You probably want to double check my math, but I tried 
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Even if it gives me a place to start calculating and which numbers are important, it helps - I’ve been so busy this week, the comparison felt like mud in my brain, ha.
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umm… two new pieces of information.
possibility the deductible/OOP max resets at calendar year on work plan. Calling the insurance company now to find out.
Talked to co-pay assistance and they will give me $12,000 in refund checks per calendar year if there’s a co-pay accumulator program in place.
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whoa that changes a lot of things!
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It actually doesn’t matter either way. Your deductible counts towards your OOP max.
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fuck. Okay. So. Talked to the health insurance company and the OOP max resets in Jan. It will only change if you switch plans in August and yr deductible goes up, you might have to make up the diff but will not reset.
Rerunning #s under the cut.
American is hard
Option A: Workplan
- Enroll in my work plan in January when I lose marketplace coverage. $111 premium but $7,000 OOP max. Drug cost is 50% co-insurance (~$4000 per month).
- ~$1,332 in premiums, $0 in drug co-pays ($7000 in costs paid for by copay assistance), probably $600 in specialist co-pay out of pocket before deductible, but may have to enroll in Option C if leave job
Option B: Option A + Move out of Country
Option C: SSO’s plan
- Enroll as non-dependent domestic partner on SSO’s workplace HMO plan. $150 premium, $0 in-network deductible, $2,000 OOP max. Specialty drug co-pay is capped at $150 per month.
- The employer paid premium of SSO’s workplace plan for me is taxable income, which means $3,168 of extra taxes.
- $1,800 in premiums, $0 in drug co-pays ($1,800 paid for by co-pay assistance) $30 in specialist co-pays before deductible
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Do the situations that trigger open enrollment for a married couple count for an unregistered domestic partnership?
If I lose my job mid-year, I can get onto my spouse’s insurance. So if you left yours, could you THEN, if needed, get onto someone elses’s?
Not sure if that really matters, but if you are planning for the whole year, but planning on leaving your job midyear, possibly that doesn’t stop you from using your job’s insurance still.
Otherwise, I have no help to offer. I effing hate all this.
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It looks like it but it isn’t specific just says ““If you experience an eligible qualified family status change (e.g., marriage, divorce, having a baby, your spouse’s/partner’s job changes)”.
I can also get on an exchange plan like I have now.
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I think I am going with, turning point, the $0 premium plan at my day job. $0 out of pocket costs and $0 extra taxes for SSO unless everything breaks as I originally predicted, then I’m fucked.
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Well well…I dug into the details on the plan website
And I had a Dr. appointment today
Now my new improved medication list would total $2754 per year on the HSA plan ($0 after deductible is met of course) at my preferred pharmacy in my preferred network, and would now be in the generic category on the traditional plans (!!!) - so 4 meds x 12 fills at $10= $480.
I thought I had this figured out, hahaha
Judging by this year, I can guess that I’ll have, say, 10 non-preventive visits total. On my current HSA these end up about $100-200 per visit after discounts so I can only assume they’d be the same on the new plan (same provider network). These would be $40 copays on the traditional plans = $400.
I don’t use HSA dollars; I invest them and currently just topped $20k whoop whoop
So
HSA
Deductible $3250
Premiums $652.56
Office Visits $1000-2000ish? Probably less. (Or $500**)
Medications $2754
So I’m looking likely to hit my deductible there, which is also OOP max, after which pretty much everything is $0 to me if I’m reading things right.
$500 deductible plan
Deductible $500
Premiums $1395.12
Office Visits $400 (deductible does not apply) (or $40**)
Medications $480
After deductible met, 20% coinsurance on most things.
This seems like it’s still more advantageous to be on the HSA, right? Especially with the investment option/tax advantages? So really, the HSA is great if you have no health care costs, or if you have costs over the amount of the deductible - but not great if you average spending just below the deductible…right?
**…but what if I only have four routine office visits…that’s maybe not so advantageous; I’d be paying right around the deductible so $3903 in total w/premiums…Then same on the other plan, right at the deductible with a total of $1915 but no lovely HSA contributions… lol I am NOT good at figuring this out.
I think I’m going to do the $500 deductible plan and just track everything closely for the year. If it does turn out that I have a condition that requires more frequent visits next year or more invasive procedures, I can switch to the HSA the following year (unless something is urgent but it’s not looking that way at all so far).
The only other thing I was planning for 2021 was allergy shots but I’m waiting until at least 2022 just because of COVID so it might make more sense to go back to the HSA then anyway.
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orrrrr none of this might matter because “finish this by end of the day” might have meant by 5pm which is 15 minutes ago
I can’t find the portal 
ETA Ok it moved to a different page and I have 6 hours PHEW
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Right now the $500 plan comes out to ~$2300 with your projected use and the HDHP comes to ~$3900 so a difference of $1600. Something like 800-1200 is made up in tax savings on $3600, and at 7%, $3600 makes $1500 in about 5 years (so, 400-800 in 1.5-3)… I guess it’s not a terrible timeline to break even, but I would take the lower up front cost, I think. 🤷
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Oh gosh, thank you!!!
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Did you get this uploaded to Google last year @anomalily ? Darlingpants is asking for a similar spreadsheet over in the Random Questions topic and I just remembered we’d done this.
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So, speaking of open enrollment, I caught a “typo” (they are calling it) in our open enrollment documents for a multi-university system. No big deal, just they put half the actual OOP max for a couple on the HDHP. Less than the deductible. They’re issuing a correction since I asked about it…
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Oh good, there’s a whole thread about this!
Strongly considering changing to HDHP/HSA plan this year. I’ve always had PPOs only, my entire life. But last year they switched us to an in-network PPO; no out of network coverage at all. So I’m sort of feeling like, what is the point then? The PPO has gotten so expensive.
I am really really nervous to switch though and I am not certain why? I guess because of the high deductible and lack of coverage until then? We have a meeting about it on Monday. My co-worker went to another session of the meeting today and said they explain very clearly how HSA is a better deal even if you have a health emergency.
Can anyone throw some logic in my direction to convince me that this is a good idea?
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For your situation, since you might move, look at what your options would be in NOLA… PPO is often better about out of state care (although EPO may not be).
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Well, it depends on who you are. HDHPs can still be in-network/out-of-network PPOs, it’s just a matter of the deductible. How much is the premium difference? does your employer contribute to the HSA? Is the HDHP a HMO?
Things to look for:
- the cost of any drugs you take on the plan
- if the providers you use are in network on the new plan
- if you will hit your deductible with these costs based on your previous use
- the amount you will be expected to cover after deductible on the plan for any drugs/visits/emergency care
- how much you will save on taxes with the HSA - i.e. compare how much you spend out of pocket on the PPO vs what your tax rate is (if you usually spend $3000 out of pocket per year, and you pay 30% taxes, then you will save $900 on taxes)
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Also remember that due to the ACA, deductible does not apply to some things, even on an HDHP. So this includes
-
certain annual exams (like gyno) and tests
-
certain drugs - blood pressure and BC drugs are included, so look for yours on the formulary and how much you will have to pay. it will have a star if deductible does not apply
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