https://boards.hellobee.com/ Pregnancy, Baby and Parenting blog, by Hellobee en Tue, 28 Apr 2026 12:23:37 +0000 https://boards.hellobee.com/topic/unraveling-healthcare-options-and-actual-out-of-pocket-costs#post-2781984 Wed, 25 Oct 2017 14:40:22 +0000 karenbme 2781984@https://boards.hellobee.com/ <p>Like others have said, pay attention to how much the company contributes to an HSA. It sounds like you use a lot of health services, but HSAs are permanent, you don't have to spend them every year, so if your employer contributes and you don't spend that money you have it as a cushion for the future. Where I work the employer covers 60% of the (several thousand dollar) deductible for people on the HDHP (which makes the cost to the company the same as the HMO). And we've been able to save enough in my HSA over the past 5 years that we have 2x the deductible socked away so any out of pocket at this point is mostly coming from money my employer adds every month to the HSA. I'm sure we're going to burn through most of this when we have our first next year, but at least most of the costs for my prenatal and baby's first 5-6 months will be on one plan year. And we've started adding enough of our money each month so that by the end of 2018 it should be back up to double the deductible. At the beginning an HDHP sounds scary, but if your company is decent about contributing, it can work out really well. </p> https://boards.hellobee.com/topic/unraveling-healthcare-options-and-actual-out-of-pocket-costs#post-2781894 Wed, 25 Oct 2017 10:01:04 +0000 ShootingStar 2781894@https://boards.hellobee.com/ <p>Our health insurance got complicated this year because I intended to be on DH's insurance, but this year they have a new rule that there's an extra charge for spouse's that use their ins when they could get their own. I think that's complete BS, but not much I can do at this point.</p> <p>So we looked at all the of costs. DH almost never goes to the doctor, maybe one or two urgent care visits per year. I might have one specialist visit per year and a couple urgent care visits myself. The kids have 5-10 sick visits. We've never had a hospital stay with either of them.</p> <p>Ultimately we decided he would get a high deductible plan and put the kids on it, and I would get my own high deductible plan. It didn't seem to make sense to pay the higher premiums for the HMO, especially because his company gives $1500 towards the HSA and mine gives $500. I will also contribute an extra $1k to the HSA. Their deductible will be $3k and mine is $1500. So we'll have 3000 in our HSAs and total deductibles = $4500. At this point I'm not super worried about the difference. We'll see how the year goes and we can always change one of the HSA contributions. </p> <p>Next year we'll probably all go on my plan but I missed a deadline for getting a reduced rate because I thought I'd be on DH's. </p> https://boards.hellobee.com/topic/unraveling-healthcare-options-and-actual-out-of-pocket-costs#post-2781874 Wed, 25 Oct 2017 09:11:05 +0000 Adira 2781874@https://boards.hellobee.com/ <p>@sunny: Yeah, I get that. My kids have asthma and have been hospitalized a bunch, so we've hit our out-of-pocket max every year so far. I'm HOPING that they are finally on the right kinds of medication to keep them out of the hospital, but I want to play it safe and go for a lower out-of-pocket max, even if it means higher premiums, just to be on the safe side. If we get through 2018 without an hospitalizations, I'll reassess! </p> https://boards.hellobee.com/topic/unraveling-healthcare-options-and-actual-out-of-pocket-costs#post-2781866 Wed, 25 Oct 2017 08:58:42 +0000 sunny 2781866@https://boards.hellobee.com/ <p>@Adira: I think you just have to make your best guess at what the likelihood you’ll hit that kind of # is. If the premiums are way lower on a HDHP, even if the OOP max is higher you are going to be better off in some years if you don’t use a lot of care. For my family, the first 3 years we were on a HDHP we did not even hit the deductible so the low premiums were great. The next 2 years we hit our family OOP max of $5000 because we used a lot of care. Actually this year we hit our OOP max early in the year and then I changed employers so now we are back at hitting the deductible again so we will end up spending more than $5000 on care this year. It’s a bummer but that’s one of those annoying things that is driven by healthcare tied to an employer. </p> https://boards.hellobee.com/topic/unraveling-healthcare-options-and-actual-out-of-pocket-costs#post-2781861 Wed, 