Health insurance options revisited

When I’m on half pay, I have to pay for part-time benefits instead of full-time benefits which means the university contributes a lot less and we need to revisit our insurance choices.  Previously we’d opted for the family plan from the university which was a bit less expensive than the other options from DH’s company (partly because DH’s company’s plan covers a lot more stuff even if it’s not any more generous with copays or coinsurance).

This year, just to make it difficult, DH’s company has added a second health insurance option.  We can do either their PPO or their HSA.  If this were a “we have lots of extra money” year, the HSA would be tempting on the basis of the way they act as additional tax-advantaged long-term savings.

Based on my calculations the cheapest monthly payments are:
1.  DH’s family HSA:  $494.06
2.  DH cover himself and the children with the HSA I take my insurance:  $584.41
3.  DH’s family PPO:  $611.88
4.  DH covers himself and the children with the PPO I take my insurance:  $660.87
5.  DH covers yourself with the HSA, I cover the children:  $701.09
6.  DH cover yourself with the PPO, I cover the children:  $742.43
7.  I cover the family:  $791.74

Of course, these plans all have different copays and different deductibles and different coinsurances. With only a fraction of the full-time subsidy, my plan is just flat out dominated by DH’s PPO, so we can throw that out. The HSA costs more every time it is used and has a higher out of pocket limit than DH’s PPO.  All three plans have exactly the same provider networks.

So, the difference in monthly payments between DH’s two family plan options is $1413.84 annually. If DC2 stuck a pony bead up hir nose, it would be $3000 + possibly another $170 for the emergency room trip under the HSA and $500 + possibly another $170 for the same trip under the PPO-500.

Do we want a sure savings of $1400 vs. a potential additional cost of $2500 for one emergency trip? That’s a potential out of pocket loss of $1100, not counting the unknown costs of doctors visits under the HSA.

The final piece of information is how office visits are treated.  From the literature they gave us, it is clear that preventative visits are free and office visits for sickness are $25 under the PPO.  With the HSA it wasn’t clear if we had to pay for the entire visit up to the deductible or if they were free without copay.  That could make a very big difference when you have two kids going into a new disease environment for a year.  After googling and looking on the plan’s webpage only produced information from 2009, we called up.  And were told to call again the next day during business hours.  After a lengthy discussion the next morning we determined that we would have to pay the entire negotiated rate for an office visit under the HSA and just the $25 copay under the PPO.  The numbers the lady on the phone threw around for predetermined office visit rates were something in the 100 range, though she wasn’t quoting anything.  (Online rates range from $65 to $380, but I’m guessing the negotiated rates are in the $100-$200 range.  Who knows!)  Because we have children, it’s likely that we will have to visit the doctor’s office for more than just the one annual allowed well-child check-up.

Assuming no emergency room trips and that an office visit is $150, then we would need to visit the doctors office 10 times while sick over the course of the year before we lost monetarily.  Assuming a $200 trip, that would be 7 visits.  Those assumptions put the HSA in as being more beneficial.  But, thinking about it another way, we will need to have at least two visits under the HSA because you always need doctors visits for school and preschool and DC2 won’t quite be three yet meaning ze won’t have tripped onto the allowed annual well-child check-up and DC1 has already has hirs for the year.  So that would really only be a savings of $1100 under the HSA or perhaps $1000, given higher office visit costs.

Really it comes down to risk.  Will DC2 need to use the emergency room?  Will we be way more sick?

We can afford the $3000 HSA max should the worst case scenario happen.  But a sure loss of ~$1000 also isn’t that big of a deal to us if it pays for peace of mind.  Having an HSA account would be nice, but it would also be a hassle given that we’ll only contribute to it for the one year (since my insurance will be more attractive once I’m full-time again).

After a long discussion with DH, we decided we’re risk averse and, more importantly, hassle averse.  We think chances are very high that we’ll be out $1000 for the year but we’d rather not have to think about how much the doctor costs in advance of a visit or what bank to use for an HSA that we will at most put $3000 in.  So, we’re going for the PPO, even though financially the HSA would make more sense.

How do you decide between insurance options?  Do you get any options?  (And are you like me and would prefer not to have options?  That ‘more options is always better’ part of microeconomics is such bunk.)

 

Advertisements