High Deductible Health Plans vs PPO Explained // PPO vs HDHP
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- čas přidán 21. 10. 2020
- Well, it's that time of year again - time to decide between a High Deductible Health Plan or a Preferred Provider Organization (HDHP vs PPO if you will). In my first video I go into detail regarding Health Savings Accounts (HSA) and in this video we discuss specific figures and give examples to help you decide whether a PPO or HDHP plan.
In our personal situation, as a family of four, it made more sense to select the High Deductible Health Plan with HSA. However, in the video I shares some pros and cons for HDHP and PPO options. Regardless of which one you select as the best fit for your family, please make sure that you are making your health a priority & taking care of your body. If you'd like to improve your financial-health, please consider subscribing to the channel and checking out a few of the videos below. Thanks!
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ABOUT ME 👇
I've been involved in people's financial decisions for 15+ years (7 yrs Real Estate experience & 8+ yrs as a former Financial Advisor)...I now bring the financial successes, mistakes, failures, and best financial habits/tips to you through these videos.
My mission is to bring Financial Awareness to the forefront of your daily decisions so you can: improve your quality of life, increase your net worth, and grow upon your financial literacy. My videos are a reflection of my real-world experience as a real estate investor, stock market investor, student of finance, entrepreneur, and of course...my experience as a Former Financial Advisor.
This channel allows me to share my passion for personal finance, stock market investing, real estate investing, and entrepreneurship. I produce content that I would want to watch, and because of that, I give 100% effort in every video that I make. I also believe in complete transparency and open communication with my audience.
#HighDeductibleHealthPlan
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DISCLAIMER: I am not a financial adviser or a certified public accountant. These videos are for educational purposes only. Investing of any kind involves risk. While it is possible to minimize risk, your investments are solely your responsibility. It is imperative that you conduct your own research. I am merely sharing my opinion with no guarantee of gains or losses on investments.
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Hey, I recently started a Financial Vlog - would like to invite you to follow along if interested: czcams.com/video/YnZrh9YwNQo/video.html - Kyle
Hey Mr Scholl, i know it is tough to address all the moving pieces involved but loved what you shared. My concerns is when I switch from an PPO to HMO HSA plan. HMO don't seem to provide any coverage if something is deemed "out of network" and those costs would not go toward my deductible...so my actual cost could be considerably higher if i am out of network on a vacation and I get sick, injured or a facility doesn't take HMO (Marketplace) Is that correct or do I miss understand?
@@mkendall68 - So first of all, WOW...what an incredibly intelligent question. Really appreciate you sharing that perspective as it is something I had not thought of before. My family is blessed to be quite healthy and we travel very little (thus far at least) and this thought hadn't crossed my mind...so again, thank you! Appreciate you taking the time to watch this video.
I took the time to review the exact same document I flashed and went over throughout this video and here is what I've learned as a result of your question...
- For ALL options (PPO vs HDHP) the co-insurance (what we have to pay) is not as good for out-of-network as it is for in-network providers. This is obvious and is what I already knew.
- The CALENDAR year deductibles are not as good for out-of-network vs in-network. This is obvious and what I already knew.
- However, for BOTH PPO and HDHP options...BOTH!!! ...there are NO LIMITS to CALENDAR YEAR out-of-pocket-maximums. This was surprising to me because the way I read your question I was assuming to discover that PPO had an out-of-network calendar year-out-of-pocket-maximum, but it does not.
So, to answer your question/comment, I would still pick the HDHP because although the out-of-network options/limits are higher than in-network options, the fact still remains that both of these options have NO LIMIT on calendar year out-of-pocket maximums. Which makes me want to beef up my Emergency Fund and HSA account due to this potential uncertainty happening during a vacation.
Another learning opportunity for me is to review our health insurance coverages for any potential travel destination so that I know where the closest "in network" hospital would be in any city we vacation to.
Good stuff! Thanks for taking the time to watch the video and share your insights...much appreciated!
Amazing video, A friend of mine referred me to a financial adviser sometime ago and we got to talking about investment and money. I started investing with $150k and in the first 2 months, my portfolio was reading $274,800. Crazy right!, I decided to reinvest my profit and get more interesting. For over a year we have been working together making consistent profit just bought my second home 2 weeks ago and care for my family.
@Tyrell-rr However, if you do not have access to a professional like JUDITH ANN PEACE, quitting your job to focus on trading may not be the best approach. It is important to consider all options and seek guidance from reliable sources before making any major decisions. Consulting with an AI or using automated trading systems can also be helpful in managing investments while balancing other commitments
@Tyrell-rr Judith Ann peace is her name
Lookup with her name on the webpage.
@Tyrell-rr You are welcome
as a person who never had insurance but now researching... I appreciate you my guy... im 36 with a wife and 13 and 8 yr olds.
Only learned about HSAs recently (as in about a week ago). Been binging HSA CZcams videos and happened across yours. May I say, yours is perhaps the most informative and clearest provided perspective on the differences between my current plan and an HSA. Thank you so much! I'll probably never be able to repay you, but here's a like and a sub. It's the least I can do.
@Phil Ossifer - Oh my goodness, Phil! That is just so nice of you to say....wow....thank you so much! You made my day man. If you're ever feeling like wanting to support the channel, please feel welcome to share any videos with your friends/colleagues or if you ever have a personal/financial question you're welcome to book a call with me...other than that man I really do appreciate you watching the videos and if I can keep adding value to your financial life then I'm pretty happy with that by itself as well. Cheers boss!
This is just great explanation! Thanks man, I really appreciate that you took the time to educate us
Probably the best explanation I have seen so far in relation to HC plans, thank you
@Thomas Just - Thanks boss man! Appreciate the feedback…hope some of the other vids are of interest and that you find a few more financial nuggets of info. Cheers!
We need to keep informing people and enlightening them. Well done for sharing this!
The Money Management - Thank you! Yeah, I agree...I think the more informed and educated people become about any financial decision the better off they’ll be as they move through life. Appreciate you.
best visual breakdown of the difference on youtube. Great video !
@Jeff Barr - Thank you, sir!
This video is amazing… you really simplify everything.
@Xavier Velasco - Thanks boss! Appreciate you checking out the video and glad it was easy to follow. Cheers!