25 Oct 2017 08:25:42 +0000 Adira 2781861@https://boards.hellobee.com/ <p>@Mrs. Tiger: Oh, yeah, that's expensive, regardless! That's like one of our options - it comes with lower premiums, but the out of pocket max is $13,000. No thanks!! </p> https://boards.hellobee.com/topic/unraveling-healthcare-options-and-actual-out-of-pocket-costs#post-2781856 Wed, 25 Oct 2017 08:20:07 +0000 NorthStar 2781856@https://boards.hellobee.com/ <p>@HappyBaker: This is what we do too. I compare the worst case scenarios (premium + deductible + to out of pocket max for a family) and see how they all compare. We don't expect to hit our deductible, but of course, you never know what could happen. The only potential thing that we know of is a vasectomy for DH. Any clue how much they cost? I've heard under $500. </p> <p>My husband just changed jobs, so we literally just went through this exercise a few days ago to figure out coverage for the remainder of 2017. We met our deductible with his former employer, so I'm crossing my fingers that we have a healthy remaining two months and don't have to meet another deductible in 2017. :meh: </p> https://boards.hellobee.com/topic/unraveling-healthcare-options-and-actual-out-of-pocket-costs#post-2781855 Wed, 25 Oct 2017 08:14:43 +0000 Mrs. Tiger 2781855@https://boards.hellobee.com/ <p>@Adira: that's an excellent point, but I can't remember! I want to say the out of pocket max was still over 10k... This was back in May when I switched jobs, I decided to do cobra and kick the can down the road for a year 😊 </p> https://boards.hellobee.com/topic/unraveling-healthcare-options-and-actual-out-of-pocket-costs#post-2781852 Wed, 25 Oct 2017 07:51:10 +0000 Adira 2781852@https://boards.hellobee.com/ <p>@Mrs. Tiger: Just curious - are the plans you looked at that had the hospital costs a percentage - was that not included in the out-of-pocket max? Our insurance options list everything hospital related as "80% covered after deductible is met", but it's still subject to our out-of-pocket max, so we'd never spend more than $6,800 as a family. </p> https://boards.hellobee.com/topic/unraveling-healthcare-options-and-actual-out-of-pocket-costs#post-2781850 Wed, 25 Oct 2017 07:24:24 +0000 Mrs. Tiger 2781850@https://boards.hellobee.com/ <p>I've had luck doing HMO (Kaiser) for a lower cost option that isn't as financially risky. One thing I always look at - are hospital costs capped or a percentage? I will never go on a percentage plan after having D - just one of his NICU stays was nearly $700,000 - I cant pay 30% of that, or 30% of surgeries, etc. With our insurance we paid our max hospital deductible which was $750. </p> https://boards.hellobee.com/topic/unraveling-healthcare-options-and-actual-out-of-pocket-costs#post-2781827 Tue, 24 Oct 2017 20:33:45 +0000 Pollywog 2781827@https://boards.hellobee.com/ <p>I'm posting the worksheet I made on your wall. It was by hand and is messy (and factors in tax benefits), but we found it helpful </p> https://boards.hellobee.com/topic/unraveling-healthcare-options-and-actual-out-of-pocket-costs#post-2781819 Tue, 24 Oct 2017 18:15:54 +0000 PurplePumps 2781819@https://boards.hellobee.com/ <p>@gotkimchi: Sent! </p> https://boards.hellobee.com/topic/unraveling-healthcare-options-and-actual-out-of-pocket-costs#post-2781813 Tue, 24 Oct 2017 17:11:29 +0000 Ms. RV 2781813@https://boards.hellobee.com/ <p>Does your employer pay toward your HSA at all? Where I am at now plus where I used to be gave you $1000 annually if you had a HDHP. Between that money and the lower premiums, I save money. I see a therapist every other week, DD gets an echo every year, and both of us are on prescriptions. Throw in three sick visits for her, two for me and I am still only up to $1800 in costs. </p> https://boards.hellobee.com/topic/unraveling-healthcare-options-and-actual-out-of-pocket-costs#post-2781807 Tue, 24 Oct 2017 16:36:56 +0000 gotkimchi 2781807@https://boards.hellobee.com/ <p>@PurplePumps: I'm going to walk you because we need to switch plans this year as well </p> https://boards.hellobee.com/topic/unraveling-healthcare-options-and-actual-out-of-pocket-costs#post-2781790 Tue, 24 Oct 2017 15:32:04 +0000 PurplePumps 2781790@https://boards.hellobee.com/ <p>I haven't found a good calculator cause all the details are so personalized. I think you just have to make an excel sheet and enter your details and then make a guess as to how many visits you make and how much it will all cost to make a best choice. I've done this with my plan and the results were quite surprising. It turned out the lowest