1/7/09: Is that Fahrenheit or Celsius?

[davidlevine]

Word count: 3727 | Since last entry: 559

The story keeps chugging along (the streak now stands at seven days). It's still awfully talky and I am certain the first draft will be far too long for the story's weight, but I can already see places to trim it. I also begin to see a possible ending, though not how to get there.

Kate thought the new hot water heater was set a bit too high, and I agreed, so I went to turn it down. The temperature control knob is labeled as follows: a dot, LOW, another dot, another dot, a triangle, A, B, C, VERY HOT. I turned it down from B to A.

We're looking into health insurance options. I had resisted the idea of a Health Savings Account, but after our insurance broker explained how it works it might actually be simpler (no claims to process... you just pay all your medical bills with the HSA debit card) and, as long as we stay generally healthy, cheaper. Has anyone reading this used an HSA? Any opinions on US Health Group as an insurer? The other option is a conventional plan with ODS. Any opinions on them?

Comments

[redbird]

I'm nervous about the "as long as we stay generally healthy" clause, given that I think the hospital and doctors billed my insurer on the order of $30,000 for less than a week of care last year that I had had no inkling I might need until shortly before I got a friend to drive me to the ER. (Not in the "I thought the simple meds were handling this" sense, in the "no idea I had any problem with that organ" sense.)

[joycemocha.livejournal.com]

We've had challenges with our HSA broker, but that's through DH's work and it's been submit payments after we've made them. Not everything gets approved, and we've not had a debit card.

ODS--um, there's been issues that I've heard about through work. Nothing personal, but some of that might also be due to having to change types of coverage from district-wide to a state insurance pool. ODS didn't handle that transition very well. I've had ODS dental, though, and it beats the pants off of Blue Cross easily. The key is to find a health provider who groks ODS well and has the billings down smooth. It's taken me three dentists to get that.

[matthewsrotundo.livejournal.com]

Not a fan of HSAs, me. They're usually sold in conjunction with a high deductible health plan (HDHP). The arrangement is basically a bet that you'll stay healthy.

And if you lose that bet . . .

[twilight2000.livejournal.com]

No personal info, but Standlee has a good bit of knowledge about HSA's...

[dd-b.livejournal.com]

My employer just changed from a conventional plan to a high-deductible plan with an HSA. It looks like a MUCH better deal to us (and the change was cost-neutral to the company).

However, the details of its being better are specific to this deal, and don't apply in general. My employer is putting $1500 into the HSA for me, in addition to anything I put in (the deductible is $2250 or some such; paperwork not here). So it's kinda neutral if we hit the deductible, and a win if we don't, *plus* our own contributions and the employer contributions can build up over the years if we have a few healthy years.

On the third hand, if you're buying individual coverage, the things that made it a win for us and revenue-neutral for my employer might well make it a win for you at a given cost point too.

Being able to pay with pre-tax dollars, *and* roll that over from year to year, is *huge* IMHO.

[rmeidaking.livejournal.com]

I would wait six months or so to see what shakes out of the national government in terms of health care. Health care companies are currently desperate to get people signed up under current laws, because they know the laws are going to change, and probably not in favor of health care companies.

[foomf.livejournal.com]

Is there a way to do both?

[davidlevine]

The HSA-based plan includes a high-deductible medical plan as well as the actual Health Savings Account. The point of the plan is that you pay for ordinary expenses (doctor visits, prescriptions, etc.) using dollars from the HSA, which is tax-deductible like an IRA, and the high-deductible plan pays for unexpected major expenses. Both the HSA-based and the conventional plans have an out-of-pocket max of about $5000, so they are pretty much the same as far as covering medical catastrophes.

The difference is that in the conventional plan you pay more every month in premiums but when you go to the doctor you pay only a $20 co-pay, while with the HSA you pay less in premiums but you pay 100% of each doctor bill (using tax-deductible dollars, which nets you an effective discount of around 30%, plus you may get a discount from the doctor for paying cash). So the "as long as we stay generally healthy" clause refers to number of doctor visits rather than possible medical catastrophes.

[davidlevine]

Who's the HSA broker? We're looking at US Health (and there's a tough name to Google for!).

Unfortunately, we are not going to have either dental or vision coverage. Individual dental and vision coverage is not available for a price that makes any sense at all.

[davidlevine]

The trick is to choose an HDHP whose annual out-of-pocket max is something you can afford. The point is to prevent you from getting wiped out by a medical catastrophe rather than to pay for every little medical expense. It's equivalent to this: would I rather A) pay more each month for a car insurance plan that includes free oil changes and tune-ups, or B) pay less each month for a plan that only covers wrecks? Plan A makes your expenses more predictable, but plan B may be cheaper if the difference in the premium is greater than what you actually spend on oil changes and tune-ups. It's a gamble, yes, but the HDHP is there to prevent you from being wiped out if you lose the bet.

[davidlevine]

Yep, but our current coverage (COBRA from the ex-job) expires May 1 and I don't want to count on the Congress acting that fast.

[davidlevine]

The HSA-based plan kind of is both. It includes a high-deductible medical plan as well as the actual Health Savings Account. The point of the plan is that you pay for ordinary expenses (doctor visits, prescriptions, etc.) using dollars from the HSA, which is tax-deductible like an IRA, and the high-deductible plan pays for unexpected major expenses. Both the HSA-based and the conventional plans have an out-of-pocket max of about $5000, so they are pretty much the same as far as covering medical catastrophes.

The difference is that in the conventional plan you pay more every month in premiums but when you go to the doctor you pay only a $20 co-pay, while with the HSA you pay less in premiums but you pay 100% of each doctor bill (using tax-deductible dollars, which nets you an effective discount of around 30%, plus you may get a discount from the doctor for paying cash). So the "as long as we stay generally healthy" clause refers to number of doctor visits rather than possible medical catastrophes.

