information do I need to start analyzing this? Family of 5.

https://docs.google.com/spreadsheets/d/1W4edCU4sHRIs3q6RaD5QU6tATAmALP_ZX8BZ-x220Rg/edit?usp=sharing

# ? Oct 22, 2018 12:35

EPICAC: Mar 23, 2001

Here�s our open enrollment info. All info for a family of 4:

https://docs.google.com/spreadsheets/d/1jYGEBkIQ82SmMauWFookimytrlwEh-1xrVBAHLrehuE/htmlview

We did the HSA this past year, and are close to the out of pocket max at $4500 right now, but this was included 1) a bunch of physical therapy appointments for myself, 2) having a kid + some extra prenatal screenings.

Even coming close to the OOP max, the HSA seems like a no-brainer. Next year�s expenses should be lower barring something catastrophic.

# ? Oct 22, 2018 19:25

howdoesishotweb: Nov 21, 2002

TraderStav posted:

Updated with Premiums! What information do I need to start analyzing this? Family of 5.

https://docs.google.com/spreadsheets/d/1W4edCU4sHRIs3q6RaD5QU6tATAmALP_ZX8BZ-x220Rg/edit?usp=sharing

Hard to answer without your health care usage marginal tax rate, but the value cdhp is a catastrophic type plan, and the other cdhp is probably a better �balanced� plan in case one of semen demons breaks an arm. The PPOs are better if you use a ton of health services a year and won�t fund an HSA at all. For my family of 4 my own plan resembles your regular cdhp and max out the HSA.

# ? Oct 22, 2018 21:59

TraderStav: May 19, 2006; It feels like I was standing my entire life and I just sat down

howdoesishotweb posted:

Hard to answer without your health care usage marginal tax rate, but the value cdhp is a catastrophic type plan, and the other cdhp is probably a better �balanced� plan in case one of semen demons breaks an arm. The PPOs are better if you use a ton of health services a year and won�t fund an HSA at all. For my family of 4 my own plan resembles your regular cdhp and max out the HSA.

My marginal tax rate is 22%, I can pull my health care usage for this year (and presumably previous years) from my BCN portal I think. One of my semen demons did break an arm this year, so far it's been several hundred dollars in co-pays and specialists. Not to mention the deductible he didn't meet. Think we have $200 individual, $400 family.

I'm trying to figure out the best way to pull the data to represent for the analysis. Showing total charged YTD of $21,213.05 and total covered of $20,056.25 for a total paid of $1,156.80. About $10.3K of that was my sons broken arm. $485ish out of pocket.

The plan cost me $6362.57 for the full year.

Given that the non-value CDHP is only a $100 cheaper than the HMO, I'm not sure the cash the company gives me in my HSA makes it more economical.

I did fully fund my FSA this year, but it was primarily used for dental work so not in the equation here. Likely again this year. I have lovely teeth!

I'll try to play with the earlier spreadsheet posted to see if I can make sense of the data needed to do this analysis. Not sure why I'm struggling so much to grok this!

# ? Oct 22, 2018 22:37

CornHolio: May 20, 2001; Toilet Rascal

Oh hey, just the thread I was looking for. I have always had a PPO and some friends are trying to convince me to go to an HSA, which I don't have any experience with. I like having cheap copays for doctor visits, it makes them much easier to deal with. I am in Indiana for what it's work, 36 and I have two children on my insurance. My wife has her own.

PPO Plan
$112.68 per week, so $5,859.36 per year
$900 individual deductible
$1800 family deductible
$2800 annual medical coinsurance maximum individual
$5600 annual medical coinsurance maximum family
$30 copay physicial visit
100% preventative care coverage
$40 copay specialist/urgent care
$200 emergency room visit, waived if admitted

HSA Plan
$53.57 per week, so $$2,785.64 per year plus whatever I put in.
$1800 individual deductible
$3600 family deductible
$2800 annual medical coinsurance maximum individual
$5600 annual medical coinsurance maximum family
physician visit: plan pays 80% after deductible
100% preventative care coverage
specialist/urgent care: plan pays 80% after deductible
emergency room: plan pays 80% after deductible

The catch is that the company preloads $500 into the HSA account.

I can contribute up to $6500 to the HSA, but would likely contribute $59 per week (an additional $3,068) into the HSA just to match what I've been paying with the PPO.

I tend to be a hypochondriac and we go to urgent care a few times a year, plus regular doctor's visits for all of us a few times a year, and it seems that with this in mind (even though none of us have any serious health issues) it would drain the HSA pretty quickly whereas with the PPO I have the copay and that's it.

There is another, higher deductible HSA plan available.