deductible plan ended up costing the most across the board. I couldn't believe it. If you want to wall me your email address, I can send you what I did and you can see if you can tailor it to your plans. </p> https://boards.hellobee.com/topic/unraveling-healthcare-options-and-actual-out-of-pocket-costs#post-2781780 Tue, 24 Oct 2017 14:14:34 +0000 DesertDreams88 2781780@https://boards.hellobee.com/ <p>For us, between TTC and allergies and some bad luck, we have both hit our deductible for 4 of the past 7 years and our OOP max twice (LO1 and my DH just having a bad year). So budget based on worst case scenario, like others said. </p> https://boards.hellobee.com/topic/unraveling-healthcare-options-and-actual-out-of-pocket-costs#post-2781777 Tue, 24 Oct 2017 14:12:40 +0000 DesertDreams88 2781777@https://boards.hellobee.com/ <p>I think you've gotten tons of great tips above. </p> <p>If you go the HSA route, a couple things:<br /> 1) Your employer contributions count to your contribution limit.<br /> 2) Your HSA funds rollover year-to-year.<br /> 3) Make sure you contribute at least the amount of your deductible. So, like, my deductible is $2600, my employer contributes $1000, so I need to come up with at least $1600.... divide that by 24 pay periods, it's $66 per paycheck. </p> <p>I personally try to max out my deductions bc of TTC, babies, ER visits, and pregnancy. So my family max is 6,750, employer kicks in $1000, I put in (and deduct) 5,750 a year, which is $240 a paycheck. It sucks, but, it lowers our taxable income, it's forced budgeting, and it rolls over. </p> <p>4) You can change your HSA deduction amount at any time. So, if you don't put in enough, and then you have a medical emergency, you can up your contributions ASAP and probably have the money decently quickly and see if the hospital could put you on an interest-free payment plan. On the flip side, if you contribute a lot then have a financial emergency, you can stop your contributions pretty quickly, as well, thus raising your paycheck amount. </p> https://boards.hellobee.com/topic/unraveling-healthcare-options-and-actual-out-of-pocket-costs#post-2781775 Tue, 24 Oct 2017 14:09:37 +0000 looch 2781775@https://boards.hellobee.com/ <p>I look at the deductible, the monthly payment, the co-insurance percentages. We hit our deductible the last 2 years, one as a result of speech therapy and the other an outpatient surgery. I generally feel there's no way to "game" the system and come out ahead, so I at least try to spread my payments out over the course of the year. I also negotiate with providers to prepay where possible (like in the case of my son's surgery). I also make a ton of phone calls and ask questions of several different agents. </p> https://boards.hellobee.com/topic/unraveling-healthcare-options-and-actual-out-of-pocket-costs#post-2781770 Tue, 24 Oct 2017 14:04:25 +0000 Littlebit7 2781770@https://boards.hellobee.com/ <p>@HappyBaker: yep this is pretty much what we do as well. And ours pays 80% after we hit the deductible. I've been surprised by how hard it is some years to even meet the deductible. The negotiated rates have all been much lower than I've expected. I think we've only met our deductible once (the year I gave birth to LO) in the 5 years we've had a HDHP. We are a generally pretty healthy family though. We'd probably hit it yearly if we went to the doctor just a bit more. HSAs are pretty great though...its not use it or lose it like an FSA so I feel like it is less risky than you initially think. We have a nice little nest in our HSA (DHs company fully funds it to meet our family deductible every year; an admittedly great perk of his total compensation package). </p> https://boards.hellobee.com/topic/unraveling-healthcare-options-and-actual-out-of-pocket-costs#post-2781763 Tue, 24 Oct 2017 13:49:49 +0000 HappyBaker 2781763@https://boards.hellobee.com/ <p>Ever since having kids we have met our HDHP deductible easily every year, so I figure out the worst case cost and then pick the plan that has the lower worst case cost. So I add up the yearly premium cost and the deductible cost. For example our current plan is $3000 in yearly premium plus a $3000 deductible = $6000, so if there was another plan where that would be less I'd switch to that. </p> <p>Things to take note of though are what you are covered at once you do hit the deductible - we are only covered 80% after that point, whereas some plans would be 100%. Also whether or not prescriptions have their own deductible or if they fall under the regular one. </p> <p>We do put the