Which Plan: HMO vs. HSA?

[bill34]

Trying to decide between 3 plans in Illinois. The third option is an HSA plan which I can put aside $7750 for 2 people and of course invest that if needed. It's also a tax deduction on my S Corp.

Family of 4, 2 small children. All very healthy, no medical issues in 2023. I have no issues getting referrals for HMO, it's a big hospital - Northwestern. All plans are through the exchange.

Monthly premiums

PLAN A HMO: $1,326.25
Deductible  $7,400 Individual total /$14,800 Family total
Out of pocket maximum: $9,450 Individual total / $18,900 Family total
Primary care doctor visit   In Network: $65 per visit from day 1
Specialist visit In Network: $105 per visit from day 1
X-rays and diagnostic imaging   In Network: $150
Laboratory outpatient and professional services In Network: $100
Outpatient facility In Network: $300 Copayment with deductible/50% coinsurance after deductible
Outpatient professional services In Network: $150
Generic drugs In Network: 10% coinsurance after deductible
Preferred brand drugs In Network: 20% coinsurance after deductible
Urgent care centers or facilities In Network: $105 per visit from day 1
Emergency room care In Network: $1000 Copayment with deductible/50% coinsurance after deductible
Inpatient doctor and surgical services In Network: No charge
Inpatient hospital services (like a hospital stay) In Network: $850 Copayment per day

PLAN B HMO: $1,303

Deductible $0 Individual total /$0 Family total Out of pocket maximum: $9,450 Individual total / $18,900 Family total

Primary care doctor visit In Network: $150 per visit from day 1

Specialist visit In Network: $160 per visit from day 1

X-rays and diagnostic imaging In Network: $250

Laboratory outpatient and professional services In Network: $250

Outpatient facility In Network: $750/50%

Outpatient professional services In Network: $400

Generic drugs In Network: $100

Preferred brand drugs In Network: $120

Urgent care centers or facilities In Network: $160 per visit from day 1

Emergency room care In Network: $2000/50% Inpatient doctor and surgical services In Network: No charge

Inpatient hospital services (like a hospital stay) In Network: $1500 Copayment per day/50%

PLAN C HSA PPO: $1,839

Deductible $4500 Individual total /$9000 Family total Out of pocket maximum: $7500 Individual total / $15,000 Family total

Primary care doctor visit In Network: 40% coinsurance after deductible

Specialist visit In Network: 40% coinsurance after deductible

X-rays and diagnostic imaging In Network: 30% coinsurance after deductible

Laboratory outpatient and professional services

In Network: 30% coinsurance after deductible

Outpatient facility In Network: $600 Copayment with deductible/30% coinsurance after deductible

Outpatient professional services In Network: $200 Copayment with deductible/40% coinsurance after deductible

Generic drugs In Network: 20% coinsurance after deductible

Preferred brand drugs In Network: 30% coinsurance after deductible

Urgent care centers or facilities In Network: 40% coinsurance after deductible

Emergency room care In Network: $1000 Copayment with deductible/40% coinsurance after deductible

Inpatient doctor and surgical services In Network: 40% coinsurance after deductible

Inpatient hospital services (like a hospital stay) In Network: $850 Copayment per stay with deductible/40% coinsurance after deductible

 

[christeveanity]

@bill34 Are those monthly premiums? Or annual premiums? Before the tax credit or after tax credit?

 

[bill34]

@christeveanity Monthly premium, before tax credits

 

[adedayor]

@bill34 Any of these options, you are overpaying for the benefits given. If these are your best options on Marketplace, and neither of y'all have access to employer coverage, I'd highly suggest getting a private plan. It would be cheaper, definitely better coverage, and you can use the whole premium as a deduction. The only issue with private plans is that you have to be relatively healthy to get on them, and they don't cover maternity or psych.

 

[bill34]

@adedayor That's the thing also. If I look on the Blue Cross Blue Shields site, same prices really. Even for plans not on exchange. These are the best options that give me access to Northwestern hospital also.

 

[adedayor]

@bill34 Even when going directly through the carrier, unless looking at a group employer plan, you'll see the same plans as Marketplace. BCBS doesn't have any private plans outside of Marketplace, and what plans are out there, are only accessible through a licensed agent.

 

[bill34]

@adedayor Understood. But from these plans, which one makes sense?

 

[ryanc111]

@bill34 If you unexpectedly had to put $4,500 on a credit card next month, could you do it without wincing?

If so, go with your HDHP/HSA heart - but be SURE to put a goodly portion of that $7k plus you can sock into an HSA, into an HSA.

If not, well, HMO A is much friendlier to the odd unexpected pediatrician visit.

 

[bill34]

@ryanc111 Yes. That shouldn't be an issue if I want to. But also the HSA plan would be $1800/month. Granted, I can stash that $7k in HSA and in an ETF

 

[bill34]

Any other thoughts? Curious