This was super helpful thank you so much!! About to deep dive through these videos bc you made this actually make sense for me
@BorealHP - Hey thanks so much for that feedback! I'll admit, not every video is the most 'searchable' topic, but I try to have a healthy mix of financial planning videos, investment vids, popular/relevant topics (like taxes or PPP for self employed)...overall theme I'm going for is 'financial awareness' but that covers such a wide array that not every video is made for 'everyone' and some vids (like this one) are made for W-2 employee folks and other are made for self employed....so I just try to mix it up a little bit.
Appreciate you watching this video and checking out a few others. Hope there are some good financial nuggets out there for you that are helpful. Cheers, boss!
I gamble with my health every year because I'm 26, in a high tax bracket with enough savings, and the numbers tell me to do it.
But I am not proud of being in an HDHP! Something is deeply wrong with society when our lawmakers repeatedly work to individualize financial shocks instead of creating a safety net capable of catching everyone. Medicare for all now.
I totally agree with that last paragraph. It’s one of the reasons why I joined the reserves so that I could have TRICARE reserve select. I get the best of both worlds where I have a low, premium and low deductible with a low out-of-pocket cost expense, but I think it’s so fucked up that people even have to be in the military just to get decent quality medical insurance plan. And I fucking hate being in the military too. What’s even more frustrating is that a lot of individuals in the military have very conservative leaning and don’t support policies like free medical care for all, but acknowledge and are very much well aware of how grateful they are for being in the military so that they have free health insurance. Like they love the free medical insurance that they get, but they don’t want those same benefits to be extended for all Americans. It’s so fucking selfish.
Such a great video. All the information I needed
@Keisha Ranks - Sweet!!! Happy to hear that. Appreciate you taking the time to learn more about this topic...hope there are other videos within my content library that are of interest to you. Cheers!
Super straight forward! Great vid!
Thank you! Yeah, I’m some of my other videos I’m not as quick to the point…preparing future content now and def making an effort to get to the point faster. Thanks for checking out the video and channel! Cheers!
Thanks for breaking this down…simply!
@Carmen Dodd - My pleasure! Thanks for taking the time to check out the vid and channel. Let me know if there are any other financial planning topics you'd like to see a video on. Cheers!
Thank you so much 🙏🏻🙏🏻🙏🏻!!! I needed an explanation like this, it helped me a lot
My pleasure! Glad it was helpful!
Thank you so much I’ve started a new job and sat here with a headache trying to read through these plans. Felt almost like trying to read tax forms
@zeb tanner - Appreciate the feedback, boss! Glad the info was helpful. Cheers!
Glad I found your video! Thanks 😊
@Chikachika - Thank you so much! Very kind of you to share that feedback. If there are any financial-related video topics you’re interested in watching please let me know and put it on my content calendar. Appreciate you. Cheers!
Thank you so much for the detailed information
Great breakdown. Thank you!
Thank you, Monica! Appreciate you taking the time to check out the video and channel. Cheers!
Thank you so much new subie. Ended up selecting PPO even though I’m healthy there wasn’t much difference for me. With PPO I pay $116 weekly and with HDP I pay $111 weekly. Since I’m constantly traveling decided to go with PPO specially since there was only $5 difference. Great video :)
@Lamulata#1 Azuquita - Thank you! LOVE how focused and intentional you are with researching your options on this topic...well done! Hope some of the other investing and financial planning videos are just as helpful. Cheers boss lady! 👍🏻👍🏻
Premiums are important but have you also compared the deductibles and out-of-pocket maximums? In my own employer's plans, the PPO option has two deductibles -- one for medical and one for Rx. Together they add up to THREE TIMES more than the HDP's single deductible. Also, the HDP holders have an out of pocket max of about $3000 whereas the PPO out of pocket max is closer to $10,000. The out-of-pocket figures are the only ones that really matter, should there be a catastrophic health event.
Very helpful. Thank you.
Chris Townsend - My pleasure man! Glad you got some value from the video. Let me know if you have questions. Appreciate you. 👍🏻
I'm doing a project on this topic for grad school and this video really helped me. Thanks so much
@burnt toast - Oh wow! So cool. Glad it helped...hope you get an “A” 😃
Awesome video. thank you
FANTASTIC VIDEO . . . GREAT EXPLANATION S FOR A COMPLICATED SYSTEM FOR ME ANYWAY! THANK YOU SO MUCH!
Thanks, SandraAnn!
I always opt for HDHP plan and contribute towards my HSA and put it in mutual funds. This year I chose a high premium plan because I am pregnant, so I know I will hit my out of pocket max very quick! Tis' the year we will milk this plan for all its worth. We still aim to contribute to our HSA because the deductible is still high with the premium plan! Everyone should contribute to their HSA if their company offers it.
I appreciate your video, wish I had gone this route years ago. Please share that every QUALIFIED health plan must include preventive screenings at no cost. (Although if that screening leads to more care or intervention , it will be subject to the deductible) .
Tina L - Thank you for sharing that...glad you enjoyed the video. It's crazy how much health insurance coverage has changed over the years!
Tina you are so right this is exactly what I was looking for alot of videos miss these points
@@18sweetestsongers - Very kind of you to say that...means a lot. If that’s the kind of vibe/info you like then I’d like to personally invite you to subscribe...would love to have you around. Appreciate you.
It would be useful to see a scenario analysis of surgeries or prescriptions. For instance, I struggle to think when the PPO would be worth it at all- so I'm sure I'm missing something. If you need a 12K surgery and you have monthly scripts for things, when would it make sense to go to the PPO plan?
This was extremely helpful! Thank you! I have a few days to decide for open enrollment on if I'll continue to stay with my HSA or switch to PPO. You made a very good point about not going to the doctor as often to get the care needed knowing I'll have to pay for it instead of the insurance company. I've only had an HSA since the start of this year and already seen it grow to nearly the out of pocket max being on Individual plan. Shame to watch something grow only to have to spend it and give it back but avoiding the doctor is never a good thing.
