mrken30

To give you some comparison for an expensive procedure. My first baby cost me $250 , but I was paying $2600 more in premiums each year (HMO Plan). My second baby cost me $6000 , max out of pocket. So it just depends.

Cami123

As far as I can tell the HSA has no vesting period - if we do not use the money, eventually it just goes byebye. But it is fully funded by work, I don't have to pay into it - they pay a yearly max per family and if not used they do not add to that.

We have been offered an HRA (or FSA?) I dunno, the one you put tax free money in out of your salary and can pay for medical expenses with but if you do not use it after a year it goes away. I am considering it for medication expenses only as those are guaranteed expenses (I am on daily inhalers but that alone keeps me out of hospital and healthy - however without them I get quite sick) but I don't want to pay anything into an account where it goes poof at the end of the year!

My wife's work gives her a little monthly cash if she opt out of her insurance and that money is actually more a month than our premium will be, so if we end up staying healthy we will "make" money with this arrangement. If we end up getting injured or sick, we will still not be as badly off as we thought. Win - sort of win I guess.

mrken30

I thought
HSA was at a minimum partly funded by the employee. The money is yours to keep. Also a slightly bigger tax headache.
HRA is employer only funded. the money can rollover, but the money is not yours until maybe a vesting period. May have more restriction on the use of money compared to HSA or FSA
FSA is employee funded but does not rollover. Use it or lose it policy.

All are contributed to using pre tax money.

Cami123

Sorry you are of course right - I meant HRA comes with the insurance and HSA or FSA or whatever is the one I can opt into/open.

No HRA vesting on my plan - it rolls over but the max is 1500, so if we don't use it, it will not replenish.

mrken30

That's a bit unfair and is against the principles of the HRA / HDHP idea. It maybe that you do not have a HDHP, as it is not a requirement for HRA. Employers usually don't pay into an HRA unless it is an HDHP. So in year 2 they will stop paying into you HRA if you have not spent anything in year 1?

I am not sure how normal that is for HRA. Most people on here go on about HSA accounts.

If you have an HDHP you could consider a HSA, but your employer won't pay into it. You could ask your HR department if you have a HDHP?

Pulaski

That's not true, in fact I believe the opposite is true - if you have traditional insurance you (can) have an HRA, and if you have HD insurance you (can) have an HSA.

We had an HRA until we switched to HD insurance.

mrken30

I didn't have option of HRA or HSA until we went to HDHP. Previously with a low (zero) deductible plan we just had access to FSA. The deductible on the HRA plan at work is higher than the HSA plan.

Both are generally offered with deductible-based health plans, which encourage members to become more involved in their own health care decisions by giving them more control over how and when they spend their health care dollars. A member can only contribute to an HSA while enrolled in a high-deductible health plan (HDHP).

HRA or HSA – which is better for you?

Cami123

Ahh, the plot thickens!

Apparently (?) J1 holders can only get low deductible insurance by law, so the high deductible plan may not be an option at all.

Pulaski

Hmmm, that's interesting, I didn't know that. There are some very specific stipulations, including requirements for repatriation in the event of serious or chronic illnesses, which presumably is why health insurance for J-1's is relatively cheap.

vikingsail

Its a gamble whenever deductible's and copay's are involved. You are betting on your health and unexpected incidents in order to offset the deductible and copay whether it be 10%, 20% or more. A routine ER visit is going to be about $2k, if your lucky a routine procedure involving minor surgery $10k, something untoward thing a break or major surgery anywhere from 25k - 100k plus. When you start factoring that in, copays become expensive fast.

I would always go for the lower copay and reasonable deductible option. The 'cadillac' plans with no deductible are harder and harder to find and usually legacy or ironically only offered to executive and of course politicians!

I have no deductible to speak of $250 max and no copay. In the last 2 years if I had even a 10% copay I would have suddenly had to find about 25K for surgery as a result of events which were totally unexpected and not planned for.

So remember the its never going to happen to me scenario is a pure gamble.

mrken30

Most people don't have a choice, they just go with their employers insurance which normally has limited options.

carcajou

The primary purpose of health insurance is to protect you in case of catastrophic injury, and only help with co-pays at the doctor etc as a secondary purpose. Many Americans have that backwards, or ignore the catastrophic aspect because they think they are "young and healthy" and will be able to see any big problem coming and adapt accordingly.

Consequently I go for lower deductibles and lower out-of-pocket since hospitals are very, very expensive. I pay a bit more each month but I'm completely protected if I get hit by a car or fall on a patch of ice and break a leg.

Your calculation should be, will the cheaper plan keep a few extra Dollars in my pocket short-term but ruin me financially if I break a leg or get diagnosed with cancer?

mrken30

THe old way of thinking was that there is always the ER . Wait until things are really bad and they have to treat you.

kodokan

My daughter has so far broken her wrist and her ankle since moving here. The wrist cost a couple of hundred for a visit to an urgent care clinic (consult, x-rays, temp gel cast); then $500-600 for an orthopedist pediatric surgeon to check it and cast it a few days later, then x-ray and remove the cast some weeks later.

The ankle was similar - $200 or so for urgent care x-rays, consult, temporary cast and crutches; then a further $5-600 for the ortho clinic to check it all over and issue a walking boot. Then there was about $800 of physio for a couple of months.

Obviously it's completely different with compound fractures and anything requiring a surgical solution, but run of the mill 'oops, tripped' sort of breaks shouldn't even hit 4-figures to treat.

robin1234

True, and I think this has changed over time and also depends on the size of your employer, and the options available regionally.

My first employer (1991) was Harvard University in Cambridge, MA. There were nine different health insurance choices, all significantly different, including three completely separate HMOs.

My second employer (1995) was a small liberal arts college in a very remote rural area. It offered just one plan. In the eighteen years I worked there, they changed providers five or six times but the plan benefits remained more or less the same.