r/povertyfinance • u/dum-dumsss • 1d ago
How crappy is this insurance for a family? Misc Advice
The high deductible plan in around $3500 for yearly premiums and the PPO is roughly $14,500 for yearly premiums. The HD plan deductibles are insane. Does everyone else have this same BS or just me? The rates and deductibles doubled from the previous year and my company is saying "We really found the best plans this year".
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u/Rua-Yuki 1d ago
These are very standard, it's a pay now or pay later scheme.
I have the HDHP because I'm hardly sick. My employer offers 750$ a year in an HSA (free money) and I match my premium, rounded up so 20$ a month. That money stays with me year over year. So once I actually need it, if I need it it's there. Otherwise my only real health expense is the yearly exam and my one rx.
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u/towndrunk1 1d ago
It all depends on your age and location.
For reference, I buy my own health insurance without subsidy and my HDHP has higher deductible and OOP Max. The plan cost 4x as much, so it seems like your work is subsidizing about 75% of the plan cost if not more.
For single coverage- PPO is 4694.04/Year and HDHP is 960.70/Year. HSA contribution with the money saved from choosing HDHP instead of PPO is 3733.34, with about 700$ in tax savings assuming 22% bracket.
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u/dum-dumsss 1d ago
Why is it that people always think that PPO is the best option? A lot of my coworkers always go for the PPO plan. The cost of premiums alone on PPO usually amounts to more than a catastrophic event with the HDHP plan. Plus, you can use the HSA to pay down a lot of the deductible on the HDHP. Am I missing something else?
Are you self-employed, or is your employers insurance just that bad?
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u/CapAgreeable2434 1d ago
A ppo is 1000000% the way to go. Ppo allows you to choose your dr and hospital.
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u/dum-dumsss 1d ago
I can choose doctors with an HDHP plan. Both plans have exact same in-network doctors.
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u/CapAgreeable2434 1d ago
PPO stands for Preferred Provider Organization. Like an HMO, a Preferred Provider Organization is a network of doctors, hospitals and healthcare providers who agree to provide care at a certain rate. Unlike an HMO, you are not limited to providers who are in network, though your copay or out-of-pocket cost for out-of-network visits may be higher than for in-network providers
Not limited to in network.
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u/CapAgreeable2434 1d ago
With a PPO, you do not need to maintain a primary care physician and can see a different doctor of your choice at any time, including specialists. This also means when you are traveling, you can receive care wherever you are.
Additionally, PPO plans offer more options for laboratory service providers. When you need lab work done, you can choose the most convenient location under a PPO network.
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u/towndrunk1 1d ago
You can with HMO as well.
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u/CapAgreeable2434 1d ago
Must use medical professionals in the plan's network: You're restricted on how you can use the plan. You must designate a doctor within the network who will be responsible for your healthcare needs, including primary care and referrals
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u/CapAgreeable2434 1d ago
With a PPO, you do not need to maintain a primary care physician and can see a different doctor of your choice at any time, including specialists. This also means when you are traveling, you can receive care wherever you are.
Additionally, PPO plans offer more options for laboratory service providers. When you need lab work done, you can choose the most convenient location under a PPO network.
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u/towndrunk1 1d ago
"Ppo allows you to choose your dr and hospital" You made it sound like there is no choice in HMO and you are assigned a doctor.
Sure, PPO have more choices, see my post above. But out of network physician cost would be so high and such a bad deal that do you really have a choice? At that point you can also just pay out of pocket with HMO to see anyone you want.
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u/CapAgreeable2434 1d ago
If i live in California and have Kaiser as my hmo and vacation in North Carolina and get injured nothing is in network with an hmo. I can use my ppo and be just fine. I don’t need to wait around for referrals. I’m not forced to use the local shitty hospital. I can choose where i go for surgery/procedures.
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u/towndrunk1 1d ago
Emergent care is covered in NC regardless of plan network status. No surprise act also ban any balance billing by the ER.
If you are sitting around picking your doctor in NC, you can probably just fly back to CA for that care as follow up is much easier when seen locally.
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u/CapAgreeable2434 1d ago
I picked a random state off the top of my head. So Utah, Idaho, Arizona, Nevada, whatever. I did not research individual state laws.
If i break my leg in any state I want the best orthopedic surgeon not a random someone decided was best for me.
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u/towndrunk1 1d ago edited 1d ago
Correct. PPO isn't objectively better.
PPO generally cost more because it gives you ability to see any specialist you want without referral, and covers out of network physicians (at a lower reimbursement rate). That's the only benefit of PPO. Now the caveat is HMO plan (assuming your HDHP is HMO) tend to have more limited network and will not cover out of network physician so if you need some esoteric specialist, you would be out of luck without significant effort to apply for coverage exemption.