Stephen Mills - Thanks, boss! I completely agree. I found that little nugget of information out not only by research, but from my own wife! Lol. She “feels” like she shouldn’t go because of how “expensive” it is - which I counter her point with math every time and then she gets it. In my opinion, if people can maintain good health and not have any accidents (like that is even a predictable thing 🙏🏻🤷🏼♂️) for a year or two then the HSA account will have time to grow to cover the most expensive out of pocket max...and yes it would be unfortunate if it were to all be spent, but we just have to remember...it’s for our own health and that’s what it’s there for. Appreciate you taking the time to research your decision...says a lot about you and you should be proud...continue that habit and you’ll continue to make educated decisions. Hope I have a few other videos that can help you with those other decisions as well. Thanks again! 👍🏻👍🏻
@@Financial_Awareness Thanks for all the info! I only wish I would have started thinking about it earlier than last minute during open enrollment. I have both a sleep study and a 10th annual colon screening coming up before the end of the year and have no idea yet as to how much it will cost...and I'm so close to the new year. If I choose PPO I'd move them both into January but I like the idea of giving the HSA at least 2 years before I bail on it or switch. It's a real conundrum. That said I have been able to contribute an extra thousand dollars to the HSA to make it $4,500 annually so if I can stay healthy it would make sense. I have to decide by Friday of this week. What I really need is a crystal ball lol! You don't have one do ya?
@@millsmixx5080 - I keep my crystal ball locked up - get's a little scary every time I look into that thing...LOL. Give a good look through all that is considered "preventative care" - it is possible your screening wouldn't cost you anything if it is considered preventative. Certainly is a tough decision for sure. For us, as our financial situation has continued to improve each year from living below our means, the HDHP with HSA continues to make the most sense as we are blessed to have the resources available should we need to max out our total out of pocket as a family of four. Don't beat yourself up about how long you waited...you're here now! Make the best educated decision possible for you and keep learning/working to improve each year. Hoping you have a healthy and safe upcoming calendar year! Appreciate you and let me know if you have any other thoughts/questions. Thanks!
THANK YOU!
@Isa - My pleasure! Appreciate you taking the time to check out this video and being part of the channel…cheers!
Thanks for the video
@OldSkoolRon - Hey, thanks Captain Ron! (if you haven't see that movie with Kurt Russell then put it on your radar....LOL) Glad you found a financial nugget or two...perhaps other videos on the channel are helpful as well. Thanks! Cheers, boss!
When I was asked to tap the like button at the beginning, I ignored, however just before the end of the video, 👍
@J A - You are a true hero!!! Thank you so much!!! Appreciate you taking the time to check out this video and being part of the channel. Cheers!
Thank you!!!
@Front Row with Lavina - Thank you, Lavina! Appreciate you sharing the love - and hope the vid was helpful. Cheers boss lady!
i hope you're still answering questions on this.. i'm new to actually having to study health insurance (military for the last 6+ years with tricare) my job offers Cigna - right now i have to report a "life event" because my coverage with TriCare ended in August. I'm also pregnant.. I've had 6 OB visits since then and have one more this friday before my Cigna coverage would be processed/started on monday. I was informed by my benefits team Cigna would 'cover' the visits i've had since August (btw tricare was charging me since then but didn't tell me it didn't count :') getting reimbursed though) I am due in 2 weeks.. i'm wondering what is my best option when i'm in such a pinch. I've googled every plan they offer but haven't been able to determine this. Can you please explain? I'll have to report another life event when baby arrives of course. Now is just not enough time to put anything meaningful into HSA.
Hey Kay! Thanks for the great video! I wanted to mention you prob don't need 4K on this type of content, most folks I follow us 1080p 30 frame, it cuts down on post and saves a ton, unless you're obviously filming a movie or some sort of documentary I would assume you could streamline things w/ that content. Also sub'd and hit that like button, cheers!
Sup Kurt! Thanks man. Yeah, I’ve enjoyed filming in 4K, but you’re 100% correct about post. I’ve edited every vid from my iPhone because my computer at the time of starting the channel wasn’t as fast as my iPhone. Planning and prepping some future vids - so thank you for sticking around! Cheers!
Ultra High Deductible is great, if you are healthy -- and your family is healthy. I put all the extra I would of spent for PPO in savings. By the end of the first year with the difference -- we had enough to easily cover the high deductible. 50% of that difference now goes to add to our own health care savings, and the other 50% goes to investments (silver/gold/IRA)
Awesome job, Cheesepuffs! Love it. I literally was just commenting something similar to this on another reply. Sounds like you get it for sure!!! Keep it up! Well done.
I like how you explained this. The one thing that I am now wondering is how much do I put in my HSA to closely resemble if I had chosen the the PPO plan? I am subscribed now because I think I could use you video content again in the future on other topics and you do such a good job explaining. Thanks
Thank you for subscribing! I’m not a full time YT’r and have lost some of the motivation to make fresh content…really focused on evergreen content for a while. Appreciate you and hope future vids can deliver on the quality that is expected. Cheers!
Like & Sub 👍 I choose HDHP, but my understanding was limited. Each open enrollment period, I search for a good overall explanation and is the first time I didn't come out with my hands empty. Thank you.
Thank you! That means a lot
I have an ongoing autoimmune disease and visit the dr quite often. I usually get the PPO.
Oh my goodness…yikes. I’m completely unfamiliar with that type of treatment. Ugh, is it tough on you? I’m so sorry you have to deal with that. Seems like I would go PPO if I were in your shoes as well.
Thank you for the video. I watched it about 6 months ago. I am having a hard time to find a good HDHP that makes sense. Can anyone share any recommendations? Thank you!
God i hate insurance this shit is so complicated.
Brenna E - Hi there! Sorry it can be a little frustrating. It's only for the next year (2021)...so if you don't have a 'life event' then you can change it next November. What questions do you have? How may I help?
I think the PPO is right for me. I'm relatively healthy however I do make doctor visits for minor things frequently. Maybe 2-3 times a month. And they're only $25 copay each time as opposed to full cost. My PPO is only $360 more per year than the HDHP and the deductible is only a $500 difference between the two. I don't think I spend $500 in doctor visits over the course of a year. Now if I was certain that I'd have a huge expense in a year I'd choose the HDHP since its out of pocket is lower, pay all of it, and then everything is free (other than the premium) after that.
HDHP with HSA is almost always best. Ignore the deductible, look only at the OOPM, then contribute to HSA. Some employers contribute to HSA as well.
Thank you for this information. My question is, If you have to seek medical treatment and let’s say you get hit with a 20,000 hospital stay bill, will the insurance cover their portion minus the deductible amount up front? Basically, do you have to pay the entire deductible amount upfront since the medical bill would be higher than the deductible and then for the rest of the year the insurance covers 100% of the costs?
@L Yarbray - Yes, correct. Once your total out of pocket deductible has been met then insurance covers the rest.
I get Johnny Sins vibes watching this. Definitely fits his repertoire of jobs too.
