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HSA seems like a bad idea – for emergencies

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  • Avatar jaja123 
    Participant
    Status: Physician
    Posts: 22
    Joined: 02/04/2019

    Open enrollment. Deciding between a 0 deductible plan versus HDHP with HSA.

    What I didn’t realize is the HDHP does not offer any type of out of network coverage – is this standard or is this specific to my provider?

    We are physicians. We travel, go on vacation, go to conferences… multiple times a year. I can’t imagine having to foot a 40k bill for a car accident/blowing a hole in my colon/surgery etc.

    The 0 deductible plan at least has an out of pocket max and and a deductible for out of network care. How do you guys justify having a HDHP/HSA? You can be as healthy as you want but simply can’t protect against emergencies costing tens of thousands of dollars from occurring. Am I missing something obvious here? Is there some sort of nation-wide federal-level out of pocket max that you cannot exceed in a given year? Maximum out of pocket max per ACA says $7900 –  I’m not sure what this even means. My 0 deductible plan itself has an out out network max higher than this.

    I personally know of at least two people that were charged $20k+ because they were seen by an out of network physician at an in-network facility.. obviously they had no choice in the matter at the time… and are disputing it. Regardless, having a plan without an out of network out of pocket max seems like an absolute nightmare.

    #240057 Reply
    Avatar huskie92 
    Participant
    Status: Spouse
    Posts: 105
    Joined: 01/23/2018

    Interesting. I know our plan has a 5k family out of pocket max in network and then another 5k out of pocket max out of network. I don’t know if we are a typical HDHP or if we are an exception as I have not really done any research on the topic.

    #240066 Reply
    Avatar hightower 
    Participant
    Status: Physician
    Posts: 1484
    Joined: 12/07/2016

    The high deductible plan should have a max out of pocket as well, even for out of network services and providers.  You wouldn’t be hit with a 40k bill unless it’s the worst plan on the planet.  We have a high deductible plan and when my wife and baby were hospitalized (pre-eclampsia and pre-term birth), the bills racked up to well over 100k…we didn’t have to pay anywhere near that.  I think we have a 13k out of pocket max, some of which had already been met with various office visits and such before hand.  We used our HSA and didn’t feel a thing financially.  I was VERY thankful that I had our HSA at that time.  I am currently working on building it back up and I plan on continuing to have one as long as possible.

    Also, if you’re worried about travel, there is such thing as travel insurance that would cover emergencies anywhere you go.

     

    I don’t know why you would pay for a zero deductible plan if you’re otherwise fairly healthy and younger.  That HSA space is very valuable at this age.  Fill it up IMO

    #240096 Reply
    Liked by childay, Zaphod
    q-school q-school 
    Participant
    Status: Physician
    Posts: 2629
    Joined: 05/07/2017

    we had a partner whose kid broke clavicle during skiing trip.  so far they are over 13k out of pocket on HDHP and he’s still having trouble sorting out whether he’s done or not 8 months later.

     

    #240099 Reply
    Liked by AZPT, Craigy
    CordMcNally CordMcNally 
    Participant
    Status: Physician
    Posts: 2806
    Joined: 01/03/2017

    Our plan also has an in-network maximum out of pocket and out-of-network maximum out of pocket. I thought that was standard but obviously only have experience with the health plans I’ve had.

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

    #240107 Reply
    Avatar spiritrider 
    Participant
    Status: Small Business Owner
    Posts: 1903
    Joined: 02/01/2016

    Not too mention, your scenario would be covered by any HDHP plan I have seen. They have all fully covered emergency care out-of-network. For all I know it might be legally required.

    #240110 Reply
    jfoxcpacfp jfoxcpacfp 
    Moderator
    Status: Financial Advisor, Accountant, Small Business Owner
    Posts: 8113
    Joined: 01/09/2016

    Every plan I’ve seen has a max OOP cost for both in-network and out-of-network. The highest I’ve seen is $10k in network – maybe $20k out of network, can’t recall b/c I don’t pay as much attention to the OON.

    Of course, there is a risk to choosing a HDHP, otherwise, it wouldn’t cost less. If you judge the risk/cost of having to go OON as higher over the long term than the tax and premium savings, then don’t go with the HDHP. Of course, the outliers are what generate the most publicity, but, by definition, they aren’t typical.

    4 years of HSA contributions @$28k/yr for a HIP will generate > $10k tax savings (assuming the contribution limits don’t increase), even more in high-tax states, not to mention savings on lowered premiums. The tax savings is being ignored in this conversation, but it is the risk equalizer. If you really can’t afford the OOP costs for OON bills, that’s what the HSA savings are for. But that’s typically not an issue for HIPs who have their financial affairs in order, is it?

    I put the value of HSA contributions ahead of Roth contributions in the hierarchy of savings options. Impo, it would be illogical to take distributions from your HSA ahead of Roth distributions. And, as we all know, the Roth is sacred.

