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Health Insurance

Posted

Specializes in ER/ICU/STICU. Has 6 years experience.

Work is changing health insurance plans for 2011. There are 3 types, Health Savings (High deductible), PPO, and EPO.

I'm on the fence between the EPO and the Health Savings. I wanted to know if anyone has any experience with either of them and how they like them. Thanks.

coolpeach

Specializes in ER/Ortho.

I have the PPO, and love it.I know each time we go to the Dr it will cost x amount of $. If we get x-rays, blood work etc in the the office is included in the co-pay,and cost nothing additional.

Unfortunately, that is a really difficult question to answer here on the boards and especially from the information provided as you need to take into account your health (any re-occuring medications/dr visits?), how much your employer contributes to your heath savings, how accident prone (lol) you are, and most importantly, what each plan covers.

Some EPOs and PPOs are co-pay based, some are co-insurance based. Some health savings are partially funded by employeers, some are not.

Work is changing health insurance plans for 2011. There are 3 types, Health Savings (High deductible), PPO, and EPO.

I'm on the fence between the EPO and the Health Savings. I wanted to know if anyone has any experience with either of them and how they like them. Thanks.

I have a PPO plan. I don't know what EPO is. As for health savings, you have to look at several tings:

Your age?

Do you have any health problems?

How many times did you see a physician in the last twelve months?

How many times have you been to the ER, in the last twelve months?

Have you had to use a rescue squad in the past twelve months?

Have you been an inpatient in the last twelve months?

What blood work have you had done in the past twelve months?

Do you take any medications on a regular bases?

Have you had any x-rays in the last twelve months?

Have you had a MRI or CT in the last twenty-four months?

Have you had any minor or major surgeries in the past twenty-four months?

You are totally responsible for payment of your health care needs. And this means that each provider can and will charge you full price. Someone has to make up the difference for what the insurance companies negotiate. You may see this as a way to save money but I don't think it really is. And all you need is one major illness, accident or surgery to put you in the poor house.

Just my opinion.

GrannyRN65

I have the PPO, and love it.I know each time we go to the Dr it will cost x amount of $. If we get x-rays, blood work etc in the the office is included in the co-pay,and cost nothing additional.

Wish my PPO was like that. Everything has a co-pay for me.

GrannyRN65

HSAs are meant to be "true" insurance, meaning they are more like having something in case the worst happens. They are only worthwhile if you have no medical issues, and don't ever go to the doctor more than about once a year and take maybe one prescription medication one time through out the year.

Instead, they typically have a super high deductible of like 5,000 (single) which, once met, makes the HSA start to act like traditional insurance (either 80/20 or 70/30). Typically, HSAs are also usually funded by your employer meaning they give you 2000 dollars at the begining of the year (in which case, if anything bad every happens it's only 3,000 out of pocket deductible). They also usually have an out of pocket max which means once your bills get up to x amount of dollars, insurance then pays 100%

It's actually far cheaper for the employee and employer (which is why they give you "seed" money most times) and a very good idea if you fall into the above criteria because typically with HSAs, you're only paying a fraction what normal insurance costs each paycheck. Plus, at the end of each year, the money left in the account rolls over to the next year

ckh23, BSN, RN

Specializes in ER/ICU/STICU. Has 6 years experience.

I have a PPO plan. I don't know what EPO is. As for health savings, you have to look at several tings:

Your age?

Do you have any health problems?

How many times did you see a physician in the last twelve months?

How many times have you been to the ER, in the last twelve months?

Have you had to use a rescue squad in the past twelve months?

Have you been an inpatient in the last twelve months?

What blood work have you had done in the past twelve months?

Do you take any medications on a regular bases?

Have you had any x-rays in the last twelve months?

Have you had a MRI or CT in the last twenty-four months?

Have you had any minor or major surgeries in the past twenty-four months?

You are totally responsible for payment of your health care needs. And this means that each provider can and will charge you full price. Someone has to make up the difference for what the insurance companies negotiate. You may see this as a way to save money but I don't think it really is. And all you need is one major illness, accident or surgery to put you in the poor house.

Just my opinion.