full deductible cost into our HSA by taking whatever amount out per paycheck that amounts to, and then just reimburse ourselves while hitting the deductible. </p> https://boards.hellobee.com/topic/unraveling-healthcare-options-and-actual-out-of-pocket-costs#post-2781736 Tue, 24 Oct 2017 12:45:33 +0000 gingerbebe 2781736@https://boards.hellobee.com/ <p>I can't help much in finding a calculator for specific plans, but here's some general ones:</p> <p><a href="https://www.dinkytown.net/java/HSAvsTraditional.html" rel="nofollow">https://www.dinkytown.net/java/HSAvsTraditional.html</a></p> <p><a href="https://www.calcxml.com/calculators/ins11" rel="nofollow">https://www.calcxml.com/calculators/ins11</a></p> <p>Worse case scenario, I think if you can keep a cash reserve through an HSA or FSA or just in savings that covers your entire OOP deductible, it might be worth a 1 year experiment. If it ends up not working out, you switch back to the better coverage plan next year. </p> <p>An average doctor's appointment where we live is $150-$300 when paid in cash. Labs are $150-200. An high level MRI is $2500-3000. The last time I had a run of the mill stye in my eye while we were out of town, I had to get antibiotics and drops and it cost me $180, plus $150 to see a doctor at urgent care. When I ran out of my hormone replacement drug while stranded out of town, it cost me $160. </p> <p>We are on a traditional health plan through my job, but we almost always get sick or need to go to an urgent care when we travel and basically, we assume its going to be $300 per incident. Sometimes its more, sometimes its less, but that's about where we land on average. If you have 20 incidents a year where someone is sick and needs a routine prescription, that's $6000 and usually that's close to a family OOP max. So depending on if that savings works for you, it could be worth a gamble. </p> https://boards.hellobee.com/topic/unraveling-healthcare-options-and-actual-out-of-pocket-costs#post-2781727 Tue, 24 Oct 2017 12:08:12 +0000 Bluebonnet 2781727@https://boards.hellobee.com/ <p>@Anagram: Call your HR to see if there is a calculator that compares your plan options. (Or see if your HR will help you think through the costs of each plan and calculate it yourself). My employer provides the calculator @Adira: is talking about. You enter in how many doctors appointments, prescriptions, etc you anticipate for the year and it estimates what you’d pay on each plan (so you see the comparison of what you would pay and when on each plan, which also takes into account premiums and employer HSA contributions).</p> <p>In general, I’ve heard High Deductible plans are best for people who don’t use their health insurance that much AND for people who have a lot of medical expenses (which it sounds like may be the case for you). But I don’t think you can know which plan is the best for you unless you calculate your expenses each way. </p> https://boards.hellobee.com/topic/unraveling-healthcare-options-and-actual-out-of-pocket-costs#post-2781722 Tue, 24 Oct 2017 11:53:48 +0000 Anagram 2781722@https://boards.hellobee.com/ <p>@Adira: there's a calculator but it only "calculates" the yearly premium. Doesn't take into account anything else </p> https://boards.hellobee.com/topic/unraveling-healthcare-options-and-actual-out-of-pocket-costs#post-2781687 Tue, 24 Oct 2017 10:27:47 +0000 Adira 2781687@https://boards.hellobee.com/ <p>So something you want to think about - with a high deductible plan, you'll have to meet your deductible before the insurance kicks in. If you have a lot of specialist visits, labs, urgent care visits, and/or prescriptions, you might end up paying your full deductible. But if your premiums are low, that might be worth it.</p> <p>Between my kids and me, I anticipate we'll spend around $3000 just on prescriptions (damn Epi-Pens). So we'll hit our deductible just on that. Then throw on urgent care, emergency room, and all the additional follow-up visits because of that, it starts to give you an idea of how much you'll spend. We've hit our out-of-pocket max the last two years ($6,800) because of hospitalizations. So when I'm looking at plans, I've been looking at the out of pocket max, add the premiums, and assume that's how much I'll be spending for the year. Neither my husband or my work offer anything but high-deductible plans though. With a traditional low-deductible plan, it might be possible not to hit the out of pocket max, since your insurance will kick in a lot sooner. But will you be paying the difference in