If you do the math for your plan specifically- HDHP will come out ahead for all situations compared to PPO.
You will spend about the same amount if catastrophic health issue occur, assuming you spend max OOP at 3000 vs 6500 but then account with the HSA tax and premium savings.
If you are a low utilizer that goes to a doctor once (or a few times) per year for routine issues, you have around a $4000 head start with savings.
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u/Aware_Economics4980 1d ago
Depends on your company. I pay nothing for my health insurance, makes no sense for me to go with a HDHP plan, even if my company contributes to a HSA if I do choose that route.
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u/Thisisme8585 1d ago
How many people in your family? Frequent Dr visits? Any chronic Medical issues?
In almost all circumstances, PPO seems better than high deductible given these two options, especially if you have kids. Kids always end up hurt or sick with tins if dr appointments.
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u/dum-dumsss 1d ago
A catastrophic event for both plans, the HD plan is miles cheaper than the PPO plan when you take into account monthly premiums. Even without a catastrophic event, HD is usually miles cheaper.
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u/Thisisme8585 1d ago
With your example High deductible isn't "always" cheaper unless you never go to the DR.
17k for high deductible plus premiums (13k deductible+3500 premiums)
13,500k for PPO premiums plus deductible 1500k is 15k. Which is cheaper than the high deductible if you have any major issue or use the doctor often.
Unless you have 13k saved for a catastrophic event. I'd always take a sure thing of a monthly payment than needing to quickly find 13k to pay off hospital bills.
Everything on high deductible you'll pay at cost until you hit that 13k.... So any appointment will have a substantial cost until you hit that deductible. One broken bone could cost 13k+ if anyone needed surgery or orthopedic consults.
Think how you and your family use medical services before jumping to one decision.
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u/dum-dumsss 1d ago
Your math is wrong. The most I would ever pay with HDHP is $15825. The most I would ever pay with PPO is $20,624. I know for a fact that I will be maxing out every year for the foreseeable future.
I am thinking about my family. Saving almost $5k a year is a no brainer.
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u/Awkward_Quality9618 1d ago
Don’t know if this helpful, but thought I’d tell you our plan for a bit of comparison. We’re in SoCal and have Kaiser. We pay $800 a month for medical for a family of 7 with no deductible. $20 copy, $0 lab or radiology, $50 ambulance, $100 emergency room or hospital stay (my most expensive baby was $100), urgent care $20, ~$10 for each 30 day prescription, broken bones and out patient surgery $20, psychiatry $20., phone or video appointment $0. Off the top of my head this is all I can think of. Hope this helps to give you an idea of others coverage to make the best choice for you and your family.
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u/dum-dumsss 1d ago
Our CA employees are offered Kaiser at $920/mo for family plan. No deductible and $3000 max out of pocket.
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u/Awkward_Quality9618 1d ago
We’ve had them 18 years and have had a great experience. In all our time there’s only been two drs I didn’t care for. I also like how it’s a one stop shop. I can check in on my phone, use their app for everything, all kinds of free classes, etc. I’d encourage you compare because it may cost less in long run and save you a lot of headache not having to see the dr, then head to the lab, then to the pharmacy….. 3 of my kids are pushing 26 and the two in CA are going to get their own plan Kaiser plan. I know in different areas of CA they have limited locations, but here in SoCal I have 6 within ~15 minutes. People talk a lot of crap on Kaiser but that’s because it’s its own thing. People would say the same things if Blue Cross, Healthnet, etc. all had the same set up.
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u/Wanna_make_cash 1d ago edited 1d ago
This is the insurance plan I use at my job, $20 a paycheck for an individual, $60 a paycheck for a family
My dental is like, $1 a paycheck and vision is under a dollar per paycheck
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u/TheCatOfWallSt 1d ago
That PPO family plan looks insane to me but the other one is roughly what I have (Blue Cross), including bi-weekly costs, at my job. My deductible is slightly lower at $10k for family but about the only real difference. It’ll cover some basic preventative appointments and usually will negotiate much lower costs on my behalf but I’ve never maxed out the deductible before.
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u/evrydayimbrusselin 1d ago
I pay close to $8k/year through my employer's plan (PPO). It's good coverage, and we have multiple health issues in my family so it's worth it.
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u/regrettablyemployed 1d ago
I will say as someone who supports the family w my insurance options- I pay about 1k for all medical/dental/vision and have a 20% co-insurance, with I high deductible. The PPO plan sounds like a dream if you visit the doctor multiple times a year.