Cami123

Hi,

I have to choose my health insurance - it is through Harvard Pilgrim in case someone has had it before and has any advice and it gives me 3 options.

1) very low weekly payment, high deductible (1500 in network or 3000 out of network with a 3000 or 6000 max our of pocket per year depending if in network or out) my employer would put 750 into an HRA for the deductible, then it is 20% copay for most everything except for like a checkup as far as I can tell (preventative primary care).

2) medium weekly payment, low deductible, 10% copay. But all of this only in network, nothing outside.

3) high weekly payment, lowish deductible (not as low as option 2 but significantly lower than option 1), 10% copay in and 20% copay out of network.

I have never dealt with private health insurance before so I don't know what to do... I am young at 32, pretty healthy, used to play an extreme sport and still only had to go to hospital once in the past 3 years (though it was for a destroyed finger that required several visits and was considered for amputation). I am unlikely to play this sport here as i worry too much about insurance and also being out of work for a prolonged period of time.

We are in Boston and all the local hospitals (of which there are so very many) fall under "in network" (the insurance lady at work said that if we are on holidays elsewhere the insurance would cover emergencies but no scheduled dr visits)- so I am tempted to say option 2 sounds best.

Any advice from long term USA transplants? Is there something I need to make sure I keep in mind? It all sounds so complicated and contrived on paper and the internets.

SanDiegogirl

Young and pretty healthy, I'd go for the low premiums and high deductible plan; and you get some pre-tax money to pay for any bills.

tom169

If you're not anticipating regular doctors visits then the HDHP will likely work well for you.

The deductible and out of pocket looks in line with what I have for an individual (my wife is covered by her own plan).

You should look into a HSA instead of a HRA.

After all this is insurance, so if you're paying more and you don't use it then it's being flushed down the drain.

SpoogleDrummer

If you go with option 2 you'll have to make sure the facilities you go to AND the doctors etc are in network. I just got hit by a bill for the kids' doctor who apparently only joined the network the month after my kids saw her despite the facility being in network.

I'd go with option 1 though, 1500 as a deductible is pretty low and if your boss is putting $750 in to a HRA then you're laughing.

nun

It sounds like you are married as you say "we". So if you are a woman or married you should consider that at a young age women tend to use healthcare more than single men.....basically because of pregnancy. Option 1) actually sounds pretty good as the deductible is quite low.....are the numbers you quote for a single person or a family? If you are ok with the network (most Boston plans have excellent in network providers) and think you might use healthcare quite a bit then I'd go for option 2).

FYI I'm a healthy, single man in my 50's and I chose the cheapest premium plan from my employer because my local hospital is in network and it has Boston hospitals like Beth Israel Deaconess for really serious stuff and I have no problem paying the deductible and out of pocket max.

Cami123

I am a married woman - but I am also gay - so accidental pregnancy is out of the picture for us luckily (there had to be some upside to this!).

We do want to have a child at some point but we would prefer to do so after returning to the UK because treatment options in the US are insanely expensive. However if we did end up staying - would it be possible to change plans later on (to go to a different premium and/or to add the child?)? Presumably that is possible.

scrubbedexpat099

Insurance is an annual thing, what may be on offer, what you choose in the future, well who knows

tom169

There are certain qualifying events that allow you to change coverage.

https://www.healthcare.gov/glossary/...ng-life-event/

nun

If you are ok paying a 20% copay the option 1) looks good. But if you like the in network hospitals in option 2) and want lower copays then go for option 2).

Basically you're going to get excellent healthcare with Harvard Pilgrim, so if you think you will not use much healthcare and can afford the out of pocket max and copays go with option 1)

Cami123

Thank you so much guys - this was really helpful and after much number crunching it makes sense for us to go with the low weekly, high deductible, particularly since their medication cost policy is pretty cheap and my work will put 1500$ in an HRA for us to use (we don't have a choice between HRA and HSA!) and the out of pocket max therefore is 4500 which is affordable for us.

My wife just had her benefits talk. Her company has a health insurance company attached to it and they were pretty insistent that the most expensive policy (500$ a month for us both) was the right choice and that 80% of their staff choose this. Just the monthly would cost us more than the out of pocket on my insurance plus there would be deductible, copay etc... and medication does not count for out of pocket max on her plan. I think there is a real conflict of interest there since they sell the bloody insurance themselves!

Anyhow, I am rambling - thank you again!

mrken30

What's the vesting period for the HRA? Not that you have any options. If sound like you have one option.

tom169

If the plan supports it then a HSA can be opened up separately to your employer. Many banks and credit unions will allow you to open an account.

Of course your employer won't be helping you out with contributions.

mrken30

And I don't believe you can have HRA and HSA. My HRA was restricted to medical expenses only and did not cover dental or vision expenses. If this is the case you may want to put some money into an FSA. I think you can roll over HRA funds into an HSA account after a vesting period. You may want to ask this question.

MidAtlantic

But be aware that FSA funds cannot be rolled over at the end of the plan year.

Pulaski

Just because "most people" choose the high cost option doesn't make it the right one for you, or, quite frankly, for "most people" either!

I have noticed that my colleagues are switching over to HD insured once they realise the benefits - low premiums and savings that easily exceed their medical expenses, and as in our case, we weren't meeting the deductible of even our low deductible insurance, so looking back we were flushing $,000's down the toilet every year. The savings on our premiums have enabled us to fund our HSAs to the maximum allowed by law effectively for "free".