Going to share a little bit of personal information in hopes that I can get some clarification from the group.
So last year my company introduced a CDHP health plan in tandem with an HSA account. On paper, the CDHP plan looks very good, having a much MUCH higher deductible ($3000 versus $900), but better coverage once that deductible is reached (90% vs 80% with the POS). Also, perscriptions count towards the deductible (where the POS does not and there is no maximum out of pocket for scripts). Last year I spent over $1600 out of pocket for perscription expenses alone, so it looks like a lot of that would go towards the deductible (and my company contributes $1500 in the HSA over the year, there’s the $3000). The other great benefit is that the CDHP is it costs like $140 a month versus the $325 a month for the POS. Both have a maximum out of pocket for the year of $6000 (which I’ve NEVER been anywhere close to reaching).
From some of the things I’ve read it almost seems to say that if you are a healthy individual you pick the plan with the smallest monthly cost, since you won’t be paying out of pocket all that much you want that money to go into savings.
On the other hand it almost makes sense that if your yearly expenses are HUGE you’d also want to go with this plan, since you’re paying out of pocket at least the deductible anyway, you want the added savings once you reach it.
The POS plan only seems like a good idea for people who have a chronic condition but don’t quite reach the CDHPs deductible for the year.
Last year I thought this was us, but I’m wondering if it makes sense to move to the CDHP with the HSA for the tax benefits as well. My expenses are only going to get higher with the new baby. We pretty much have nothing left in savings with all our expenses last year which is another concern for the CDHP. But the almost $150 in savings between the two plans can be put into the HSA along with the $125 from my work. Not to mention the $135 or so a month we spend on scripts. So there’s over $400 a month going into a plan.
Now, I know with the CDHP, any huge medical bills and perscriptions need to be paid up front and out of pocket for 100% of the cost. Until your HSA can catch up and then you can file a claim to get that money back. Aside from this negative, does anyone have any experience with any downfalls with a CDHP plan?
I wonder how bad this would be for my insulin and pump supplies? I think right now it’s about $400 every 3 months with the POS plan I can only imagine how much 100% of that cost would be.
One of my coworkers said she had a sister who did this plan and paid a lot more than she thought she would on the plan, spending close to $6000. I just don’t see how this is possible for normal every day stuff. The only way I can see that happening is that if the CDHP plan doesn’t have as good coverage or higher expenses for the same drugs and procedures as a POS plan.
Does anyone have any experiences (both good and bad) with this type of plan they can share? Any experts in the heath insurance industry that can shed some light on whether a CDHP plan is a good idea for 2 adults with chronic conditions and a new baby?