GrannyRN65

Thanks for the response. What I should have added is that the Health Savings plan is attached to a high deductible insurance plan so there is an out of pocket maximum and coverage. I'm coming to the conclusion that it is for people that are generally healthy and do need the doctor much. In this particular plan all preventative services are included with no deductible. I'm just still kind of skeptical because the company seems to be pushing this plan over the others so that's why I wanted to know if anyone had used this plan in the past.

coolpeach

Specializes in ER/Ortho.

We also had the HSA added this year. I looked at it, but didn't choose it. There are a few reasons why I didn't choose it. First the company would put in $1300 in the account, but I would have to say I want you to take out X amount of dollars from my check for my account each pay period. I didn't want to do that, and thats sort of the whole point of the health savings account. In addition the deductible was really high. Even with what the company put in it wouldn't be enough to pay the deductible meaning I would have to pay a lot out of pocket in addiction to the money insurance deduction, and the deduction to the HSA.

We also had the HSA added this year. I looked at it, but didn't choose it. There are a few reasons why I didn't choose it. First the company would put in $1300 in the account, but I would have to say I want you to take out X amount of dollars from my check for my account each pay period. I didn't want to do that, and thats sort of the whole point of the health savings account. In addition the deductible was really high. Even with what the company put in it wouldn't be enough to pay the deductible meaning I would have to pay a lot out of pocket in addiction to the money insurance deduction, and the deduction to the HSA.

HSA is all about the roll over. This year you got 1300. If you went to the dr. twice, one well check up and one sick visit, the well would be covered by the insurance, you might pay 200 for the sick visit. That leaves you 1100 dollars. Now, when January rolls around, the company gives you another 1300 and now you have 2400 in your account.

With traditional insurance, you might be paying 40 dollars every two weeks plus have to shell out 1000 for your deductible, then possibly co-insurance of 20% on everything after that, which means if you have the same 2 visits as above, with a typical EPO you just shelled out 40x24 = 960 dollars in payroll deduction, and then 100 dollars for the negotiated sick rate visit(which you have to pay since you have 1000 deductible), which is 1060 dollars you paid for the year for those two dr visits.

That's why each person really has to look at it closely and decide based on their needs/past history and what each plan offers exactly

TDCHIM

Specializes in Health Information Management.

Be careful with HSAs. They look attractive on the surface, but it's the fine print that can make or break them as viable options. How much is the deductible? What percentage of costs does the insurance coverage actually pay once you reach the deductible? What about prescription coverage - is that different? Does it have a separate deductible? How much money is the company contributing? Are you allowed to roll the entire sum remaining in your account over to the next year? Can you only roll a certain amount of the company contribution over to the next year? Is there a maximum to how much you can save in the HSA over one year or multiple years? What happens if you leave or lose your job - do you get your contributions for the year or multiple years back? When the insurance does kick in, what's the out-of-pocket maximum? What does and doesn't the insurance cover if you have to use it? Do you have free choice of providers or can they tell you who to see (or who's considered "in network")? Is there a ceiling the insurance company will pay lifetime? How about per event?

The devil's always in the details with any insurance plan. I tend to distrust anything employers push as the "best" choice, but I'm a suspicious, detail-oriented sort by nature.

I have a PPO and it works best for my family. I also have a Flexible Savings account to cover dental, vision and copays. The PPO plan makes it easy for me to budget expenses, I know a doctors visit will be $25 or $35 (specialist) no matter what tests they run. I tried a different plan that had a deductible from the same company and paid percentages and I hated it, it cost more upfront for the insurance and the actual costs of doctor visits was higher, the only thing that was cheaper was prescriptions. I wound up having a well check cost me well over $200 because of lab work and spirometry.

I am willing to pay more for good coverage because there are several health issues in my family and know we will go to the doctor alot (usually 4-6 times a month). If I was single, a HSA plan would probably be great,

PPO's can screw you. If you use a provider (emergency situation) outside of their directory it will be complete hell to get them to pay for it.

been there, done that.

mappers

Specializes in Med/Surg/Tele/Onc.

I've had HSA before and it is designed for people without a lot of HC expenses. When I went on it, my insurance company provided information on their website that should me what my expenses where the previous year, including premium and presciptions. It also showed me the "real" cost, what I would have paid without the PPO I had been on.

I then looked at how much I would have paid for the premium of the HSA. It was much less expensive for me to use the HSA. At the time, we had maybe three doctor's visits and one or two presciptions for antibiotics (family of four, with two kids past the well-baby & ear infection stage). My HSA covered the expenses I had and I saved a lot of money on premium.