premiums? </p> https://boards.hellobee.com/topic/unraveling-healthcare-options-and-actual-out-of-pocket-costs#post-2781683 Tue, 24 Oct 2017 10:21:33 +0000 Adira 2781683@https://boards.hellobee.com/ <p>Here are the details they use to make the calculations if you want to try to make your own. All costs are the average:</p> <p><b>Preventative Care</b><br /> Adult Physical Exams: $159<br /> Child Well Visits: $134<br /> Adult Screenings: $115<br /> Child Immunizations: $87</p> <p><b>Routine Care</b><br /> Primary Doctor Visits: $119<br /> Specialist Office Visits: $145<br /> Laboratory Services: $65<br /> Chiropractic Visits: $39</p> <p><b>Prescription Drugs</b> - Short Term<br /> Generic: $29<br /> Formulary-Brand Name: $342<br /> Non-Formulary Brand Name: $402</p> <p><b>Prescription Drugs</b> - Mail-Order<br /> Generic: $58<br /> Formulary-Brand Name: $592<br /> Non-Formulary Brand Name: $745</p> <p><b>Maternity</b><br /> Office Visits: $2,819<br /> Maternity Hospital Stay: $13,651</p> <p><b>Hospitalizations</b><br /> Non-Maternity Hospital Stay (6+ Days): $65,119<br /> Urgent Care Visit: $190<br /> Emergency Room Visit: $1,663<br /> Outpatient Surgery: $3,622 </p> https://boards.hellobee.com/topic/unraveling-healthcare-options-and-actual-out-of-pocket-costs#post-2781682 Tue, 24 Oct 2017 10:17:01 +0000 Adira 2781682@https://boards.hellobee.com/ <p>Are you looking for insurance through your work? Do they have any sort of calculator? Mine has an estimated medical cost calculator where you enter information like number of well-visits, number of specialist visits, number of labs, number of short-term prescriptions, long-term prescriptions, urgent care visits, ER visits, hospitalizations, etc. Then it calculates your expected costs for each plan. Do you have something like that? </p> https://boards.hellobee.com/topic/unraveling-healthcare-options-and-actual-out-of-pocket-costs#post-2781679 Tue, 24 Oct 2017 10:06:03 +0000 avivoca 2781679@https://boards.hellobee.com/ <p>I'm following because of something similar. I used to be on my husbands (awesome) insurance due to excellent maternity coverage, but they started charging a monthly $150 fee for spouses who were enrolled and didn't use their own employer healthcare. So I switched to my company health policy and I'm finding that I'm paying tons of copays for things and still getting billed for doctor's visits and literally nothing goes toward my deductible. My OOP max is *only* $4k, but I will never hit that unless there is a hospitalization. ER visits are a $300 copay and urgent care is $100, so I usually end up paying whatever the cash price is (because I only seem to get sick when my PCP isn't open).</p> <p>I'm annoyed. </p> https://boards.hellobee.com/topic/unraveling-healthcare-options-and-actual-out-of-pocket-costs#post-2781672 Tue, 24 Oct 2017 09:48:19 +0000 Anagram 2781672@https://boards.hellobee.com/ <p>I don't know what category to put this in...</p> <p>But the season of open enrollment has begun. We have been paying for the best plan coverage plan that my employer offers, and my whole family is on it (including my husband, who is out of his employer provided insurance).</p> <p>I felt like it was the best option while we were having kids. But now that my kids are 2 and 4 and we are done, I want to see if we could safely downgrade and save money. But I don't want to save money in premiums only to pay it (or more) on the back end with higher copays, coinsurence, and super high OOP max limits.</p> <p>I should also note that I have an autoimmune disease and between me and the kids, we've probably had 20-30 doctor and specialist visits, 5-6 rounds of labs per year and that will probably continue. I have to get a colonoscopy every couple years and am due for a diagnostic mammogram in 2018. So no hospitalizations that I foresee, but some outpatient stuff and ai also want to be covered in the event of unknown illnesses or accidents. </p> <p>Are there any websites that let you input all the possibilities and premiums and compare plans? I know theoretically people can save money on High deductible plans because they can use HSAs to pay their deductibles and expenses and make their overall income lower and same money on taxes. But short of sitting down with a pen and paper, is there an easy way to compare different plans that takes consideration of taxes, HSAs, etc?</p> <p>How do you all make sense of this stuff? I have o many friends who went to high deductible plans and then got burned because they didn't have enough cash to cover the out of pocket max and then had a major hospitalization. </p>