15% Coinsurance or Copayments

[HoosierLife]

So my wife has two health insurance options through her employer and I wanted to get your opinions. She works at Simon Property Group and has Cigna.

Option 1 normal health ins:

$1500 family deductible 85/15, $25/$50 co-pays, $4800 max OOP, $3276 annual premiums.

Option 2 normal health ins + HSA:

$4000 family deductible 85/15, 15% coinsurance, $6000 max OOP, $2080 annual premium. Employer funds HSA at $1500/yr + an extra $500 the first year.

If we get the HSA, I was going to pay the difference in premiums as extra to fund the HSA.

Seems like the HSA is a no brainier, but there are a few other considerations we have to take into account.

1. My wife had colon cancer 3.5 years ago. So there's follow up visits, cat scans, colonoscopies etc. Barring any reoccurrence, she'll only need 1 of those scans every few years now, but she could still relapse.

2. I know you're supposed to wait 3 months to share the news, but who are you guys going to tell? My wife is expecting our first in June of next year.

She already having to go to a high risk obstetrician. She will most likely have to have a C-section because of scar tissue from her cancer surgery. Which I assume is more expensive than a normal delivery. And I have no idea what 15% of an office visit would normally cost compared to the $50 for a specialist visit.

With these other considerations, I'm wondering if we should hold off one more year before getting the HSA.

What are your thoughts?

 

[TwiLight]

I would get the least OOP you can get for the next year..... Combined with Premium you would pay......

With a High Risk Pregnancy, the cost will max you out, especially at delivery.... Just Saying.... I see these bills all the time and you WILL max out your OOP....

Congrats by the way. May he/she be a healthy baby... God Bless.

 

[HoosierLife]

I would get the least OOP you can get for the next year..... Combined with Premium you would pay......

With a High Risk Pregnancy, the cost will max you out, especially at delivery.... Just Saying.... I see these bills all the time and you WILL max out your OOP....

Congrats by the way. May he/she be a healthy baby... God Bless.

Thanks!

See that's the thing. With option 1, max OOP is $4800 and the premiums are $1200 more.

With option 2, max OOP is $6000 with $1200 less in premiums.

Seems like they are a wash. Then there's the fact that Simon will fund the HSA $2000.

Wouldn't that make option 2 better?

 

[TwiLight]

Thanks!

See that's the thing. With option 1, max OOP is $4800 and the premiums are $1200 more.

With option 2, max OOP is $6000 with $1200 less in premiums.

Seems like they are a wash. Then there's the fact that Simon will fund the HSA $2000.

Wouldn't that make option 2 better?

I would normally say yes..... however the oop max of $6k seems low for an hsa and is more of a single oop max.

Your oop max will be the family out of pocket max with an hsa plus family deductible.... check your plan again..

 

[kgmom219]

Do an actual spreadsheet to figure this out. Annualized. (PM me if you need help)

The $6K OOP on the HSA is what I sell all day long, so it seemed fine to me.

BIG QUESTION...do you pay a separate deductible at delivery? Or is the baby included, as long "it" leaves with mama? You need that info to make a decision.

Congrats!!!

 

[unic.consulting]

Congratulations,

It's a whole new world, and you'll enjoy every minute of it.

As for the HSA vs Copay - I agree you will probably max out this year. If you're going to use the HSA account to pay the bills, it's not worth it. If you're going to be able to put that money aside and keep it for later, I feel that is the best option.

 

[HoosierLife]

I would normally say yes..... however the oop max of $6k seems low for an hsa and is more of a single oop max.

Your oop max will be the family out of pocket max with an hsa plus family deductible.... check your plan again..

Yeah I just checked again. The max OOP is $3000/$6000.

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Do an actual spreadsheet to figure this out. Annualized. (PM me if you need help)

The $6K OOP on the HSA is what I sell all day long, so it seemed fine to me.

BIG QUESTION...do you pay a separate deductible at delivery? Or is the baby included, as long "it" leaves with mama? You need that info to make a decision.

Congrats!!!

I assume it's included. The deductibles and OOP maximums are either individual or family.

 

[kgmom219]

So your max OOP on the HSA plan is $4k? ($6K family minus the $2K that Simon puts into the HSA?)

Multiply the employee/spouse premium by 6. Then add the family premium multiplied by 6. Add $4K. Assuming you stay in network, that's your maximum exposure.

Next, take the same premium calculations as above on a copay plan. Then add copays, deductibles, coins, etc. Find out on the baby deductible.

There's NO way you aren't going to come our ahead on the HSA plan.

 

[HoosierLife]

So your max OOP on the HSA plan is $4k? ($6K family minus the $2K that Simon puts into the HSA?) Multiply the employee/spouse premium by 6. Then add the family premium multiplied by 6. Add $4K. Assuming you stay in network, that's your maximum exposure. Next, take the same premium calculations as above on a copay plan. Then add copays, deductibles, coins, etc. Find out on the baby deductible. There's NO way you aren't going to come our ahead on the HSA plan.

Thanks mom! That was what I was thinking. I just wanted some confirmation.

 

[TwiLight]

There's NO way you aren't going to come our ahead on the HSA plan.

I concur.... HSA is a good Choice...


To bulk up your Deductible make sure all the Iron Supps and other Pre-Natal nutrition is by Rx.... should help add to the deductible.....