You truly have to look at your lifestyle and your health. There might be a gap between the HSA and the deductible, but that would only be reached if you had an ER visit or had to go to the hospital or had a major test. Look at how much that gap is and is that something you could afford to pay. For example, is it $2000? That seems like a lot of money, but for some people, that's a new living room suit. It could be paid off pretty quickly.

Your company is pushing it because it is the least expensive for them. Health Insurance is the one of the highest employee-related expenses a company has.

mappers

Specializes in Med/Surg/Tele/Onc.

You guys keep using HSA like it's an insurance. It isn't. It's a Savings Account that employers may contribute to and it rolls over every year. It is often connected to a high deductible plan, but that plan is really seperate. Employers bundle them together in their plan design frequently, but they are two seperate things.

With an HSA you really are paying for what you use. You and/or your employeer put money into the account and you use it to pay your medical expenses. You do pay "full price" for your expenses in that you aren't just paying a co-pay, but you often still get the negotiated PPO rate from the insurance company, not the true full price charged by the HC provider.

Someone said something about having to pay a lot of money out of your check into the account. Lets say you have a choice between paying $100 a month into the account or toward insurance. If your healthcare expenses are generally very low, you get to roll over that $1200 you pay into the account, so next year, you end up with $2400 in the account. The following year, you have $3600, etc. Eventually, when you sprain your ankle, you'll have a nice bundle in your account to cover the high deductible for that ER visit. (This is above and beyond what your employer may put into the account. If they are putting $1200 in, then you are hitting that deductible amount in half the time.)

If you pay $100 a month for insurance and you don't go to the doctor that year, that $1200 you paid that year is gone. And if you have a $1000 deductible for an ER visit, guess what, you're paying $1000 for that sprained ankle AND you've paid at least $1200 a year for the insurance up until you've needed it.

If you have chronic health problems or take regular RXs, or if you're planning on getting pregnant, etc, this plan may not work for you. But many young and healthy people are "over-insured". This is a way for you to truly insure yourself for what you think your expenses will be.

coolpeach

Specializes in ER/Ortho.

I guess I like the PPO because I have kiddos. We have a 1000 deductible, but only $500 per person. So if only one person needs their tonsils out then I only have to pay $500 before the insurance pays 80%. In addition, automatically I only pay $30 for the dr, $40 for the specialist and their is no deductible that starts right away. My Dr's office had has an x-ray machine, lab, etc. So if we need lab work, a chest xray, or some minor stitches they can do it right in the office, and it still only cost me the office copay $30. All preventives are fee. I do pay more in premiums, but its only about $30 more a paycheck for the peace of mind of knowing everyone is covered. My son had some digestive issues this year and needed to see a specialist, get an upper and lower GI, some X-rays etc. The rest of us just had a normal year. I hardly went to the Dr (maybe twice other than preventative, and the other two boys a few times for minor stuff. We racked up around $20,000 in medical costs, and we paid less than $2000. The real savings came from the Dr's office doing all that stuff in office. Often the bill will be $400 for blood work, x-rays etc, and my portion is $30

TDCHIM

Specializes in Health Information Management.

I guess I like the PPO because I have kiddos. We have a 1000 deductible, but only $500 per person. So if only one person needs their tonsils out then I only have to pay $500 before the insurance pays 80%. In addition, automatically I only pay $30 for the dr, $40 for the specialist and their is no deductible that starts right away. My Dr's office had has an x-ray machine, lab, etc. So if we need lab work, a chest xray, or some minor stitches they can do it right in the office, and it still only cost me the office copay $30. All preventives are fee. I do pay more in premiums, but its only about $30 more a paycheck for the peace of mind of knowing everyone is covered. My son had some digestive issues this year and needed to see a specialist, get an upper and lower GI, some X-rays etc. The rest of us just had a normal year. I hardly went to the Dr (maybe twice other than preventative, and the other two boys a few times for minor stuff. We racked up around $20,000 in medical costs, and we paid less than $2000. The real savings came from the Dr's office doing all that stuff in office. Often the bill will be $400 for blood work, x-rays etc, and my portion is $30

Wow, seriously? Can I be on your plan??? ;)