Health Insurance "HSA Thread"

[The Boys]

Here are some sites that will better explain the HSA:


http://www.ustreas.gov/offices/public-affairs/hsa/

http://www.hsabank.com/?gclid=CJLa8Jj9hJMCFQmQGgod3hIuFQ

http://en.wikipedia.org/wiki/Health_savings_account

The site below is for Blue Cross HSA across the United States:

http://www.health--savings--accounts.com/blue-cross-blue-shield.htm

 

[dawgball]

Profile:

Me: 34 years old (later this year)
Wife: 32 years old
Son1: 4 in June
Son2: 1 in June
Need maternity coverage

Son1 goes to doctor 1-2 times per year (including well visit)
Son2 goes to doctor 3-4 times per year (including well visits)
Wife goes for annual woman check up. Has not been to doctor for other reason since we've been here (4 years).
I met with a doctor yesterday just to get a relationship started as "family doc". This was first doc visit for me since we have been here.

We are with BCBS of GA and currently pay approximately $800 per month (company pays $400 of this). We have $40 office visit co-pays; $100 emergency room co-pay. This includes dental that is supposed to cover two check ups per year, but I always have to pay something. :shrug:

I get lost when I am trying to read up on this stuff. I think it is made confusing, so we can't choose the best plan for us.

Example: What the **** is the real difference between co-pays and co-insurance, then out of pocket maxes?

 

[ajoytoy]

Profile:



Example: What the **** is the real difference between co-pays and co-insurance, then out of pocket maxes?

copays are a flat amount you owe...i.e $30 copay...ins. co will pay all the remainder to the doctor and you owe nothing else except the copay amount

co-insurance is a percentage coverage of the total amount billable...i.e. you have a 50% co-insurance...the total amount for a office visit is $100 after the visit is reduced to the doctor's contracted fee rates...you owe $50 and your insurance company pays the doctor $50

 

[dawgball]

Where I don't understand is when you have co-pays and co-insurance.

That will be $20 co-pay, then you owe $60 co-insurance.

Sounds to me like the $20 co-pay has just been relegated to a marketing tactic that they had to keep around because everyone knows how they work.

 

[Mags]

Profile:

Me: 34 years old (later this year)
Wife: 32 years old
Son1: 4 in June
Son2: 1 in June
Need maternity coverage

Son1 goes to doctor 1-2 times per year (including well visit)
Son2 goes to doctor 3-4 times per year (including well visits)
Wife goes for annual woman check up. Has not been to doctor for other reason since we've been here (4 years).
I met with a doctor yesterday just to get a relationship started as "family doc". This was first doc visit for me since we have been here.

We are with BCBS of GA and currently pay approximately $800 per month (company pays $400 of this). We have $40 office visit co-pays; $100 emergency room co-pay. This includes dental that is supposed to cover two check ups per year, but I always have to pay something. :shrug:

I get lost when I am trying to read up on this stuff. I think it is made confusing, so we can't choose the best plan for us.

Example: What the **** is the real difference between co-pays and co-insurance, then out of pocket maxes?

Are you buying insurance in the individual or group marketplace?

I can tell you that Maternity in the individual marketplace is priced very high - all you are doing is "prefunding" your maternity stay.

Think about it - Maternity is one of the few "illnesses" that are intentional and self inflicted. Almost all who buy maternity coverage plan on having a child in the next 12-24 months. The insurer knows this also - so they charge accordingly. There are few non utilizers to spread the cost over.

You are best off NOT buying maternity (as insurers mark up the maternity cost to be able to pay commissions, pay expenses and of course profit) and save to pay it yourself. The expensive portion of maternity (complications of pregnancy) are almost always automatically included as part of the base insurance contract - but you need to make sure of this.

Companies do not offer the same plans - and in my opinion that is a good thing. It's not a one size fits all world. There is a lot of product differentiation, choices, and price points available to most can find a plan that suits them.

A good insurance agent can help you navigate through the choices and find the one that is best for you and your family.

There are a lot of good individual insurance carriers out there. Blue Cross Blue Shield is good is some states, not so much in others (especially in the individual marketplace). You may also want to look at Assurant, World, United HealthCare (Golden Rule) for example.

 

[ajoytoy]

Where I don't understand is when you have co-pays and co-insurance.

That will be $20 co-pay, then you owe $60 co-insurance.

Sounds to me like the $20 co-pay has just been relegated to a marketing tactic that they had to keep around because everyone knows how they work.

copays are for doctor visits...gen prac, ob/gyn, pediatrician, dermatologist, chiropractor

co-insurance are for hospital stays and/or surgeries...really depends on the plan you choose

 

[Mags]

Where I don't understand is when you have co-pays and co-insurance.

That will be $20 co-pay, then you owe $60 co-insurance.

Sounds to me like the $20 co-pay has just been relegated to a marketing tactic that they had to keep around because everyone knows how they work.

Upfront copays help control the amount one goes to the doctor - to help make sure you are only go when you REALLY have to.

USUALLY copays have 100% coinsurance included - meaning you will pay $20 for a doctor office visit and then the remainder is picked up by the insurer.

SOMETIMES it will be a copay/coinsurance structure. You may have a $20-80% type benefit - where you would pay the first $20 and then 20% (Company pays 80%) of the remainder. So if the charge was $100, you would pay $20 + 20% x $80 = $36 of the total $100, and the insurance company would pay $64.

 

[marine]

Think of co-pays like a cover charge to walk in the doc's office.

I think its to prevent you from running down to the doc office every time you get the slightest little sniffle.

 

[dawgball]

Bottom line for me is that I wish co-pays did not exist. I wish you had to pay the bill when you went. Lower my monthly premium while doing that, please.

The said intent of a co-pay may be to avoid unnecessary doctor's visits, but who is NOT going to go for a $20 bill? I don't think it is an effective enough tool.

I want insurance to be for unexpected, big ticket items.

Mags -- we are on a group plan, but the group is very small (5 people, one includes my family of 4).

I'm thinking that at the minimum we should stop maternity coverage and keep paying the same amount in. This would go into a savings account for future maternal needs. ??? would this make sense?

 

[MadJack]

Bottom line for me is that I wish co-pays did not exist. I wish you had to pay the bill when you went. Lower my monthly premium while doing that, please.

The said intent of a co-pay may be to avoid unnecessary doctor's visits, but who is NOT going to go for a $20 bill? I don't think it is an effective enough tool.

I want insurance to be for unexpected, big ticket items.

Mags -- we are on a group plan, but the group is very small (5 people, one includes my family of 4).

I'm thinking that at the minimum we should stop maternity coverage and keep paying the same amount in. This would go into a savings account for future maternal needs. ??? would this make sense?

dawgball, i've been working on this for 2 days and know more about it than i ever have. i'm sure the HSA is perfect for your family. i'm not finished yet but i don't think it's good for me because my out of pocket costs for meds is over $300 month which screws things up for me.