HDHP or PPO

Old Aug 16th 2011, 4:47 pm
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Default HDHP or PPO

With my new job, I have a choice of entering a traditional PPO plan with a 2k deductible. No out of pocket max. $25 office in network visit. $50 specialist office.

Or I believe entering into a HDHP with a HSA and a 2.5k deductible. $1,000 out of pocket max. 100% for office visits

100% co insurance after deductible on both. Both with United Healthcare.

Is one better than the other ? What would you pick? Any advice?
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Old Aug 16th 2011, 4:52 pm
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Default Re: HDHP or PPO

Don't know the answer, but glad to see you have got a job.
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Old Aug 17th 2011, 12:26 am
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Default Re: HDHP or PPO

Depends on how sick you see your selves getting over the year and if you can afford $2.5K or not.

PPO is good if you're a hypochondriac, so you can go see what ever specialist you want straight off, but the downside could be you having to pay first before getting recouped v insurance paying up front and telling you a flat no chance of being covered.

Congrats on the new job though!
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Old Aug 17th 2011, 1:24 am
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Default Re: HDHP or PPO

It depends on how often you will use it and what the premium price difference is. For very infrequent visits then it's usually cheaper to go with the HSA, especially if you just go for your free once yearly physical and blood work. The premium is usually a lot less and even if you pay 100% for a couple of doctor visits and some antibiotics it usually works out less than the PPO plan over the year. Likewise, if you go to the doctor a lot and have a lot of prescriptions, it usually works out cheaper with the HSA since you will hit the deductible and all your stuff will be free or in the case of prescriptions, likely a cheap co-pay. For instance the price difference in premiums for the plans we have access to is about $2300 a year more for the PPO plan. In a lot of cases, an HSA will be cheaper over the long term but with a PPO you have predictable costs. If you do go with an HSA I would advise putting at least the difference between the PPO and HSA premium into the HSA as additional contributions. I know that sounds like a contradiction to the pros I gave above, but if you work out the sums it makes sense. That way you will have some tax free money to pay for things and unlike a flex account, it will roll over year after year, even if you switch plans.
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Old Aug 17th 2011, 4:46 am
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Default Re: HDHP or PPO

I think it also depends on your health. Do you have any health issues? I need to see specialists several times a year. I'm not a hypocondriac I just have certain health issues that need to be kept in check. Is there a big difference in premiums? Is there a prescription plan? By the way Costco has great prices on prescriptions. It's actually cheaper than on some insurance plans! So are some mail order drug companies. You need to really compare the two and see what is right for your situation. Congrats on the job by the way!
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Old Aug 17th 2011, 10:41 am
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Default Re: HDHP or PPO

actually on the subject of insurance, could you explain to me how something work? I read that you have every year to have paid a certain minimum of money before being insured.. Did i understand it well? as it seem strange. if not how does it work?
My husband's work will pay for 80% of the costs and we pay the rest, and have the co-pay and a maximum out of pocket of 5k a year i think, but they are also mentionning this minimum payment which im not sure to understand (and im not sure if im explaining this properly either )
thank you!!
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Old Aug 17th 2011, 1:50 pm
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Default Re: HDHP or PPO

Originally Posted by laety View Post
actually on the subject of insurance, could you explain to me how something work? I read that you have every year to have paid a certain minimum of money before being insured.. Did i understand it well? as it seem strange. if not how does it work?
My husband's work will pay for 80% of the costs and we pay the rest, and have the co-pay and a maximum out of pocket of 5k a year i think, but they are also mentionning this minimum payment which im not sure to understand (and im not sure if im explaining this properly either )
thank you!!

Are you talking about a deductible?
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Old Aug 17th 2011, 3:10 pm
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Default Re: HDHP or PPO

Originally Posted by Sugarmooma View Post
Are you talking about a deductible?
yes thats it! a deductible.. so if my deductible is (im just making up a number here) $500 and i start my coverage paying $200 a month, does this mean I cant calim anything until I pay at least 2.5 months?? and it is reset every year?
My husband will obviously start to pay his medical insurance in October, so we have only 3 months and then we have to start over again?
as you can see im very confused about this.
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Old Aug 17th 2011, 3:16 pm
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Default Re: HDHP or PPO

Find out if under the PPO plan (which is what I have BTW but without a deductible) is that 2K deductible for major medical, i.e. hospital stays, emergency room visits or does it include well / sick visits to your primary and specialist physicians. I'm assuming those visits are not included since you have a co-pay listed. If my assumption is correct, it is far better IMO to go with the PPO.