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

    #240113 Reply
    Avatar G 
    Participant
    Status: Physician, Small Business Owner
    Posts: 1799
    Joined: 01/08/2016

    Agree with others, are you sure there isn’t an OON cap?

    Hopefully this is something that gets fixed with the new new healthcare legislation…nobody is OON.

    Ofc, if the insurers get to pocket more of the doctors’ income, who can afford to travel for vaca? 😉

    #240117 Reply
    Craigy Craigy 
    Participant
    Status: Spouse
    Posts: 2049
    Joined: 09/16/2016

    We have a POS plan which only provides in-state coverage.

    It was explained to us during the annual meeting (2 years now) that if we get sick on a trip, we would need to travel back to the state to have coverage.

    We appear to have an unlimited out-of-pocket maximum.

    I won’t pretend to be an expert on health coverage, but the plans are getting worse and worse.  In my particular instance my employer is choosing the cheapest plan possible, or perhaps one of the cheapest plans possible offered by their broker.

    LEVEL 1 WCI FORUM MEMBER.

    #240120 Reply
    Liked by AZPT
    Hank Hank 
    Moderator
    Status: Attorney
    Posts: 1394
    Joined: 03/27/2017

    Good lord Craigy, does your managing partner ever travel out of state? That sounds like a terrible insurance plan: you effectively have no insurance if you go to a conference out of state or take the kids to Disneyworld!

    #240121 Reply
    Liked by Craigy, jfoxcpacfp
    Avatar AZPT 
    Participant
    Status: Other Professional
    Posts: 115
    Joined: 02/02/2019

    Im sure you are right OP, that there isn’t an OOP Max on this plan. My employer offered a plan similar – something called “Local Access”, and in reading the fine print only had IN benefits and coverage. I was mortified – considering I had been enrolled in it for 2 years w/o realizing it, and the only reason I caught it was my employer had added an additional option for this year during Open Enrollment. I immediately switched to the “Open Access” plan, which was more traditional with IN/OON coverage. Sure, the premium was about double compared to the other, but for the reasons you stated (vacations, travel out of state, etc) there is no way I would stay on that other plan.

    #240167 Reply
    Liked by Craigy
    Phoenixdown99 Phoenixdown99 
    Participant
    Status: Physician
    Posts: 160
    Joined: 03/20/2017

    can you be covered by travel insurance if you are travelling and have this kind of plan?

    #240187 Reply
    The White Coat Investor The White Coat Investor 
    Keymaster
    Status: Physician
    Posts: 4525
    Joined: 05/13/2011

    Open enrollment. Deciding between a 0 deductible plan versus HDHP with HSA.

    What I didn’t realize is the HDHP does not offer any type of out of network coverage – is this standard or is this specific to my provider?

    We are physicians. We travel, go on vacation, go to conferences… multiple times a year. I can’t imagine having to foot a 40k bill for a car accident/blowing a hole in my colon/surgery etc.

    The 0 deductible plan at least has an out of pocket max and and a deductible for out of network care. How do you guys justify having a HDHP/HSA? You can be as healthy as you want but simply can’t protect against emergencies costing tens of thousands of dollars from occurring. Am I missing something obvious here? Is there some sort of nation-wide federal-level out of pocket max that you cannot exceed in a given year? Maximum out of pocket max per ACA says $7900 –  I’m not sure what this even means. My 0 deductible plan itself has an out out network max higher than this.

    I personally know of at least two people that were charged $20k+ because they were seen by an out of network physician at an in-network facility.. obviously they had no choice in the matter at the time… and are disputing it. Regardless, having a plan without an out of network out of pocket max seems like an absolute nightmare.

    Click to expand…

    Crazy stupid health care system we have here eh?

    Site/Forum Owner, Emergency Physician, Blogger, and author of The White Coat Investor: A Doctor's Guide to Personal Finance and Investing
    Helping Those Who Wear The White Coat Get A "Fair Shake" on Wall Street since 2011

    #240226 Reply
    Avatar jaja123 
    Participant
    Status: Physician
    Posts: 22
    Joined: 02/04/2019

    Highly doubt I have an out of pocket max for out of network. It clearly says with HDHP there is no out of network coverage – there isn’t even a column for it.

    The two other health plans are: a Basic plan that is 0 deductible for in-instiution care, a premium plan with the same plus lower deductible for in network coverage, and then lastly the HDHP with HSA.

    #240265 Reply
    Avatar tylerjw12 
    Participant
    Status: Spouse
    Posts: 19
    Joined: 05/23/2016

    Your OON benefit set up has nothing to do with the QHDHP and everything to do with how your employer chooses to set up the plans. Hospital systems are known to set up plans with no OON coverage, as they want to steer their members to their own facilities. They can do this on HDHPs or traditional PPOs. IRS/ACA guidelines on Deductible and OOPM apply to In Network benefits.

    On top of travel out of state, you could have a dependent on the plan living in another state! I’d work to convince HR or other decision-maker to correct this. It’s a retention issue; employees DO change jobs for benefits. Is that type of plan common in your area/state?

    #240361 Reply
    Liked by Zaphod

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