High Deductible Plans | Arthritis Information

So I'm trying to do the math.

My share of the premium would NOT go up OR down.

My employer would contribute 00 into an HSA (but a little with each check, not all available January 1).

I could contribute another 00 tax free (again, will accumulate across the year).

So I know people get these when they think they are going to spend little on health care, that you would spend less than what the employer contributes (or what the premium costs). But my reasoning is that I am paying so much in copays that it may make sense to pay 3K early in the year and then have nothing to pay.

My out of pocket max individually is 00. Then 0 for prescriptions and copays, co insurance...no more to pay.

My deductible normally is 0 individually, then 20% co-insurance.

I probably spend 0 a year in co-pays (24 visits, easily, times 30 a visit). And I spend 0 a month on prescriptions--let's say 00 a year (and I may be on a biologic soon).

So that's 0 for deductible plus expected copays of around 00. So only 00. But if I have extra prescriptions or co-insurance above my deductible...it could get close to 00.

I don't think I'm going to do it because it doesn't make a ton of sense for the rest of my family...but hey we get 00 free, basically, which should cover them (it's 00 max for all of us).

Any experience or opinions?

How much would Enbrel etc. cost me? I have a PPO and the set up is 10/30/55. Is Enbrel a shot? So it would be like 0 a month? Because then this might make a lot of sense for me...

KatieG2008-12-04 09:47:30

These insurance considerations seem to get tougher and tougher, its hard to weigh everything. Sorry, I don't know much about HSAs, but I do take enbrel. My copay is a month (I take 2 25mg shots a week, so that's 8 shots a month), but I know there's a lot of differences in what health insurance drug plans cover and charge. I "think" the actual cost of enbrel for a month supply is 00-00, there was a discussion about this before here, you might do a search, or perhaps others here can confirm.

Can you get info about your insurance company's drug formulary list online? Some insurers provide that. Or call them?

Good luck, take care.

Edited to add enbrel shot frequency.

Joie2008-12-04 10:13:24I've been on Humira and now Enbrel and my copay is 0 for mail a way, which means it's a 3 mos. supply. I am probably going on Orencia next so I have no clue how that works.

Insurance is confusing. My husbands company was trying to push a new product on us. It sounded great, however, I took the time to break it all down and it would have cost us a lot more as the medications were covered differently. I would have had to pay over 0 for my Enbrel every 3 mos....be careful, call HR, or call the insurance carrier and go over every scenerio. Yes, they get pissy about this but it's your pocketbook.

I have no clue how it would work for you..

I pay 50. for 12 weeks supply..... I have a PPO.

what is an HSA, anyway?

I spend alot of time trying NOT to think of insurance premiums, deductables etc...but every month it chews away at my budget. So frustraiting. I posted before about my insurance.

I will go and see if I can locate it.....be back....don't go anywhere...........i'm going now....................wait....ok....be back in a minute................

[QUOTE=babs10]I have no clue how it would work for you..

I pay 50. for 12 weeks supply..... I have a PPO.

what is an HSA, anyway?

[/QUOTE]

I "think" a HSA is a health savings account.

.......Back......couldn't find squat!.....must of been all in my head. I can sum it up.

Insurance+premiums+dedutables+chronic Illness = frustration and confusion.

Good luck figuring it out. Might want to talk to a Insurance agent, for guidance.

At my job my employer pays 80% of our premium and we pay 20%. For me that's about 0 per week. Then we also have an option of contributing to a pre tax FSA account. I contribute 00 per year and it really comes in handy. I submit any co-pays, eye wear, dental visits, etc to them and get a check. I could use more money but I can't afford to have anymore taken out of my check. I usually bank the money when I get a check or use it for an unexpected expense.[QUOTE=wanttobeRAfree]At my job my employer pays 80% of our premium and we pay 20%. For me that's about 0 per week. Then we also have an option of contributing to a pre tax FSA account. I contribute 00 per year and it really comes in handy. I submit any co-pays, eye wear, dental visits, etc to them and get a check. I could use more money but I can't afford to have anymore taken out of my check. I usually bank the money when I get a check or use it for an unexpected expense.[/QUOTE]

What's an FSA? What type of savings account is that? So, you get reimbursed from this FSA, which is your untaxed earnings/money for out of pocket medical expenses?

FSA is Flexible Spending Account. It's exactly as you described. I love it.

I really like my HSA. There is no end of year struggle to spend it all. If by some miracle I don't spend it all, I just have a head start on next year.

My high deductible plan (total 3200) has actually saved me money. Those endless no limit co-pays for PT really add up.

I'm glad the HSA works for ya! What kind of coverage does it allow for RXs or is that separate? Are all your services covered at a percentage after deductible?

I guess it all depends on your insurance carrier and your group employer. Some HSAs I've seen have horrible coverage and would only work well for people who are rarely ill. It's reassuring to know there are plans that work though!