Originally Posted by Ginblossom View Post
With my new job, I have a choice of entering a traditional PPO plan with a 2k deductible. No out of pocket max. $25 office in network visit. $50 specialist office.

Or I believe entering into a HDHP with a HSA and a 2.5k deductible. $1,000 out of pocket max. 100% for office visits

100% co insurance after deductible on both. Both with United Healthcare.

Is one better than the other ? What would you pick? Any advice?
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Old Aug 17th 2011, 5:00 pm
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Default Re: HDHP or PPO

Originally Posted by laety View Post
yes thats it! a deductible.. so if my deductible is (im just making up a number here) $500 and i start my coverage paying $200 a month, does this mean I cant calim anything until I pay at least 2.5 months?? and it is reset every year?
My husband will obviously start to pay his medical insurance in October, so we have only 3 months and then we have to start over again?
as you can see im very confused about this.
The way it works in a gist.

You pay a monthly for the insurance out of pay salary, which employer contributes.

You have a co-pay, this is the amount you pay for every visit to the doctor, hospital, procedure you have.

Deductible, you usually have different amounts for different things, hospital stay, emergency care, etc, etc. You have to pay your co-pay and what ever this deductible is before insurance kicks in. As you mention having a 80/20 split, that means you have to then pay the 20% cost of all care until you hit your personal max level, which you said was $5K.

The deductible is generally reset at the beginning of the year, but depending on your policy, it could be on the anniversary of signing on.
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Old Aug 17th 2011, 5:15 pm
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Default Re: HDHP or PPO

Originally Posted by laety View Post
actually on the subject of insurance, could you explain to me how something work? I read that you have every year to have paid a certain minimum of money before being insured.. Did i understand it well? as it seem strange. if not how does it work?
My husband's work will pay for 80% of the costs and we pay the rest, and have the co-pay and a maximum out of pocket of 5k a year i think, but they are also mentionning this minimum payment which im not sure to understand (and im not sure if im explaining this properly either )
thank you!!
That sounds the same as our plan. Insurance pays 80%, we pay 20% up to a max out of pocket of $5k per year. But the 80/20 split doesn't kick in until after the first $400, so the first doctor visits of the year are always ridiculously expensive as we effectively pay 100%

Last year hubby spent January 2 in hospital, meaning we kicked into the insurance immediately, we paid $400 + 20% of the remaining bill, insurance paying the other 80%. We haven't even met the $400 this year.
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Old Aug 17th 2011, 5:34 pm
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Default Re: HDHP or PPO

urrghhh I think Im going to hate this!!
So i found the document that HR sent us.. its actually 90/10
yearly deductible $250
deductible for hospital treatment $500
annual out of pocket maximum $1500 pp
copay looks like $20
so it looks ok I guess??

ahhh I wished they had a normal system

thank you for your explanation, its a bit clearer now!!
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Old Aug 17th 2011, 6:23 pm
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Default Re: HDHP or PPO

Originally Posted by laety View Post
urrghhh I think Im going to hate this!!
So i found the document that HR sent us.. its actually 90/10
yearly deductible $250
deductible for hospital treatment $500
annual out of pocket maximum $1500 pp
copay looks like $20
so it looks ok I guess??

ahhh I wished they had a normal system

thank you for your explanation, its a bit clearer now!!
Actually that is not a bad deal at all
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Old Aug 17th 2011, 6:39 pm
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Default Re: HDHP or PPO

excellent! thank you so much for your help!
I love this website!
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Old Aug 17th 2011, 6:54 pm
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Default Re: HDHP or PPO

Originally Posted by laety View Post
excellent! thank you so much for your help!
I love this website!
I have a $700 deduct, then it is 80/20%. $25 co-pay for GP, $50 co-pay for specialists and $1500 OOP expenses.

In October it is changing to the evil Aetna Deductible is going to be $1500, co-pays $75 and OOP expenses $2000....also most of the doctors in the immediate area are not on the plan either
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