Health Insurance Utilization
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By In Around the Web, Do the Math, General Benefits Knowledge, Health Insurance Utilization, Health Savings Accounts (HSAs), High-Deductible Health Plan (HDHP), Participating Provider Organization (PPO) Insurance

How to Make the Most of How Much It Sucks to Make the Most of Health Insurance

Tanja Hester at Our Next Life wrote a fantastic, comprehensive piece on the limitations and downsides of health savings accounts (HSAs) and high-deductible health plans (HDHPs). Before you dig deeper into this post, you should head over there and read it, because it’s chock full of awesomely useful information.

OK, see you back here when you’re finished…

Welcome back!

The Bottom Line

Now that you’ve read her post, you know that HSAs aren’t the magical “triple-tax-advantage” savior some might claim. Yes, there are definite benefits to HSAs if your circumstances are right (more on that in just a moment). But as we’ve said many times, HSAs are a contextually good idea attached to a pretty bad one — HDHPs — and you have to really lean in to avoid letting that bad idea drive your future more than the contextually good one.

Here’s the bottom line: Our “best in the world” health care system puts a great deal of pressure on us as individuals to make the right decisions about our health without giving us much to go on. It’s a system wrought with tradeoffs, and no one type of plan or solution it right for everyone. While HDHPs aren’t doing what they were meant to do, which is to make us better healthcare consumers, older plan designs like PPOs and HMOs aren’t doing that at all, and in fact could end up costing you more than an HDHP, with no added tax benefits and without drastically improving your health and longevity.

The TL;DR message is this: if you’re young and invincible or old and rich already, you can get an HDHP without much further consideration. For the other 99%, read on about some of the challenges we face as “consumers” of healthcare, with an HDHP and without one.

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By In Health Insurance Utilization, Health Savings Accounts (HSAs), High-Deductible Health Plan (HDHP)

Know Your HDHP’s Preventive-Care Benefits

If you have an HDHP, you may be working from the assumption that your insurance won’t cover anything before you meet your deductible. While the insurance company may wish that was the case, HDHPs are able to (and, in some cases, must) cover certain kinds of preventive care. These services can add up to hundreds or even thousands of dollars in essential services every year, so be sure to read the fine print on your plan before and after you choose it, and also to ask your company’s benefits administrator for these details if you can’t find them on your own.

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By In Health Insurance Utilization, Prescription Drugs

Another Example of Why You Should Always Ask the Price

My wife went to the pharmacy the other day to refill a prescription. We changed insurance on January 1, so when they told her the first time she got the it filled three weeks ago that our plan didn’t cover the prescription we needed for one of our kids, it didn’t seem out of the ordinary. In fact, the pharmacy was nice enough to give us a discount through GoodRx — something I talked about in this post.

Well, it turns out that the discount was a whole lot more than we should have paid, anyway.

When the pharmacist told my wife our Rx would be $152, she texted me just to commiserate about the high cost and ask if it was because of our new insurance. I said yes but that they gave us a discount to get it down to $90 and that she should be sure to ask if they can give it to us again. That ask set off a series of events that blew our minds.

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By In Health Insurance Utilization, Medicare, Retirement

New Medicare App Helps You Figure Out ‘What’s Covered’

Whether you have regular health insurance or you are of the age/eligibility to receive Medicare coverage, one of the trickiest things to have to deal with is whether the service you need is covered. I have heard many stories about people who have gone into a doctor’s appointment thinking that Medicare will cover their needs and found out later, via a huge bill, that they did not. My mother spent more than a year reconciling a bill that my stepdad received and she would have loved to have easy access to coverage information on her smartphone while the doctors appointment was happening.

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By In Health Financial Accounts, Health Insurance Utilization, Health Savings Accounts (HSAs)

What Expenses Can I Pay with My HSA?

While we at The Benefits of FI see great benefit, no pun intended, in treating your health savings account (HSA) like a second retirement account and not making any withdrawals until you’re in retirement — in the case of HSAs, that’s IRS-standard retirement age. But we know that there may be occasions that arise in which you need to use your HSA funds, or where it’s simply prudent to use those funds because they’ll help you pay more in a shorter period. One such example is the birth of a new child, which is a scenario I’ve spoken about before that originally got my family into an HSA.

Also, if you’re reading this just to get information about how to best manage your money and aren’t on the FIRE path, it’s valuable to know what does and does not qualify as an HSA-eligible expense.

Long story short, there are quite a few things for which you can pay with HSA funds — things like eyeglasses and breast pumps. There are more things that may qualify under special circumstances — things like massages if prescribed by a doctor for pain relief and a wig if due to hair loss from a medical condition or treatment (chemotherapy, for example). And, of course, there are plenty of things you cannot pay for with HSA funds, such as hair removal or hair replacement. Also, uh, veterinary services. Sorry, Fido.

Here is the full list and, for more information on each, here is Publication 502 from the IRS that goes into greater detail on qualifiers and regulations for use.

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By In Do the Math, Health Insurance, Health Insurance Utilization, Money-Saving Tips

Should You Pay Cash for Medical Care?

In the “My Benefits ‘Intentions’ for 2019 and Beyond” post, I noted that it’s important to always ask the price for a service. The premise is pretty basic — we ask the price for pretty much everything else we want to buy, so why wouldn’t we ask the price and be able to see it before we have something done to us.

Of course, reality can be a relative term in healthcare. First, you’re not always in a position to shop around when it comes to your health. A recent article by Vox writer Sarah Kliff, who’s been tracking and reporting on outrageous emergency room bills for the past year, showed how the largest public hospital in San Francisco is “out of network” for ALL private insurance and the result is insured people getting bills for tens of thousands of dollars. Remember, this is the emergency room and, as one “victim” of a crazy bill noted, she was so overcome with the pain and confusion of her migraine that she didn’t have the capacity to ask where she was being sent for care and whether they were in-network for her insurance.

Second, and this is the nutso boondoggle of our system, prices are really, really hard to get straight because there are so many different negotiated rates that you might pay. There’s a different in-network and out-of-network rate for every different brand insurer and plan a provider accepts. There’s a Medicare rate, a Medicaid rate, and possibly many others.

The one (hopefully) consistent rate is straight-up cash. Depending on what kind of insurance you have and what kind of treatment(s) or service(s) you need, this might be your best bet.


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