{ "media_type": "text", "post_content": "I am in a single income family with a small army of children.\nWe have enough medical bills from chronic meds and random happenings that we just do the plans that have the smallest deductible(out of pocket) due to risk of large medical bills.\nTherefore I do not do the HSA because I don't have the high deductible plan. \n\nShould I rethink that?\nHelp me think through this.", "post_id": "61ad372b9a1ce600358bc9f4", "reply_count": 32, "vote_count": 5, "bowl_id": "59064a3cb12379001006592c", "bowl_name": "Personal Investment Chatter" }

I am in a single income family with a small army of children. We have enough medical bills from chronic meds and random happenings that we just do the plans that have the smallest deductible(out of pocket) due to risk of large medical bills. Therefore I do not do the HSA because I don't have the high deductible plan. Should I rethink that? Help me think through this.

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We are family of six. Two high-schoolers and two elementary (KG, 2nd). I used to have high premiums/low deductible plans in the past because of the fear that I will need more coverage. Last year, I experimented for the first time with a high deductible plan (low premiums/pay check deductions) and put the saving into HSA. I came out ahead by about $1700. I did the same this year but looks like I will be breaking even. Although, on of my kids required hospitalizations twice as well ambulance expenses. For perspective, my older kids been receiving therapies. My wife is dealing numerous medical and psychological issues that regular counseling therapies and as well as doctor's visits in 5 years. In short, high deductible plan is working out ok for family. Though, I had this impression that high deductible plans fit better for those who younger and healthy (or may be for singles) that require less provider visits. (Side note: I have always fully funded FSA each year for other out of pocket expenses but with HSA in the picture, its usage now has limitations. I am mainly using it for kids orthodontics and other dental services)

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This is an important add. Once kids need orthodontic work the HDHP and LPFSA together. So my D11 needs braces. A $5k plus bill. The dental plan pays $2500. The LPFSA will take $2850 that can go to that. Then i still have HSA money.

So my firms plans push toward HSA. The premium increase for traditional plans is about the cost of HSA contributions. And some years I have money left in the HSA. Some years I don't. HSA can also be used to save toward stuff that insurance does not cover like the money above $2500 for teeth braces. It depends but in the tradiomal plan sum up your out of pocket plus premiums. On HDHP sum the premiums, and deductible and look at that compared to HDHP and any HSA funding contributions from your employer. I wish I had understood this better on 2009 with one kid and less medical bills. That HSA would have been stuffed with post 2009 crash investment return for the tween medical bills. Employers seed contributions were huge back then.

@P2 thanks for the detailed responses, I was not sure we could get reimbursements for past years medical expenses given receipts are saved. It’s wonderful to know.

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I think you need to run the numbers and your choice might not be the best option. I think the better way is to sum the deductible, premiums, coinsurance, and co-pays. You’re only looking at the lower deductible, but you’re paying a much higher premium such that your total out of pocket cost might be higher than it would be with a different plan. Of course, actually knowing what your costs will be is impossible, because America, but you can estimate based on past history.

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Can you afford to pay the deductible and any cost sharing required before the insurance company pays 100% for a high deductible plan without using the HSA money? If you can, it's worth considering doing it; if you can't and would have to use the money you put in the HSA, it's probably a wash at best and you might even make out better with the low deductible plan.

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I only have two kids but choose an FSA plan over an HSA plan for the same reason - kids are just magnets for medical costs. HSA is pretty sweet from a tax advantaged standpoint, but if you’re outlaying a lot that would have potentially been invested because of a higher deductible or worse plan coverage that will have the opposite effect on your overall long term financial picture. The 2021 contribution limit for HSA is $3600, which is nice but not like life changing from an impact on your financial health. I would look at that number and then see how much you save on average going with the lower deductible plan. If it’s close then maybe consider switching.

likehelpful

Yep, I do that. Single income and ordinarily would phase out of Roth IRA and other things but by maxing 401(k) and HSA, it gets me under the limit so I can do everything.

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One thing to look at is how pharmacy is covered in high and low deductible plans. My child was on a treatment where the drugs were around $80k/year. Our high deductible plan covered pharmacy 80/20 while our low deductible plan covered at a max cost of $90/month. I used low deductible plan until that was over.

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My wife is going to put the baby on hers and Ill run with the HSA for myself.

I assume you are calcing your max exposure for each plan before deciding which to choose. And that you’ve also considered which plans have true fam vs embedded deductibles into that equation? In my experience, HDHP plans are true fam deductibles. Meaning if the total family deductible is $3k, any one person (or combined) have to total $3k for the ded to be satisfied. If the other plan is embedded, your cost exposure is per covered person so if the family deductible is $3000, the stop per person could be $1500. So your higher cost dependent is capped more or less.

Pretty sure the math would up in HSAs favor if you occasionally cross the deductible in expenses.

Our HDHP is still a PPO. The deductible is higher, but it’s still 80% coverage. As you earn more, the PPO FSA premium goes up, but ACN gives you and your spouse HSA funds. That pretty quickly offsets. The question is whether you want more up front - the FSA is available to you Jan 1, vs HSA is just what you put in.

This max loss thing is a bit of a misnomer. In $40k medical years I have not hit max loss so it's a data point. But usual use is more beneficial.

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