Best older brother a guy can ask for. 😂
I have a peculiar case I need some insight on. I have worked PRN (no insurance) at my hospital for the past 2 years as a healthy 24-26 year old man mainly to have time for classes and the most flexible schedule possible. I hurt myself playing sports and will need surgery for an inguinal hernia. I've just changed to part-time and can now have insurance coverage. I plan to only have this coverage for the PCP visit, Radiology visit, Specialist visit, Surgery, and rehab costs which should all be done in 2-3 months. After that I don't have any medical problems and have no reason to go to the doctor as of now. For the kind of care I'm trying to pay for, which kind of plan would cover me better? the average costs of this surgery in the US is $7000 ranging from $3,300 to $14,000.
Sorry your comment is a couple months old and I’m just now getting to it. By now you likely have already made the decision on which plan you selected and are making payments on your health insurance premiums already.
So, you can tell me if I’m right or if I’m wrong…lol.
At age 24-26, if I had confidence in my earning ability to continue & had an emergency fund already in place then I would have selected the HDHP option and sunk a bunch of money into the HSA BEFORE the surgery/medical visits take place so that I could at least get a small HSA deduction in 2023 as a single person.
However, here’s why personal financial planning is different: IF I was 24-26 years old and was timid, insecure, not confident in my earning abilities moving forward (due to school/health/desire to work hard/etc), then I would have likely done the “easy thing” and just paid more for the PPO and not have had to worry about the uncertainty of “how much outta pocket am I gonna be hit with?” type of fear. Typically the person that fits this build is the one that lives pretty closely to paycheck-to-paycheck and can’t scrape together $700. The fact alone that you’ve researched the cost of your surgery tells me you are not this type of person. Just my opinion using deductive reasoning.
But, ignore everything I just said because I have no clue what the PPO premiums would be for you annually as a single person based on your employers plan. Perhaps, IF the cost of PPO for you was LESS than the assumed cost of the surgery, then going the PPO route would hands down be better because then you’re saying your annual premiums would be LESS than the cost of the surgery had you done HDHP with an HSA. In my head, as this math is playing out, then that would be like having “free” health insurance for the whole year for less money than the outta pocket HDHP path for one surgery. So, in your example, if the surgery costs $7,000 then you’d need to pay less than $583/mo in PPO health insurance premiums in order for my idea to make sense.
Also, if you’re 24-26 and in the RN/medical world…then I’m praying and hoping you’re going to school to further your medical career. If that is a path you believe you have an existing passion to pursue, then my friend let me be the first of many to tell you…go to school to become a crna. Don’t go PA route unless you love that white coat type of day. My wife went back to school to become a crna after 8 yrs of bedside critical care nursing (PCU then ICU for 7 yrs) and I’m telling you…that’s one of the reasons we are as successful as we are…we developed good habits when we had less money so that we’d know what to do when we have more.
Let me know what you decided and what path you’re on! I’m curious. 😃
Im glad i bumped into this video..thanks for the explanation.My wife and i are expecting our 1st baby in October this year.My wife lives in the UK 🇬🇧 and i am a permanent resident in the USA.My wife and i agreed the baby to be born in the USA.Should i enroll to the PPO that will help us cover maternity bill?
@Jackson Michael - Oh wow...congrats on your 1st baby! What a game-changer that will be for you. When I did the research and math for this video I confirmed what I had already known - which is that the HDHP combined with an HSA is the best option. However, I’ve had a few folks reach out to me that had a better pricing option to go with PPO/Core plans...so I think generally speaking HDHP is better value/cost, but there are some circumstances where PPO/Core plans may be better in terms of annual out of pocket costs. Just run the numbers to see what makes the most sense for y’all.
Appreciate you taking the time to invest in your knowledge by watching this video. Cheers!
🙏🏼
My current benefit offering for medical is HDHP PPO,
They don’t offer a straight PPO. I’m a consultant & have always elected PPO. I’m not understanding why Employers are only offering this option. Now this is confusing, my aim is only to be able to see my existing specialty doctors. And I have (9) I hate HMO. I want to see any specialist without limitations. I don’t under that the only way I can have PPO is to have HDHP combined with an HSA SAVINGS ACCT. And I don’t know if I’m saving. I’m not critically ill but I like to maintain my health by seeing the podiatrist, Dermatologist, Orthopedist I see my doctors all year round & have always met my annual out of pocket. I’m irritated that this new ER is only giving me this option
Hey hope you are still answering questions. Biweekly HDHP $31 vs PPO $55 if selected. Not much off a difference. Should I go PPO? I’m very healthy. Might get injured at the gym at most.
@Alexis Rodriguez - Definitely still answering questions - love responding and helping folks where I can. Yes, not too much of a difference at first glance, but $55 is nearly double...it's "only $24 more" per paycheck, but that's nearly double. At any rate, since the cost to you is within your comfort/budget ($55 vs $31) AND that you are very healthy...then I would encourage you to lean towards the HDHP, but ONLY if you plan to dump some money into an HSA. If you don't plan on putting money into the HSA then stick with the PPO since the cost is within your budget...but again since you asked for my opinion...I'd go HDHP with HSA contributions.
Thanks for checking out this video...hope there are a few more on the channel that are helpful to you. Hope you're crushing it at the gym!!! Cheers, boss lady!
@@Financial_Awareness thanks for the feedback!! Yes it’s with a HSA. I’m not sure how to put into it yet, but I am going with it. I believe the PPO has a much higher premium as well.
I was thinking the same thing we never go to the dr.
I was thinking of adding a health savings account
@Gary Brown - Def a pretty good idea if y’all are healthy and rarely see a doctor! Thanks for checking out this video!
You don't necessarily have to have cash for a medical emergency if you have an emergency and you get care you can generally get that on some sort of 0% interest payment plan
Respect the insight and am grateful you watched the vid…appreciate you. However, this mindset is not one I’d want to follow.
At one of my lowest financial moments in my life I had just put gas in my car, but couldn’t find coins for the toll roads I needed to drive on…although I could and did just drive through the tolls, it ended up with a ticket in the mail a couple weeks later. Although you don’t need to pay cash for a medical emergency, if you get a 0% loan for 12 months…and your life DOESN’T change during those 12 months and you’re able to pay the minimum and “invest the difference” (yeah right, like people do that with medical bills. Lol)…then sure, I guess that works…but if you lose your job, have another medical emergency, or something unexpected happens to you (don’t they happen in 3’s?)…then you’re what they say…up the creek with no paddle. You’re screwed. And that’s how people begin the downward spiral…medical problems, then money problems, then collector problems, then rent/mortgage problems…and it could get real bad. Do yourself a favor, Joshua, please make sure you have some cash on hand man…you just never know when you’ll need it.
