Change from EPO to HDHS?
I’ve always had an EPO or similar, where I know the office and specialist copays (though imaging and lab work are still anyone’s guess). For the last couple years, I’ve been considering switching from the EPO to the HDHS w/HSA (going to just call it the HSA plan since that’s what it’s referred to as in the plan selection). My employer provides a comparison tool, and supposedly that’d be the less expensive option, given some estimated medical needs.
My concern, though, is not knowing what anything costs. The HSA plan is less per pay period, yes, but would I end up spending more upfront? (like a couple hundred for each doctor visit, therapist, etc)
To me, it seems like the HSA plan would still be more expensive, given the high deductible, and potentially paying more upfront. Plus however much I’d contribute to the actual HSA per pay period. But, if I hit the OoP max (which I absolutely would with surgery), then the difference in annual premium alone is a few thousand saved.
I am aware of the triple tax advantage of the HSA. I feel like I’d fall into the trap of “but I should save that for retirement!” rather than actually use it to reimburse medical expenses. I’m already contributing to my 401k and some of my own investments.
just me, no spouse or dependents
I will likely have at least 1 outpatient surgery
I see my PCP several times a year
I see a handful of specialists at different regular intervals
3 RX drugs do not have generics or comparable alternatives. Some of them are, supposedly, over $1k (without insurance, or amount billed to insurance)
I get bloodwork done a few times a year
For me, out of network coverage is only a plus for finding therapists
see therapist weekly
.
EPO
HSA
Premium
87
36
Deductible
750
2250
OoP Max
3750
4250*
Coinsurance (I pay)
0% after copay for office visits, 20% for most other services
20%, including office visits
RX counts towards deductible
no
yes
RX tier 1 (30 day)
$10 copay
20% coinsurance
RX tier 2
35
20%
RX tier 3
60
20%
Examples
Therapist
0% after $20 copay. No out of network coverage
20% coinsurance in network, 40% coinsurance out of network
Lab work or X-ray
20%, no deductible
20%, after deductible
Outpatient surgery
Facility – 20% after deductible, Office 20% after copay
20%, after deductible
Physical therapy
0% after $30 copay
20%
Premium is per biweekly pay period.
*Employer contributes $500 to HSA, so OoP max is theoretically the same.
So, should I switch to the HSA plan, or stick with the EPO?
