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HDHP and HSAs

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  • Avatar wcinewbie 
    Participant
    Status: Physician
    Posts: 84
    Joined: 09/30/2017

    Our family has a high deductible health plan and HSA with an in-network deductible and out of pocket max of $2700/5400 individual/family and separate out-of-network deductible and out of pocket max of $5400/10800.  We have an in-network doctor who offered us a 20% cash pay discount.  If we do not plan to hit our deductible/out of pocket max this year, would it be advantageous to just pay cash?  Can we still use the HSA if we pay cash?  Does this change at all if we end up hitting our deductible?

    #244605 Reply
    CordMcNally CordMcNally 
    Participant
    Status: Physician
    Posts: 2805
    Joined: 01/03/2017

    Is the 20% cash pay discount 20% of the insurance negotiated in-network rate? I probably wouldn’t mess with the cash discount. Many insurances will cover preventative health visits so it sounds like you’re not really planning on using it on much else.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #244606 Reply
    Avatar wcinewbie 
    Participant
    Status: Physician
    Posts: 84
    Joined: 09/30/2017

    Unfortunately starting down the path of reproductive endocrinology so not quite sure.  Not even sure if it is “covered” by our health plan and/or to what extent.  Could we conceivably run up to our maximums within 3 months?  (end of calendar year).

    #244610 Reply
    CordMcNally CordMcNally 
    Participant
    Status: Physician
    Posts: 2805
    Joined: 01/03/2017
    Unfortunately starting down the path of reproductive endocrinology so not quite sure. Not even sure if it is “covered” by our health plan and/or to what extent. Could we conceivably run up to our maximums within 3 months? (end of calendar year).

    Click to expand…

    You could absolutely meet your maximums that quick. I feel like most insurance plans don’t cover reproductive endocrinology but you really need to read your insurance coverages and understand it. I’d bet you’ll be paying everything out of pocket regarding that with no coverage by insurance.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #244611 Reply
    jfoxcpacfp jfoxcpacfp 
    Moderator
    Status: Financial Advisor, Accountant, Small Business Owner
    Posts: 8113
    Joined: 01/09/2016

    Unless you would spend down the basis in your Roth IRA to pay qualified medical expenses, why would you use your HSA? I’d recommend saving the receipts for future medical expenses (in retirement or in a God-forbid catastrophic situation) if you can possibly afford to pay OOP at this stage.

    Understandably, what you’re undergoing is expensive and emotionally draining – sending the very best wishes your way that it is successful and in a very short time.

    Johanna Fox Turner, CPA, CFP, Fox Wealth Mgmt & Fox CPAs ~
    http://www.fox-cpas.com/for-doctors-only ~ [email protected]

    #244615 Reply
    Avatar wcinewbie 
    Participant
    Status: Physician
    Posts: 84
    Joined: 09/30/2017

    So they told my wife it’s illegal to have her as cash pay if she has insurance. Is that true?

    #245306 Reply
    jfoxcpacfp jfoxcpacfp 
    Moderator
    Status: Financial Advisor, Accountant, Small Business Owner
    Posts: 8113
    Joined: 01/09/2016

    So they told my wife it’s illegal to have her as cash pay if she has insurance. Is that true?

    Click to expand…

    Not at our local hospital, although I no longer get a 50% discount – I think they trimmed it to 20-25% (but still let me pay with a credit card!)

    Johanna Fox Turner, CPA, CFP, Fox Wealth Mgmt & Fox CPAs ~
    http://www.fox-cpas.com/for-doctors-only ~ [email protected]

    #245310 Reply
    Avatar wcinewbie 
    Participant
    Status: Physician
    Posts: 84
    Joined: 09/30/2017

    Just went to have labs done. People with no insurance get a 50% discount but if you have insurance you have to pay full price. No cash pay discount. Not hard to understand why so many people believe insurance as currently structured is a scam. I’ve never had my pharmacy refuse to allow a good rx coupon cash pay though. Are the rules for drugs different?

    #245373 Reply

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