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Old 12-06-2017, 04:51 PM   #1
chrisinhouston
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Our new insurance

I am on my wife's insurance policy offered by her employer. Every year the insurance renews on December 1st and there are usually a few changes to consider. This year the changes were large; the company has new ownership and this year they offered 2 different plans which was nice as it gave us a bit more choice. The problem is that the company is small and the employees are either older like my wife or young and with families, both drive up the costs.

Plan 1 or the Gold Plan was not too different from what we have had in the past. My wife would pay about $1000 per month, the company also kicks in about that much and that covers her and me. The deductible is $1200 per person and they offered an 80/20 copay on procedures, lab work and hospitalization. The doctors copays are $35 for a GP and $55 for a specialist and the drug tiers were $15/$35/$55/$105. We take mostly Tier 1 and 2 but I do have 1 Tier 3 asthma drug. While the month to month costs are not too bad in the event of a major hospitalization we would still end up having to pay the 20%. When my wife had her stroke the bills were over $40,000 but luckily that year her insurance paid 100% after meeting the deductible which they don't offer now.

Plan 2 or the Silver Plan was more of a high deductible PPO. Her company would pay all the premiums for us so no paycheck deduction which is good but the deductible is $5000 per person which could be bad. But they offer an HSA with this and due to an IRS rule that because we are moving to this plan in December we can fully fund the HSA this month and get the tax benefit which we really need due to all the bonus and stock money we got this year. I think she can put in $7750 this month. Then each month next year she will put in around $645 per month to fully fund it again which is less than her old insurance premium was. They company will also give $500 towards the HSA. There are no drug tiers or Dr. copays until you reach your deductible, then everything is paid 100% as well as hospitalization and procedures and lab work.

Also offered is a fairly good plan for dental and vision which is cheaper than in past years. They are offering an FSA plan that can only be used for dental and vision but at least we can put pretax money into that and use it for procedures. I think the FSA can only carry over $500 per year so we are funding that a bit more carefully but we do plan to try to get some needed dental work done before she retires and looses that benefit.

She did the homework, several spreadsheets based on past years medical expenses and decide Plan 2 was the better one for us. This was mainly due to the HSA which will save us on taxes and that instead of paying $1000 monthly premiums we are instead building a health savings account which can be used for all medical expenses towards our deductible and is ours to keep. The other thing is with this plan, doctors visits, procedures, etc. are at an agreed rate within the network so the cost is not like if you had no insurance. Today I paid $180 to see the orthopedic Dr. and with the other plan it would have been $55. But that will come out of my HSA. If it weren't for the HSA and the fact that we are in a financial position to fully fund it for this year in one month we probably would have picked the other plan. My wife things her 2 paychecks for December will amount to less than $800! But it's only one month.

My wife is eligible for Medicare but the company insurance is better since we are both covered. She plans to work until the end of the year she turns 70 and then switch to Medicare with a supplemental plan. I will be 64 so will only have to find coverage for a year until I am eligible. Hopefully by then the Republicans won't have destroyed Medicare.

The crime is that we have to do all this shit and it still costs so much. My family and friends in Australia, Canada and the UK will admit that their National Health has it's limitations but is no where near as costly. We are the only first world nation that still uses an outdated model where employers provide insurance.
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Old 12-06-2017, 10:36 PM   #2
xoxoxoBruce
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Chris, what about when your wife is on the road, does your insurance or the company cover that?
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Old 12-07-2017, 07:16 AM   #3
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Quote:
Originally Posted by chrisinhouston View Post
The crime is that we have to do all this shit and it still costs so much. My family and friends in Australia, Canada and the UK will admit that their National Health has it's limitations but is no where near as costly. We are the only first world nation that still uses an outdated model where employers provide insurance.
Indeed.
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Old 12-07-2017, 08:58 AM   #4
chrisinhouston
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Originally Posted by xoxoxoBruce View Post
Chris, what about when your wife is on the road, does your insurance or the company cover that?
Good one. In the USA seeing a Dr. or going to a clinic or hospital generally is covered although we sometimes fall into that stupid gap where the ER is covered but the doctor working there whom you had no choice over is not on the insurance. Thankfully some states are changing that. A couple of years ago she slipped getting into the hotel bathtub and broke her wrist. She went first to the ER and then on the the jobsite where she was doing training. People were so surprised to see her in a cast. In the end I think Insurance covered it all.