# ? Oct 23, 2018 16:06

EPICAC: Mar 23, 2001

Having done an HSA for the first time this year, it�s definitely a much different experience compared to a PPO, much more painful from an effort and psychological perspective.

We had an expensive year, I had quite a few PT appointments, we had some expensive prenatal tests, and an uncomplicated birth and hospital stay. Since this was our first year, and high cost we were constantly on the edge of having enough in the account to pay. A few times I had to wait a couple of weeks for the next pay check, and for one pre-deductible $1000 bill I paid over the course of 2 months. This wouldn�t really have been an issue if not for the fact that we had so many more expenses than usual.

The other factor is that it really highlights how hosed healthcare in this country is in terms of cost/transparency. I would go to an appointment, and the payment would be unknown. No one in the office could tell me how much I would be billed, or even give me an estimate, and I�d have to wait weeks to get the bill in the mail/online, and then pay. I had no idea what my first 8 PT appointments were costing me until I finally got a statement.

This year the HSA was stressful, especially early on before we hit the deductible. It should be much less painful once we build up a balance in the account. Despite this, I still like the plan, and I still think we�ll come out ahead even though we�re approaching the OOP max.

# ? Oct 23, 2018 17:11

TraderStav: May 19, 2006; It feels like I was standing my entire life and I just sat down

Is this the most straightforward way to think about CDHP vs. HMO?

HMO(Plan Cost + expected Co pays inc. $400 deductible) vs CDHP(Plan Cost + deductible - employer contribution + 10% thereafter)

So, using 2018:

HMO: $6362.57 + 903.84 (copays so far) = $7266.41
CDHP: $6262.57 + 3000 deductible - 1000 + 10%*X = $8262.57

So it'd be better to go HMo all else equal? 2018 was a heavy year (broken arm) and I don't remember what the CDHP would have cost me last year, but it's $100 difference now.

Am I on the right path for the most part? I put about $2k into my FSA last year, may do it again for dental stuff.

# ? Oct 26, 2018 23:59

ChickenOfTomorrow: Nov 11, 2012; god damn it, you've got to be kind

I think one thing to know is if you're a heavy enough user that you'd run through your deductible on the CDHP. If you wouldn't, then try Plan Cost + (expected use - employer contribution).

# ? Oct 27, 2018 00:16

TraderStav: May 19, 2006; It feels like I was standing my entire life and I just sat down

ChickenOfTomorrow posted:

I think one thing to know is if you're a heavy enough user that you'd run through your deductible on the CDHP. If you wouldn't, then try Plan Cost + (expected use - employer contribution).

I think I would, looking at the last two years (this year is YTD) for Medical only (99% sure my prescriptions don't count toward my deductible):

2017: $5,466 - OOP: $490
2018 YTD with broken arm: $16,511.29 OOP: $903.84
2018 YTD w/o broken arm: $5,943.76 - OOP: $380

There's wankery about meeting $200/400 deductibles in there on the HMO, but I think I'd hit the max on the deductible.

If it's razor thin, I think the deal breaker is prescriptions. It's full price until I hit deductible, then 10%. If I took 10% of what I spent those years it'd be double what I did on my HMO.

My head starts hurting when trying to sort this all out, because you have to hit your individual maxes AND your family maxes. I don't know if I have the patience to model this all the way out.

# ? Oct 27, 2018 00:22

howdoesishotweb: Nov 21, 2002

TBH I was phone posting initially, and didn�t see your HMO options. It vs CDHP depends on your usage.

Also lol at 5 choices. In my group practice we have one HSA plan and a garbage PPO, and it costs me about 21k!

# ? Oct 27, 2018 02:11

Fluue: Jan 2, 2008

My girlfriend is working on getting Marketplace healthcare with (hopefully) a subsidy because she works part time while going to grad school and just rolled off her parents' insurance. Her employer is a city government, but the union-negotiated rate for part-time workers' healthcare exceeds the "9.56% of AGI" qualification for the "value" test.

Since she needs coverage for the rest of 2018 (and that's what she's applying for right now), will she need to re-up for 2019 at the same time or just let it auto-renew the plan she selects for 2018?

# ? Oct 30, 2018 00:22

SiGmA_X: May 3, 2004; SiGmA_X

Thread, sorry for not being in here. First quarter close with my new department, our senior analyst left for maternity leave, and I've been working 5-7 day weeks at 10-12hr/day+... We won't be done with the quarter for a few more days, and we're starting the month end tomorrow! Yay! I don't even want to get into the things I've found during my usual understanding of process -> overhaul process procedure...

