OT: Kaiser high-deductible plans, experience?

Gawd! I'm glad I'm old ;-)

...Jim Thompson

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|  James E.Thompson, P.E.                           |    mens     |
|  Analog Innovations, Inc.                         |     et      |
|  Analog/Mixed-Signal ASIC\'s and Discrete Systems  |    manus    |
|  Phoenix, Arizona            Voice:(480)460-2350  |             |
|  E-mail Address at Website     Fax:(480)460-2142  |  Brass Rat  |
|       http://www.analog-innovations.com           |    1962     |
             
I love to cook with wine.      Sometimes I even put it in the food.

Yeah, this is so freaking complicated. And up to now I know next to nothing about HSA accounts. The design of that fiber-optics circuitry was a cake walk compared to figuring out all this health care stuff.

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Regards, Joerg

http://www.analogconsultants.com

Some doctors (very low percentage but growing) who are beginning to refuse to take customers on insurance. They ONLY take customers who pay in cash.

Even some of the doctors are dropping out of carrying malpractice insurance:

It may not work in your case, but there are lots of Americans with no insurance (likely not by choice). Obviously good health and luck are important if you go insurance-less. Or you could go to work for "The Man", like the rest of us... and he'll pick up the tab. :-)

It was only a matter of time until that would happen.

Our tort law is spiraling so far out of control that this was bound to happen. Same with engineers BTW. For many business areas (such as mine) the number of underwriters willing to take you has reached pretty much zero. So my clients have three options:

a. Accept the waiver in my standard agreement. b. Accept that my designs are lab only and not for production. c. Look for another consultant that carries insurance.

The latter usually doesn't work. Some try but then come back after realizing that they can't find anyone in the world of med electronics.

I am not worried about a doctor visit. We need converage only for when something big should happen. I just don't see a point in shelling out almost $630 a month which is what Kaiser wants to charge us next year.

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Regards, Joerg

http://www.analogconsultants.com

Take it, one uninsured weekend in the hospital (2 MRI, ER, cardio doppler, some Xray, telemetry ward , labs) cost me 5000$ in doctors bills and 17,000 in hospital bill. settlement, just paid off all the doctors. Followup was another 1400 when meds went wrong. meds are 75$ a month. now paying hospital 100$ a month for probably the next 14.6 years. They scale it to your income, if you fight them a while.

Steve Roberts

Thanks, Steve, that sounds scary. We do have full coverage right now. Actually had coverage all our life. But the premiums have now become hyper-inflationary and we don't use any services except for the occasional poison oak rash or busted ankle. So I am looking into insuring only catastrophic events and take the highest deductible that HSA rules allow.

It will make life more complicated but what can you do? Haven't gotten to the ground of it yet. Some rules say each must have his or her own HSA. Then the fine print says an HSA can pay for med expenses of a spouse or dependent. It all doesn't make sense right now. Maybe I should become a CPA :-)

One gem I have already unearthed (hopefully I understood that correctly) is that we could pay the dentist out of the HSA. That would effectively lower the dentist bills because it would be pre-tax money. Sweet.

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Regards, Joerg

http://www.analogconsultants.com

I was waiting to get my full info package, but here's what I did. My COBRA ran out as of October 31, and I applied for Carefirst Blue Cross Blue Shield. I chose an HSA compatible plan $1700 deductible 80%/20%, individual, 55-59, for $180 per month. Add $150/month to cover deductible, for $330/month. Actual premium could be 25% or 50% higher depending on underwriting, so possibly as high as $270 + $150 or $420. However, I was turned down.

I was then eligible for Maryland Health Insurance Plan (MHIP), where I got just about the same coverage for $237/month. I think it might have a higher deductible (maybe $2500), but I think after that it is 100% coverage. As far as I know, I can use my existing physician, pharmacy, etc. So this plan is about $450/month including deductible payments to the HSA.

As a reference point, I was paying $301/month for my COBRA. I was self-employed, before going full-time for a while from 2001-2005, and my insurance through NASE (Mega) had risen to about $450/month.

My friend was with NASE, and now I think she has Kaiser, but she is really unhappy with the limitations on numbers of visits to various specialists, and I think she pays over $400. She can't wait until she can go on Medicare in two years. I have quite a bit longer. Maybe the new administration will finally get the ball rolling on a single payer plan that will reduce administrative costs and make health care efficient and affordable for all. And maybe pigs will sprout wings and fly!

