Selecting a new plan through employer

The HRA plan I’ve had for years was discontinued by my employer. The thing that’s a major bummer about this is because we also qualify for Medical Assistance. So each year I fill out a paper showing that my health insurance is cost effective and the county reimburses me for my premiums. And then I would also get $1000 from the HRA, and the Medical Assistance would pay all the claims that denied to my deductible. So I never really had to pay my deductible, got to keep the $1000 a year, and for my premiums reimbursed. For instance this year it says I’ve paid $1784 towards my $2000 family deductible, however, I haven’t actually had to pay all that. The Medical Assistance and HRA paid all that.

So I now find myself picking between two different plans. For background, I have a family of 5. None of us have any major medical conditions. We do have a couple of medications and mental health visits. I’ve already checked and made sure that our providers are in-network with either plan and our meds are on the formularies.

Plan 1: PPO plan. Premium: $125 a check. Deductible: $0. OOP Max $2000/ind $4000/family. There is no deductible or coinsurance, but there is copays for everything like $20 office visit, $45 specialist, $170 MRI, $550 outpatient surgery. The thing that attracts me to this plan is the no deductible and simple copay structure. However, I’m not sure if anything will get paid by my Medical Assistance with this plan. It’s not a normal copay plan. The copays aren’t due to the provider. It says this is a new type of plan where the copays are considered a loan and I owe the healthplan the copays, they’ll send me a monthly bill. Since the provider will be getting paid in full and I owe the copay to the plan, I don’t think there will be anything for the provider to submit to the MA.

Plan 2: HSA plan. Premium $38 a check plus whatever I decide to contribute to the HSA. Employer contributes $1500 to the HSA per year. Deductible $3000/ind $6000/Family. OOP Max 4000/ind 8000/family. Coverage after deductible is 90%, so I would pay 10%. I’m thinking this might be similar to the HRA, as far as the medical assistance might pick up what gets denied toward the deductible. But I’m not sure since this might not be considered “cost-effective” for MA, since they would be basically paying everything. Also, I would only be getting reimbursed on the $38 a check. I would not be getting reimbursed on any of the HSA contributions.

I do like the idea of contributing to an HSA fund that I can build up over time and keep even if I change employers. But at the same time, I don’t think I’ll ever even hit the HSA deductible. My family doesn’t even come close. Like I said this year we’ve only put $1784 towards my deductible, and we’ve actually had more medical care than we normally do. But at the same time, if the employer contributes $1500, then that would only leave me paying a few hundred OOP, unless someone’s health takes a turn for the worse.

PPO: $125 x 26 paychecks = $3250 in premiums. A years worth of medication copays for our current meds would be about $180. Office visit copays if next year is similar to this year would be about $840. So my total OOP cost would be about $4270. Then I would get about 3250 reimbursed from MA. So about $1020 I would pay on copays and drugs.

HSA: $38 x 26= $988 premiums. plus if I put a small amount like $40 a paycheck into HSA x26 = $1040. If our medical expenses are about the same next year, then we’re looking at paying about $1800 toward the deductible, but $1500 of that would come from employer contribution. So the MA would possibly reimburse me for the premium. I would pay nothing for the first $1500 due to employer contribution. If I contributed like $40 a check, I would theoretically end the year with like $700 or $800 in the HSA account.

Does this make any sense? I’m having a lot of trouble thinking which plan is more cost effective. I think the HSA plan is better as long as we all remain healthy. But one trip to the ER or something could drastically change that.

Edit* I should add that I just discovered something else. I was leaning towards the HSA plan, but I just figured out something else. I use Doctor on Demand for e-visits. I have been using DoD for individual therapy for a couple months now. The PPO plan covers DoD at 100%. While the HSA plan doesn’t cover DoD at all until the deductible is satisfied. Which I’ll probably never even satisfy. So that is swaying me back to the PPO plan.