[foomf.livejournal.com]

Hm. Interesting. Of course, the fact that I've screwed up my health (classic type II diabetes caused by the usual things, plus a bit of fatty liver - yes, human foie gras) and inherited some odd things (narcolepsy and gout) has resulted in a situation where my medical costs have been higher from time to time.

Still... my current company (AZAD) does United Health Care/Medco for their coverage - and having coverage is WONDERFUL thank you very much - but if my consulting gig at Intel dies on the end of June as currently scheduled, I may need to do something like this.
If I can figure a way to afford it.

My doctor is part of Providence, so I don't think I'd get a discount for cash.

Also, did COBRA actually turn out worthwhile for you? I found when I got laid off in 2001 from NEC that the COBRA coverage for Kaiser was about $200 a month MORE than going with Kaiser's then-available unsponsored plan, and for equivalent benefits.
Kaiser quickly made up for that. (May they lose their Title C standing for operating as a for-profit agency.)

[davidlevine]

We chose the COBRA plan because it was simpler than going out on the market. It's a bit more expensive, but it also covers things we just can't get as individuals (dental and vision).

[fishbliss.livejournal.com]

I have an HSA option at work, and I use it.

But that credit card - it was more trouble than it was worth.
I used it several times - at Doctor's offices for the copay,
at the drug store for prescriptions, also some otc stuff.

Then I got a letter asking me to submit itemized receipts for some
of these things, to prove they were eligible. Since the drug store
would be just as happy to sell me a case of coke as a box of bandaids.

This was when our plan were using a company called SHPS to do the
administrative paperwork. And their online submnission and tracking
systems were awful. I stopped using the card and just mailed in claims.
It was easier.

Now our plan has switched to a new administrative provider, Ceridian.
Got their visa card in the mail yesterday. It has the word "DEBIT" printed
on the card. The instructions say to always select the "CREDIT" option
when using it. I do not expect good things...

I do note that the local drug store chain now automatically marks with a
star all items on a receipt that are HSA eligible. That's an improvement.

[farmgirl1146.livejournal.com]

First, I was bitten by one of my cats when he was ill, about three years ago, and the two trips to the emergency room (of course no one else could see me after 4:30 p.m.), cost $10,000. There were two visits because I received only pills at the first visit, not a shot. The bite was in the fleshy area of the palm of my hand below my thumb. I have been bit by cats before and after with no infection. This was a raging infection. All paid by traditional insurance. I was shocked/pissed at the cost, and it would have been devastating to us financially without insurance. I have never won a fight with a hospital except when I could turn the fight over to the insurance company for double billing.

I think that HDHP is an insurance accountant's wet dream. Very bad for the insured, but great for the insurer. Also, some doctors and hospitals, after being burned by this, don't accept it, so you might have to leave an open credit card. Averaged over years, even at today's high rates, for me insurance saves me money. Also, it is tax deductible, to a point, for the self-employed.

Second, look at odd places to get health insurance, such a AAA and AARP (I don't know if one of you is over 50, probably not). Maybe I am not as healthy as you two, but after reading about Kate's illness near Xmas, food poisoning (which I think she may have had from the description) has little to do with health.

Also, I think that you travel too much for a HSA debit card, as I understand how they actually work. Look at the new Group Health (do you have that in Portland?) options, it's general insurance. While the Blues have their problems and very poor dental, they are reliable in my experience, and will cover you when out of the country, if you notify them (or they used to do this). In the past I have had Aetna, Travellers, and Blue Cross/Regents. Now I have an occupation specific one through the Husband. They all work about the same. A few years ago, it was my job to choose the insurance for a company I was working with. After extensive cross referencing I chose Blue Cross/Regents -- it had fewer exclusions and a shorter time for covering the new employees. Pre-existing conditions are the key. Please remember that. No matter what way you go, look into AFLAC. It was redundant with Blue Cross, but not the others.

[e-bourne.livejournal.com]

We investigated HSAs as an option for our company, and to put it simply, discovered that they are better if you are younger, not so great if you are older. It's a question of statistics and how much of a gambler you are. We don't gamble with our employee's health. Based on the general age of our population, we chose not to do them, although we may offer them as an option for younger employees at some point.

I am happy to recommend our agent (I do my son's insurance separately because it's so much cheaper if I do it independently) but off line, if you're interested.

[e-bourne.livejournal.com]

I suddenly felt I should add, since our headquarters is in PDX, our insurance is also Oregon-based.

[coruca.livejournal.com]

I have had a HSA style plan for two years and just switched from one provider to another, but stayed with the HSA. Why? There are no co-pays and as you stated, I am fairly healthy. But I also stayed because I went to an insurance seminar and after looking at the math, found the HSA was better even if you had a bad health year. If I spend all the allowance, once the deductible was met, I would be covered by a higher percentage than the traditional plan. Check you plan against the other options and you might find it is true also.

The reason I changed providers is I messed up under my old plan and ate the entire allowance by going to an out of system provider. That was my fault, but I was very unhappy with the snotty response I got when I questioned what was going on and later found they were charging me when I should not have paid. Bad customer service was the reason I left.

[davidlevine]

James Perkins commented on the Facebook copy of this post, and I am including it here for my own reference: "I've used an HSA. I view it as a way to itemize deductions for medical copays and miscellany which doesn't have to exceed 12.5% of your AGI, and still be tax-free. Of course one wants to spend it all for something medical, so cosmetic dentristry or the like can consume any unused portion at the end of the year."