Hoping I can get some advice on picking a PPO health insurance plan vs HDHP (w/ an HSA).
The prevailing wisdom I tend to see online is that if you expect to have high expenses, go with the PPO but if you think you'll have low expenses then go with the HDHP. I've been trying to do the math and I always come up with the HDHP on top (even ignoring the tax benefits and with high medical expenses for my family of four). I'm leaning that way as a result but don't want to miss anything.
My impression is that it's because the savings on premiums is so significant between the plans and the HDHP actually has a LOWER out of pocket max than the PPO.
Really appreciate any thoughts - my stats are below.
- Family: Myself (healthy), Spouse (significant medical condition w/ ongoing care), 2 healthy kids
- Normal # of office visits for myself and two kids (a few per year each) - did the math and came out with a guess of 38 office visits for the year for my spouse at ~$7,000 total cost
- No medications for myself or the kids - about $1,350 / month total cost for my spouse if there were no insurance (and believe the medication qualifies as "tier 2" so it would not be at the 30% / $250 rate below for "specialty" drugs)
- No planned major expenses but my spouse has been hospitalized twice in the last few years at around $15k total cost each time and potential to be recurring
| PPO | HDHP | |
|---|---|---|
| Annual Employee Premiums | 5,454 | 1,499 |
| Out of Pocket Max - Indiv. | 5,500 | 5,000 |
| Out of Pocket Max - Family | 11,000 | 10,000 |
| Deductible - Indiv. | 500 | 2,800 |
| Deductible - Family | 1,000 | 5,600 |
| Co-Insurance | 20% after deductible | 0% after deductible |
| Office Visits | ~$50 | 0% after deductible |
| Prescriptions | No Deductible | Same as Above |
| Prescription Tier 1 - 3 | $10-$65 | $15-$60 |
| Prescription Specialty | $65 | 30% up to $250 |
Thank you!
Submitted November 17, 2021 at 02:43AM by Cultural_Condition_6 https://ift.tt/3clRM0Q