Sorry if I went too deep there. Lol. My bad. Again, I appreciate you. Cheers!
So me and my wife are getting insurance through my new job. She wouldn't use the insurance but I would for cancer screening and a knee surgery and seeing specialist for my lower back. If you were in my shoes what plan would best suit my needs? Any help or advice would be greatly appreciated. Thanks!
If my HDHP says $3K deductible and then also says $3K annual co-insurance limit, does this mean my out of pocket is $6k? It does not list an out of pocket amount.
I recently opted for the HSA. I have an out of network Dr that accepts the HSA card. Will this count towards my deductible? If so, I need to load the card with funds since I don't have any existing savings. This visit will account for $600 of my $1,400 deductible. I'm assuming it's best to hit the deductible as early as possible? Especially since this speciality Dr. does not accept insurance, and I would be paying that amount of money regardless. My yearly contacts cost another $600, so hitting it early does not seem unachievable.
Chelsea Sommer - Hi! Thank you for watching the video and asking your question - I appreciate that. Yes, your expenses noted above will count towards your annual out of pocket deductible. However, please keep this in mind - your “out of network” deductible is likely higher than your “in network” out of pocket deductible. Additionally, upon reading your message I quickly reviewed some of the material used in this video (our own HDHP & PPO figures)...and under “out of pocket” calendar year maximum there’s “NO LIMIT” for out of network providers....sooooo, double check your own coverage and either change doctors to an in-network doctor OR financially prepare to pay out of pocket for all of their services moving forward.
Your other question, sure the earlier you hit your deductible the better because then the co-insurance kicks in faster, but if it is at all possible to not even hit your deductible limits at all that would be good too. Was all that helpful? What do you think? Change doctors or continue to pay out of pocket?
My employer pays my premiums and gives me an option between a PSO and HDHP plan. The difference in total out of pocket is only $2000 more for the PSO plan. If high premiums aren’t a concern for the PSO, would that generally be the better choice?
@Trevor Mumford - Generally speaking, probably. However, if you don't select the HDHP then you are ineligible to be able to contribute to an HSA. No income limitation for HSA contributions/deductions...so if you're in a high tax bracket that could be a nice additional deduction to take that you wouldn't be able to if you chose the PSO option in your situation. Lots to consider - generally speaking I'd say do what's best for your situation...at the end of the day...$2,000 is $2,000 and if you could save that money & put it towards an HSA then you might be better off.
Hey, great question & thanks for checking out the video...cheers boss!
I need help. For the past 5 years my husband and I have been on a HDHP plan with HSA(employer gives a monthly contribution of $50) we pay $156/month (deductible of 3,000/fam and 9,000/fam for out of pocket). Within these 5 years my husband had a kidney transplant and has medication that he’ll be on for life as well as regular Dr visits and specialist visits. Lately we’ve been thinking about having a child and whether or not we should switch to an PPO. The PPO would cost us $216 per month (2,400 deductible/fam and 12,400 out of pocket/fam)
Can you help me decide or what should I be focusing on. I’m so lost and scared of change but the PPO would be about$35 for copay at Dr so it sounds like it might be better bu
The HDHP has always resulted in my spending less money in any scenario plus the HSA money never goes away and can be carried over from job to job. FSA's which are often associated with PPO plans are a joke with their annual "use it or lose it" rule.
Agreed. I dropped $520 on ‘medical’ family Christmas presents one year because I had to use it. Lol. What a waste. Paid that stupid tax once - never again. Lol
Thank you for making this! So you would recommend a PPO if you’re planning on pregnancy in following year?
@Brett Grant - My pleasure man...happy the vid was helpful. Such a great question! I would answer this by simply looking at the numbers...pregnancies can be quite a substantial cost these days - meaning we know that you'll be paying a significant out of pocket expense...possibly hitting your annual out of pocket deductible with a HDHP. Gathering data/numbers will help answer your question. Gut tells me HDHP would still make sense given the figures I described in the video. Call the hospital and find out how much the delivery/pregnancy is going to cost...give them your current health care coverage and they'll tell you how much you'd prob have to pay...oh and don't forget to add up all the pre-delivery day doctor visits where you'll have to still spend $$$ on co-pay if you go PPO...then crunch the PPO numbers to the HDHP numbers. If your total out of pocket costs are lower with PPO then I'd go that route, but like I said...my gut tells me HDHP might still be best route, but if it doesn't cost as much as you think then you'll have leftover funds within your HSA. Lengthy response (lol) when I could have just said...'crunch the numbers' hahaha! Cheers, boss!
@@Financial_Awareness Thank you so much for your time!
hi, I am selecting a plan for my family (Me, Wife and a newborn) for 2023 and right now i am in PPO. My son will be 4 months old by January 2023. Do you think HSA will be better or should i continue with PPO? Me and my wife are totally fine so far. I am 32 and she is 30. No Diabetes and No Hyper tension.
Just being honest here, I was in your literal shoes like 9-10 years ago. Out little ones are 11 & 9 now. It’s amazing…they can make their own food, shower, get dressed….lol. Life gets easier for you just let me tell ya! Lol. Be graceful through the hard times, be patient…and just know, “this too shall pass”…that phrase got me through a lot of tough moments as a new dad. Stay positive and energized! Your health matters too!
Ok, so, what health insurance did we have when we started our family? Well, I wasn’t in financial planning quite yet at that time in my life…I wasn’t as smart then as I am now, so just being honest, when we had both our kids we were on PPO and not HDHP. With PPO our entire delivery cost us like $250/day in the hospital…so what’s that like $750-$1,000 for a C-section delivery where they keep you for 3 days? Something like that. So for me, I remember thinking how cheap that was, but because I wasn’t as smart then as I was now, I wonder how much we were paying in PPO premiums…that would be the true cost!
So, for you, if you’re smarter than me at age 24-26 (likely you are), then I would be smart and go the HDHP path if the numbers make sense for your situation…in 2023 I have yet to see a situation where HDHP with an HSA makes sense over PPO.