CornHolio posted:

Oh hey, just the thread I was looking for. I have always had a PPO and some friends are trying to convince me to go to an HSA, which I don't have any experience with. I like having cheap copays for doctor visits, it makes them much easier to deal with. I am in Indiana for what it's work, 36 and I have two children on my insurance. My wife has her own.

PPO Plan
$112.68 per week, so $5,859.36 per year
$900 individual deductible
$1800 family deductible
$2800 annual medical coinsurance maximum individual
$5600 annual medical coinsurance maximum family
$30 copay physicial visit
100% preventative care coverage
$40 copay specialist/urgent care
$200 emergency room visit, waived if admitted

HSA Plan
$53.57 per week, so $$2,785.64 per year plus whatever I put in.
$1800 individual deductible
$3600 family deductible
$2800 annual medical coinsurance maximum individual
$5600 annual medical coinsurance maximum family
physician visit: plan pays 80% after deductible
100% preventative care coverage
specialist/urgent care: plan pays 80% after deductible
emergency room: plan pays 80% after deductible

The catch is that the company preloads $500 into the HSA account.

I can contribute up to $6500 to the HSA, but would likely contribute $59 per week (an additional $3,068) into the HSA just to match what I've been paying with the PPO.

I tend to be a hypochondriac and we go to urgent care a few times a year, plus regular doctor's visits for all of us a few times a year, and it seems that with this in mind (even though none of us have any serious health issues) it would drain the HSA pretty quickly whereas with the PPO I have the copay and that's it.

There is another, higher deductible HSA plan available.

You would be bat poo poo insane to take that PPO. It is garbage. The one exception to this maths would be you might be capped at the Individual limit for the HSA because your wife is on her own plan - I am too tired to ask Google for you tonight, sorry.

TraderStav posted:

Is this the most straightforward way to think about CDHP vs. HMO?

HMO(Plan Cost + expected Co pays inc. $400 deductible) vs CDHP(Plan Cost + deductible - employer contribution + 10% thereafter)

So, using 2018:

HMO: $6362.57 + 903.84 (copays so far) = $7266.41
CDHP: $6262.57 + 3000 deductible - 1000 + 10%*X = $8262.57

So it'd be better to go HMo all else equal? 2018 was a heavy year (broken arm) and I don't remember what the CDHP would have cost me last year, but it's $100 difference now.

Am I on the right path for the most part? I put about $2k into my FSA last year, may do it again for dental stuff.

You're on the right track with cost estimates. I have a harder time figuring it out because of the whole copay per incident thing. And I have a strong bias against HMO's so I don't try too hard...

TraderStav posted:

Updated with Premiums! What information do I need to start analyzing this? Family of 5.

https://docs.google.com/spreadsheets/d/1W4edCU4sHRIs3q6RaD5QU6tATAmALP_ZX8BZ-x220Rg/edit?usp=sharing

Jesus.

Fluue posted:

My girlfriend is working on getting Marketplace healthcare with (hopefully) a subsidy because she works part time while going to grad school and just rolled off her parents' insurance. Her employer is a city government, but the union-negotiated rate for part-time workers' healthcare exceeds the "9.56% of AGI" qualification for the "value" test.

Since she needs coverage for the rest of 2018 (and that's what she's applying for right now), will she need to re-up for 2019 at the same time or just let it auto-renew the plan she selects for 2018?

It's been a while since I looked at Marketplace, but isn't a signup today for 2019, not 2018?

EPICAC posted:

Here�s our open enrollment info. All info for a family of 4:

https://docs.google.com/spreadsheets/d/1jYGEBkIQ82SmMauWFookimytrlwEh-1xrVBAHLrehuE/htmlview

We did the HSA this past year, and are close to the out of pocket max at $4500 right now, but this was included 1) a bunch of physical therapy appointments for myself, 2) having a kid + some extra prenatal screenings.

Even coming close to the OOP max, the HSA seems like a no-brainer. Next year�s expenses should be lower barring something catastrophic.

This isn't pricing the PPO quite right as it's using 20% coinsurance vs $25/500 per incident, but it's close enough to show that you definitely should go with the HSA.

# ? Nov 1, 2018 04:52

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# ? May 8, 2024 12:47

Fluue: Jan 2, 2008

SiGmA_X posted:

It's been a while since I looked at Marketplace, but isn't a signup today for 2019, not 2018?

She's signing up for coverage for the remainder of 2018 + 2019.

# ? Nov 1, 2018 22:39

The Something Awful Forums > Discussion > Ask/Tell > Business, Finance, and Careers > Open Enrollment Thread: $6K in premiums for a $10K deductible. Thx Obama

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