International is a bit different. If wed do a personal trip I sometimes get coverage in case of an emergency, especially in more remote or places where care could be questionable. For work her company has a policy that included emergency extraction so they would pay for initial care in that country, getting her flown home quickly and then the insurance kicks in here.

In all the years we have been overseas she has only had 2 health issues. Once in England she was seen by a doctor for what turned out to be a kidney stone, just a basic checkup and advice for the flight home, not much else he could do. And in Australia she saw a Dr for a UTI. It was a town clinic and the DR. we saw did everything from paperwork to getting the vitals and running the Urine strip kit test. No nurse anywhere. The charge for non Australians was only $20 and the prescription was $5 and they apologized for having to charge us so much.
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Old 12-07-2017, 09:21 AM   #5
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Interesting you can pre load your HSA like that as starters, in subsequent years your limited on Monthly contributions, the total is about $6500 this year.

I don't think you can have an HSA and FSA, double dipping on tax deduction.

Those plans seem weird to me, ones I have encounterd have a deductible where you pay everything ($1800 to qulaify for HSA), then you pay 20% up to a maximum ( $6500 ish to qulaify for HSA), then you are covered 100%

$1000 a month premium !, also company pays and no premium also!
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Old 12-07-2017, 09:53 AM   #6
chrisinhouston
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Originally Posted by Beest View Post
Interesting you can pre load your HSA like that as starters, in subsequent years your limited on Monthly contributions, the total is about $6500 this year.

I don't think you can have an HSA and FSA, double dipping on tax deduction.

Those plans seem weird to me, ones I have encounterd have a deductible where you pay everything ($1800 to qulaify for HSA), then you pay 20% up to a maximum ( $6500 ish to qulaify for HSA), then you are covered 100%

$1000 a month premium !, also company pays and no premium also!
>>>>>>>>>>>>>>>>>>>>>>>

The IRS has a special rule called "the 12th month rule", leave it to my wife to do the research and find this kind of stuff, even the insurance agent and our financial advisior were unaware that if the plan begins in the 12th month as ours does you can fully fund it for the year in that month. For most that is $6750 this year but if you are over 55 you can deposit an extra $1000 which we will do. Then in January we just fund the year in monthly amouts. For us there is the tax break we can claim for this year which we really need and then we start the year with the max in the account should we have some major medical up at the front of the year and whatever we don't use carries over. There is also a provision when we are retired that we can roll over the HSA to a higher earning investment account like an IRA. Luckily she brings home enough in each month that we can live with 2 tiny paychecks and use money in savings.

They are allowing those on the Silver Plan to have an HSA which the company will match a $500 donation once we put in the first $1000 which is nice. They also offer the FSA. The HSA can be used for all health costs including dental and vision but the FSA can only be used for Dental and Vision and nothing else, and we can only carry over $500. And The FSA works differently that the HSA. You set up what yo want to contribute to each plan and it is taken out of your paychecks. The HSA will grow during the year each month so other than this 12 month rule allowing us to fund we will fund month by month starting in Jaunary. As I said we get the benefit of the tax write off and having a full account to start the year. The FSA works differently, you estimate how much you will spend in a year for dental and vision and set up a paycheck deductions. But the FSA is fully funded on January 1st and you are just paying into it and the company handling the FSA is reimbursed. Carrying over $500 is nice as or you could do some last minute dental or vision as the year draws to an end.

Sarah and I are at the point in life were we have decent teeth but probably have a few that should have crowns in lo of the old fillings. I sill have some old amalgam ones as well as a 4 tooth lower front bridge I had put in 44 years ago when I was in a bike accident at age 17 and is showing some wear We want to get as much done on dental and vision while we still have the coverage through work. I know there are some after retirement plans but they are not always as good.
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