The ultimate confidence-booster in this situation is when you have a nest egg/HSA account that has your entire annual HDHP maximum family out of pocket costs already in the account before Jan 1st. If you ever get to that point financially then you can remove all financial fear over this health decision and can truly make this decision based on money and not about health.
So, let me know what you ended up deciding…I’m curious! Lol. Sorry it took me a couple months to respond…just been livin.
Knowing that you have a lot of medical expenses coming (you're pregnant at time of enrollment) a high deductible plan wouldn't make sense for you right? Go with a higher premium plan with a co-pay per visit?
Amanda, yes. That is what I would do if I knew my wife and I had large medical expense coming up.
However, that said, just run the math…look over your assets & see if you can withstand the out of pocket costs that come with a hdhp.
If cash on hand (or HSA balance) is limited then it would be much safer, less financial risk, to go with the higher premium plan. Lord knows we don’t want to be putting doctor visits on credit because we don’t have the cash flow to pay for them due to having a hdhp and no HSA or limited funds available to cash flow expenses.
hi. I choosed a high premium (765 a month) with a low deductible (2000) (10% coinsurance, 10 copay), (Max OOP 8000) for myself and my wife who is PREGNANT. thinking that pregnancy expanses and delivery is highly costly and will reach the deductible and Max OOP within months. Do you think is a bad choice choosing the high premium?
@said ALG - No, I do not think it is a bad choice - FOR YOU & your situation. What I love about your comment is how intentional you come across as you weigh your options and decision...personal finance is personal and what works for one family might not work/make sense for another. So, that said, I support your decision.
In this video I think I go over how the total out of pocket money of the HDHP (including the premiums) vs the total out of pocket of more expensive options (including their premiums)...and in the video (which has my wife's company's health insurance options), the HDHP is still less out of pocket compared to selecting the more expensive plan with lower deductible.
If I understand your figures correctly then...
$756 x 12 months = $9,180
PLUS you'll spend the first $2,000 of your deductible BEFORE the insurance company kicks in their 90% and you'll only pay 10%...so you're total out of pocket is $11,180 before you'll only have to pay 10%. Regarding your total out of pocket maximum, you'll spend $9,180 on premiums PLUS another $8,000 ($2k deductible + $6k worth of 10% expenses...which assumes you'll have $60,000 worth of health care charges in order to hit the maximum out of pocket) BEFORE the insurance company starts picking up 100% of the costs. Sooooo, you're committing to spend a minimum of $11,180 + 10% of all future expenses until you hit that $8k...my question back to you...how does that compare to your HDHP option? You're potentially going to be spending $19,180...how does that compare to HDHP where you'll have a lower premium, but higher deductible? I'm curious to see what your total out of pocket maximum would be for HDHP and how that will compare to what you currently selected. Pregnancies with anesthesia are not cheap.
@@Financial_Awareness thanks for your reply and your time.
The other plan my company is offering is: liberty H.S.A EPO 2
200 premium myself and my wife PREGNANT
deductible 5000.
%50 (just copay) after deductible for office n specialist visits, lab, hospital in and out- patient, ER copay.
Max oop 12,900.
Another plan: garden state 16:
450 premium
Ded 3000.
Coinsurance %30.
Max OOP 12,700.
Lab , hospital in n out- patient %30 after ded.
Thank you again for your time and consideration
@said ALG - Hey just chiming back in. I looked over those numbers, but just want to remind you that this decision is yours to make…nobody can tell you what to do. Good news is this is only for one year…so if you want to select the lower premium, higher deductible plan next year then you totally can. From the research I did and what I shared in this video, the HDHP seems to make the most financial sense, but that doesn’t mean it is the right decision for everyone. Anyway, appreciate you sharing your thoughts and being part of the channel. Cheers!
A case study in behavioral economics. HSAs are powerful. If you pay cash and keep receipts you can reimburse yourself in future. In this case it doubles as an emergency spending account!
Also HSA payroll contributions avoid FICA unlike 401(k)s
@carlrhall75 - That’s a really good nugget right there! 👍🏻👍🏻
Appreciate you taking the time to check out the video.
@@Financial_Awareness my pleasure. I am actually building a fintech specializing in workplace HSA education 🙌
Do you have an email? We could connect!
Congrats on your fintech co! Awesome. Appreciate you asking, but I’m not sharing my email address.
My daughter is under contract with MEDPRO now , will she carry her HDHP when she transfer to another company after 30 months?
@Merlinda Posadas - Hi Merlinda! It is my understanding that company group health insurance policies are only for the company you’re employed to….and if your daughter will be leaving that company after 30 months then she will no longer have that HDHP coverage and will need to buy a policy on the open market or go with whatever group health insurance policies her next company has to offer.
Please let me know if I misunderstood your comment/question. Hey, thanks for checking out this video & the channel. Hope there are a few other financial nuggets for you. Cheers!
My job offers HDHP for $61 and they contribute $500, the PPO is $10 more are $71 a month not sure which to pick. I’m pretty healthy only go to the doctor for vaccines and just regular check ups
I am currently having to elect between a PPO plan and a HDHP plan from my job during Open Enrollment. However, the HDHP has a lowe deductible and a lower premium than the PPO plan. Is that normal?
NorwalkOriginal - Hello! The lower premium is absolutely normal for HDHP...the lower deductible isn’t normal (hence the name “high deductible health plan”) - so if you’re reading your docs correctly then that sounds awesome! Double check your insurance coverage after you meet your out of pocket deductible...normally PPO has an 80% coverage (and you still pay 20%)...and HDHP has a 70% coverage (and you still pay 30%).
@@Financial_Awareness
In this case the HDHP has a $2,100/$4,200 deductible 80/20 co-insurance with a higher premium.
The PPO plan option has a 3500/7000 deductible 80/20 co-insurance with a far lower premium.
NorwalkOriginal - Pffft!!! Geeze! Well, unless you and I failed at math in 2nd grade then it would seem this is a no-brainer....right? Don’t you agree? Seems HDHP is the way to go for you given that math. Unless you enjoy spending more money. Lol.
Actually, in all seriousness, if there’s no catch it’s a no-brainer, but just make sure both offerings of coverage (PPO & HDHP) are with the same insurance provider and not some sort of goofy different offering. Would be terrible if you couldn’t go to your normal doctor or hospital for some weird reason. That’s really all I can think of without knowing all the details.
