Individual vs family Deductibles in PPO vs HSA plan with HDHP
Hi all,
I am currently on a PPO plan along with my spouse. As part of the plan, we have an individual and family deductibles of $X Individual / $2*X Family. For this year, as soon as my wife met her individual deductible, she started paying co-insurance and did not need to meet the family deductible.
We are thinking of switching to the HDHP in order to utilize the HSA for next year. It has higher deductibles compared to the PPO plan and OOP max for individual and family are also higher.
My understanding is that deductibles work differently for a HDHP plan with an HSA and that only the one needs to keep paying 100% until the overall family deductible is met (it is enough to meet individual deductible). Is it also true for OOP maximums as well i.e., we will keep paying co-insurance until "family" OOP max is met even if one person has gone over their individual OOP max. In short, do HDHP plan with HSA not have individual deductibles/ individual OOP maximum once we select a family plan?
Hypothetical situation:
My spouse incurs health expenses (more than their individual OOP max but less than overall family OOP max) and I only use preventive services so my health expenses are $0.
In this scenario, which the the options below would we be responsible for
Option A) paying all the $ until deductible and co-insurance for amount above deductible since family OOP max has not been hit or
Option B) Spouse is responsible for paying their individual OOP max since this is their individual OOP max and they are not expected to pay beyond that because of ACA.
In my current plan which is a plan for me and my spouse, we only need to meet *individual* deductible before going to co-insurance and don't need to pay beyond *individual* OOP max even though it is a family plan.
My sense is that in our current plan Option B applies but I want to know how it would work for HDHP Plan since we are considering switching to it for next year.
Thanks!
submitted by /u/Apprehensive-Let-121
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