Paul

Turned down? Hmm, don't that sound familiar. I found that this whole underwriting process in our case was handled in a very unprofessional manner. In the end one of the parties (our local hospital network) shot themselves in the foot. They didn't transfer our medical records because they hadn't been paid their 30 bucks or so. Then time ran out, so we went with the competition and now cannot go to that hospital anymore because it isn't Kaiser. The other thing the underwriters didn't get was that part of our med files were in another country, another language. That really threw them a curve. Boy, these guys would not last one week in the electronics industry.

The offer we have here is $371 for me plus spouse at $5400 max combined deductible. They also list another plan for $329 but that only covers

70% of hospital bills and I assume that could potentially wipe people out if some big accident happens. An individual age 55-59 would be $246 or $219 respectively. Not too bad these days.

Those organizations often have non-underwritten plans. Way more expensive than Kaiser whenever I checked. Rates spirals up really fast because they tend to get the folks who are turned down elsewhere. I don't know how long the IEEE plan is going to survive.

Limits? So far I haven't heard that. Although that's based on the opinion of other (mostly elderly) people whom we gave rides to Kaiser. We know that hospital almost inside out but not from our own health experience.

New administration? When they were in power last time they didn't fix it. Plus they'd need to fix our broken tort laws and with a liberal administration we all know that isn't going to happen. Once when I was testing a new design at a big center and had a brewsky with the cardiologist after his shift I asked him about his malpractice premiums. I don't remember but his answer floored me. It was six-digit. That's insane. And I am afraid with a "new administration" that could get worse.

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Regards, Joerg

http://www.analogconsultants.com

Hi Jeorge, Yep, Dentists, chiropractors, and almost any type of doctorin' can be paid out of the HSA. Also, prescription and OTC drugs can be paid that way. Also, eyeglasses and contacts. But, be careful of the HSA's rules...

Charlie

And it seems that banks aren't exactly jumping on HSA. My bank pays too paltry of an interest on the HSA and I don't like them charging $5/month in fees. Found one other bank and they didn't even respond to an email question yet. For every other product like brokerage they are all over you when you call or write. ETrade doesn't seem to offer any HSA. This is odd.

Some web resources say every person needs to have their own HSA. Others say you can pay med expenses for your spouse out of it. That's contradictory. The other question I asked them was that if I can have a joint HSA with my wife whether they'd issue a 2nd debit card. One of the IRS rules says a claim must not have been paid by other means beforehand which I'd interpret as that you can't pay with you normal credit card if the HSA debit card happens to be in your spouse's purse. It's confusing.

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Regards, Joerg

http://www.analogconsultants.com

Basic program here costs me (if I sign up) 323 a month,

Steve

I haven't looked into private suppliers. I am stuck with my company one for now.

One advantage - while you have a fixed pay in each month, you can use the entire amount from the beginning. So, if I were getting Lasik, and knew that it would cost me $2000, I could set up the plan, get the surgery done in January, and get an interest free loan.

the can't be paid by other means beforehand usually means that you can't have both the HSA and the insurance pay the same expense. If I have a dentist visit that costs $100, and I submit it to my insurance and get paid $60, I can only get $40 from the HSA to pay for it. You can't get the whole $100 up front, and then see what the insurance will cover.

Charlie

MHIP is really pretty good about doctor participation. When I was self-employed in the late 90's I was very surprised to see that the state plans had superior doctor participation compared to most all of the plans I could buy.

In the past couple years the big doctor's practices have been playing "chicken" with the insurance companies as the insurance companies have threatened cut back on what they'll pay and the practices have threatened to drop out. This seems to apply whether it's the low-end plan or the high-end plan. In any event the office visit costs are tiny compared to lab and pharmacy costs at least for me.

Tim.

That would be ok but it leaves the nagging feeling that an IRS guy might interpret this differently. The IRS rule says "The qualified medical expenses had not been previously paid or reimbursed from another source". It's "paid" and "or". I am not sure if they'd let it fly if you paid $150 cash to a dentist because you got a tooth ache on a biz trip and then after returning home 10 days later took $150 cash out of your HSA to put that back into your wallet. AFAIK the HSA custodian must log where payments go to and I could almost bet that gets filed.

This is the doc:

Anyhow, have a few calls and email out but the financial folks show quite a lack of enthusiasm here. Maybe HSAs don't create enough in commissions or profits. When I told my bank that the conditions weren't great and I'd look elsewhere they made no attempt whatsoever to convince me otherwise. That is very different with other products they offer where they pull all the stops to keep your business.

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Regards, Joerg

http://www.analogconsultants.com