@@Financial_Awareness HDHP is definitely the better option. It just threw me off that the “High Deductible Health Plan” was actually the plan with lower deductible out of the two options. I am not sure if this is a new normal or something, but I don’t remember ever seeing the HDHP being the plan with the lower deductible.
NorwalkOriginal - 100% agree with you. First I’ve heard of it. Without getting too personal or specific..do you work for a company in the healthcare industry? Because a fantasy football buddy of mine has incredible coverage that’s super cheap...because he literally works for a health insurance provider directly.
Can you do HDHP plus have a secondary insurance from your spouse?
@TheCharmsheart - I believe you can, but I’d express caution in paying for insurance twice.
If you have HDHP coverage then your spouse should only need to pay for “employee” and not “employee plus spouse” or “employee plus spouse + kids”.
That’s my reaction…unless I’m not understanding the question.
Is the coverage free as secondary spouse?
So you are getting ripped off regardless.
High deductible- dont get sick.
PPO- pay double but we got you😂
@K J - Correct. Basically the video could have been all of 15 seconds by me just reading your comment...LOL. Appreciate you taking the time to research and check out the video. Cheers boss!
Do you know of any books with this kind of information that you can recommend?
I’m sorry I do not. Most plans get tweaked and evolve year over year. Plus laws change sometimes. This vid is a decent comparison between these two options, but there’s certainly other resources out there on the topic…I’m just not aware of any specific book.
Hey, thanks for checking out the video and channel. Hope there was a good financial nugget or two that you took away from it. Cheers!
Yeah I pay 80 percent
Who can anticipate medical needs for next year? I guess we need to be fortune tellers to select insurance.
@Ronnie Foster - Hey Ronnie! Yeah, we can’t really be fortune tellers about the next year of our health…but I think what I was trying to convey in the video was to look at the previous year’s health/medical expenses and try to use that as a base line to make an educated decision regarding the upcoming year. 🤷🏼♂️ Tough call…sometimes it depends on your employer benefits and your health. All I think any of us can do is get informed & make a decision based on the info you have and go from there.
Hey, thanks for taking the time to check out this video. Hope there might be a few others within my content library that are of interest to you. Cheers boss!
HDHP could be car insurances "liability"?
Eh...so if an employer let's you pick between these 2 types of plans but also covers 100% of premiums and claims the pay check doesn't change... then there is no reason to ever pick the HSA-compatible plan?
@Zero Fnord - Great insight! Appreciate you checking out the video and commenting. I’ve never heard of an employer covering 100% of the premiums and claims…so that’s new info to me.
If you don’t need/want the deduction of HSA and an employer is paying 100% of the premiums, then I can see how PPO would make more sense for the employee/consumer, but that is probably more rare than common. Let me know if I misunderstood you.
Cheers boss!
Isnt a big factor what the company contributes to the HSA vs the deductible? My co actually puts more in than the deductible is and then the coinsurance is 100% for hsa and 80% for ppo. So lower per payroll contrib and hsa does have the deduct vs ppo no deduct but company pays in more than deduct
Sounds like an incredible set up you’ve got there! Very nice! You make a good point. More and more employers are adding to employees’ hsa accounts as a form of comp. Def a strong factor if the benefit from the company is as good as what you explained.
Thanks for checking out the vid and channel!
Nobody ever mentions high cost prescriptions and what would be better.
This is why we need a Medicare for all in this country. I know it’s not free, but would be free at the point of service. So you wouldn’t have to come $18000 out of pocket for something you have very little control over. Who has $18000 sitting around. Medical insurance is a scam.
@Deisel 1968 - I know we all have different health histories and different incomes, but the cheapest thing people could do is quite affordable: portion control each meal (eat only what you need and not stuff yourself), drink more water, & walk/run outdoors and sweat!…self-care is huge and can absolutely contribute to lower healthcare costs. Easy to type in a comment, but hard to make the time to do exercise & actually doing it…until some actually commits to improving their diet/health.
Appreciate you taking the time to check out this video and being part of the channel. Cheers, sir!
@@Financial_Awareness He made a point, but you are absolutely right
No
@@fozzybear9114 why?
Doing business with people's health
My PPO copays say “deductible does not apply” so I would save more since the copays would be lower granted I would have to pay for other services u til my deductible but
If I have a HDHP $1500 deductible, do I pay this deductible every-time I visit a doctor?..
@Cash - Hey Cash, nope that isn't exactly how it works. From your description/comment I'm assuming that your $1,500 deductible is your annual total-out-of-pocket expenses (aka deductible) that you have to spend BEFORE the insurance will kick-in their 70% or 80% or whatever percentage your health benefits stipulate.
Based on your best guess of your health & need to go see any type of medical professional, you might be able to spend significantly less money on HDHP premiums instead of PPO larger premiums AND even if you have to pay out of pocket for some medical visits, you will likely spend less money on your healthcare needs going the HDHP route...and that extra money can go towards your HSA (you can then use in future years to pay your $1,500 deductible/expenses), paying down debt, saving/investing more, or whatever your financial plan says you should be working on.
Hope all that helps! Hey, thanks for taking the time to check out this video...hopefully there are others within my content library that you could find a few financial nuggets in as well. Cheers boss!
A lot of money why to have insurance at all?
I dont see tge point of PPO here
I have OAP can you explain to me
@mst5158 - What does OAP stand for? Sorry, not sure I follow. Will help if I can and understand.
What's hsa?
@Antonio Reyes - “Health Savings Account.” Not to be confused with the FSA which is “Flexible Spending Account” and is a use-it-or-lose-it each year…the HSA balance continues to rollover each year.
Thanks for checking out this video and the channel! Cheers, boss!
@@Financial_Awareness Thanks I just signed up for my insurance yesterday. With your video and hell from the lady on the phone I was finally able to understand what I was signing up for.
@Antonio Reyes - Nice! Now all you have to do is stay healthy all year. Lol. Happy Thanksgiving man….cheers!
That is some cheap insurance premiums
@C Paul - We went with HDHP with HSA again for 2022...might not be the best option for everyone, but it has been working out for us so far. Yeah, those premiums for HDHP are much more affordable than some other options out there....we are blessed my wife's employer has such great benefits.
Hey, thanks for checking out the video and channel...really appreciate you taking the time to invest in yourself by seeking this info out. Cheers boss!
You might have missed the money you need to put into an HSA that adds into the cost of the HDHPs. Which is tax free money but if you don't put money into it and don't use it, you lose it.
