Health Insurance

[artteacher]

My company is giving the workers a choice between staying with a PPO or changing to a HDHP with a HSA (High Deductible Health Plan with a Health Savings Account). I am still researching which plan is better for those of us with a chronic disease. For the first three years the company will be pay into the HSA along with the worker.

If I decide to go with the HDHP I have to stay with it. I would not be able to go back to the PPO.

Without going into the specific numbers finanially, is anybody on a HDHP and how do you feel about it? My first impression for this decision is that I would be better to be on the PPO. It seems to me that the prescription program with the HDHP does not cover as well as PPO.

I realize that you can only give me an opinion and I will have to decide for myself. I just would like to heard from some people who have experienced a HDHP. Thanks.

[Portia]

I don't know what HDHP stands for, but I can tell you that I switched from an HRA (health reimbursement) to an HSA (health savings) without fully understanding. The drawback for me is that copay does not apply to prescriptions until my full deductible has been met. Full deductible is $3,500. My amantadine went from $7.00 to $69.00. Gabapentin went from $6.00 to $18.00. Baclofen went from $7.00 to $26.00. It would have been a good plan for my family in 2013 or 2014, as I had two EEGs and one MRI and my daughter was carried to the ER by ambulance twice, but this year we're all pretty healthy. Now there's the bright side.
Unfortunately, I'm stuck with this plan until November and it won't have paid off.

[MSW1963]

I managed elective medical spending account plans during the initial IRS changes that allowed MSAs, HRAs and HSAs. I honestly can't remember much of the compliance, legal or administrative IRS requirements for HRA or HSA. If memory serves me correctly the legislation that allowed MRAs was revoked years ago.

The elective type spending account plans are typically based on the participant's predictable, planned expenses, versus emergency medical expenses or expenses associated with an expensive chronic illness.

For example planned elective surgery, planned orthodontia expenses, predictable annual vision care, regular expenses for other treatments like statins, HBP treatments, regular treatments for a stable heart condition, etc.

While one of the elective medical spending account type plans, HSA?, allows the unused account balance to rollover to the next year, the insured portion for these plans have such high deductibles, out of pocket expenses and I wouldn't rely the insured portion of the plan to cover the kind of expenses associated with a MS Specialist, regular MRIs, DMTs, much less the countless other expenses that could be a factor for someone with MS who's having a bad year.

Some of the elective spending account type plans may involve a forfeiture of any unused balance at the end of the plan year, while others have an IRS rollover provision allowing unused funds to be rolled into the next year.

I can't imagine that your sales rep wouldn't have a prospectus or some type of computer program to provide you with an illustration of how the plan would work for you in order to compare medical expenses during your worst year and your best year under your PPO to compared with the same expenses in a HSA or HRA.

You need to talk with the sales rep about how the plan would work for someone with a chronic illness. Also keep in mind the commissions paid to the rep and sales quotas that need to be met during any discussion.

[malaholic]

I am on a HDHP with an HSA. In my case it's kind of ironic - now that I'm no longer healthy, I'm actually spending less out-of-pocket with the HDHP because Teva's assistance program ends up covering my deductible. But that would not necessarily be true for everyone; I think it's important to understand the HDHP terms and limits and, if you are on a DMD, whether you can apply any copay assistance from the manufacturer towards your deductible.

In my example, I am the only one covered. I have an up-front deductible, and after the deductible is met, I also have a "co-insurance" payment which is basically 10% until I meet my co-insurance limit. After that, covered expenses are met by insurance 100%, so I have a maximum out-of-pocket expense each year.

What helps is that I am on Copaxone 40x3, and I've got Teva's Shared Solutions copay assistance program which will cover up to $2500/month for my Copaxone. So I fill my Copaxone prescriptions as fast as they'll let me (typically 3 weeks apart) at the start of the year. With the first refill I meet my deductible and part of co-insurance, and the next two refills take care of the rest of the co-insurance. At that point all of my out-of-pocket have been met by the Shared Solutions assistance program, and my expenses for the rest of the year would be fully covered. I just have to try not to need an MRI or other high-cost care until mid-February.

In the meantime, I keep the pre-tax money contributed to the HSA. It's sad that the maximum allowed contribution each year would only cover about 3 weeks of medication. But it's something, I guess.

I'm not sure if you are on a DMD, if you are using a copay assist program, or if you'd be able to get the same kind of mileage out of your HDHP option even if you are; but check your terms (also check that you'd still be eligible for the assistance program if you switch insurance) and figure out whether something like this could work for you as well. Regardless of which option you choose I hope that it works out well for you and that you receive the very best of care!

[MSW1963]

malaholic, that's great to hear how well the HDHP is working out for you. Very unusual that your Teva co-pay assistance is applied to your deductible, but good for you.

artteacher, I'd still recommend getting all your DMT and other med cost, annual expenses paid under your PPO and request the sales rep work up a comparison between what was covered under the PPO and what payment to expect under the HDHP.

I do have a personal aversion for HDHPs, but I've been wrong before and not the last time I'm sure.

[artteacher]

I was able to find a comparison calculator on the imternet and when I plugged in my numbers it would cost me $29 a month more to be on the HDHP. I am just concerned that I might have not done the calculator correctly. There wasn't any place to put in a dollar amount for speciality meds. Luckily, I don't have to make this decision until November.

MSW, HSA monies rollover each year, but you have to find your own account to place the money. There isn't really a sales rep to talk to. We are negotiating a new contract so it is the negotiation team and the administration that is presenting this to us. We are having another meeting with these enities to answer questions.

[jreagan70]

Fortunately, there are many comparison calculators on the Internet, so you can try a couple of others to see if one of them takes information in a different way and gives you more reliable numbers. AARP has one.

[mack1z]

I have HDHP with HSA

The deductible is mostly covered by the prescription assistance plan, and the nice thing is that other medical costs are pre-tax to the maxmium allowed (I contribute the maximum to HSA). You can immediately reimburse yourself with the HSA funds available after a medical bill.

It's worked well in my circumstances.