@Slai47 - Kinda confused by your comment. Auto correct may have switched your words around a bit….how can you lose it if you don’t put any money into an HSA? What’s to lose if you don’t put money in?
With FSAs (Flexible Spending Accounts) you do have to USE it or you LOSE it, but with HSAs you put money in and if you don’t use it then the funds remain in your HSA until you do use it. Please let me know if I misunderstood you. Thanks! 👍🏻👍🏻
@@Financial_Awareness let me better explain:
PPO cost:
Cost of deductible
Cost out of pocket
Premiums cost out of paycheck
HSA:
Cost of deductible
Cost of out of pocket
Premiums cost out of paycheck
Money put into HSA
You need to contribute to the HSA that sometimes makes up the difference between the two plans if I'm reading right. Correct me if I'm wrong
@Slai47 - I wouldn’t say you’re wrong. You are correct. The difference is that you get to keep/invest the money into your HSA that doesn’t get used…so the account grows and is an asset…albeit an asset specific to your health expenses, but an asset nonetheless.
Conversely, the money you pay into a non-HDHP plan is truly lost…only way to benefit from that is to have significantly more healthcare expenses than what you have paid in premiums. In no way, shape, or form would I wish for that to happen for anyone…because that would imply some sort of physical harm has been inflicted upon your body in order to need to spend that kind of money on healthcare expenses. That’s how I look at it at least. What are your thoughts?
…oh…and you should contribute to HSA, but you don’t “have to” and you certainly don’t have to only contribute the difference. So, what I like about that is the flexibility…you can contribute some, a lot, or very little…I like that flexibility for each family/individual.
So $14000 annually to donate …basically
😂😂😂
It seems like you're saying even worst case scenario that the HDHP is still cheaper as long as you contribute to HSA, no?
It seems like you watched the video. 👍🏻👍🏻
Thank you George W. Bush for making it easier for health insurance companies to rip us off. By helping make high deductible, health insurance possible.
My ppo is cheaper than my hsa
So basically this guy is saying don’t ever go to the doctor and you’re be good! 🤦🏼♀️
@Slm 1972 - No ma’am, that is not what I said. Actually, in this video I said the problem with HDHP is that BECAUSE of the costs being shifted to the consumer, there is a problem that people might not go to the doctor as often - due to cost…which is a problem. Never said what you’re implying, but I am very appreciative of your time to watch the content and engage. Thank you!
damn, i thought insurance premiums were paid and insurance covered any medical costs🤣
Who ever anticipates cancer? Other medical issues? I understand if you're generally healthy it makes sense... Until you're not. Healthy and you're fucked
Have you looked at the average American diet? Lol. We are all screwed! Hahaha. I’m planning on using the dividends from our HSA investments to pay for our long term care insurance premiums from retirement to death…but I’m quite sure some type of medical problem could pop up between now and then…so we just keep stacking the HSA. I guess better to have some money saved in HSA than not. 🤷🏼♂️
This is only a 12 month decision BTW. You can flip back to PPO and skip HSA contributions the following year. Fill me in on what I might be missing.
Appreciate you taking the time to check out the vid and channel. Cheers!
Ok this dude works for company right since he just buried the fact they only pay 30% I use to sell cars and this guy gives me that slimey feel . You are lying by omission. And yon know it
@k m - ??? Your comment is super confusing to me - I want to respond, but I’m not sure what you have an issue with.
The 30% that you reference is the co-insurance that the employee has to pay for HDHP medical costs and insurance company picks up the other 70%….it is literally right there in the document I used for this vid. Not hiding anything.
Selling cars - LOL…sorry if I came across in some weird/wrong way to you man 🤷🏼♂️.
What am I lying about?
What company are you assuming I’m working for? If you help me understand your perspective I can clarify and reply.
Regardless, I appreciate you checking out the video. Cheers boss! …and happy Thanksgiving!
I fucking hate our healthcare system
@Josh Borduin - There are certainly other ways to provide healthcare to the masses - as seen in other countries. What's frustrating you to dislike it so much? Anything in particular you would want to change to make it better?
Hey, thanks for taking the time to check out this video and the channel...really appreciate you for that. Cheers, boss!
What ppl dislike so much is the fact we have to pay so much up front before the insurance pays, maybe you have that kind of money not everyone else does. Example: 2,000 deductible and 6,000 Out of pocket max, so 8,000 total before insurance starts to pay. That doesn’t include the premiums. Absolutely nothing good about this kind of insurance.
@Slm 1972 - Yup! You are correct and this is the problem with High Deductible plans…for those that don’t have strong cash positions to begin with then it could be a tough pill to swallow - financially speaking - if there was such an expense incurred. When deciding between insurance policy options that has to be taken into consideration.
Lastly, yes-at the risk of sounding arrogant, I do have that kind of money and we could afford an $8,000 out of pocket expense. And I have zero issue stating that publicly in my response to you….because my wife and I have sacrificed tremendously in our lives to arrive at the point where we are now (and also at the time of filming this video) - financially speaking. We have worked hard for what we have and it hasn’t been easy. We have been married nearly 13 years and have lived below our means during our entire relationship…so, yes sir, when someone lives a lifestyle of consistently living below their means, an $8,000 expense isn’t wanted, but it can be cash flowed from proper financial discipline of saving for a rainy day…because as I’m sure you know, life throws you curveballs and you never know when or how much curve is being thrown at you, but we can financially prepare for the “what if” scenarios in life. Because we consistently live below our means (when our incomes were smaller and also now), we have $8,000 to cover such an expense. I love it when I hear of people finding financial success from hard work and I hope you or anyone else reading this understands that it is difficult to live below your means, but there are sacrifices we can make to improve our future…and my wife and I have done that and continue to do that.
…and there are many great things about this insurance - one of them being it costs less money (the premiums) for those people that are blessed to not need regular doctor visits and are healthy.
Naw I'm not paying for that type of insurance I'll pass
What about a PPO and FSA 🥲🤣 . I go to the doctor a lot so I’m stuck on which to pick 😢
I’m so sorry you have to go see a medical professional frequently. I hope the financial burden from that will subside and you get healthy. Yeah, this is a tough call…my general vibe/feelings is if you have to go frequently then PPO is perfectly fine until you can build up a cash/savings account emergency fund…then start to build up your HSA account after you eventually switch over to HSA. Until someone’s financial health is in good order, it’s harder to switch to HSA for people that already know they’ll have medical expenses going into the year.