Open Enrollment Q:
Debating between High Deductible (for HSA) & PPO options.
My spouse has some expensive medications. Annual insurance allowed amount is ~$40K for us in 2021. Since we are currently on PPO, we only paid ~$500 out of pocket.
With a high deductible plan, we would pay ~ $7K out of pocket since HD Plan only pays 90% after the deductible. Is there anyone in similar situation? Does enrolling in a high deductible plan for HSA make sense in this case? Anyone in similar situation?

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Additional info:
switching to HD plan saves about $2300 in premiums. There are tax advantages with HSA as well. My fear is... what if there is a surgery? I am a big believer in regular check ups and preventative care. I don't want either of us to be hesitant to go see a doctor just because our out of pocket is going to be higher. Appreciate your thoughts. Ages 42 and 54.

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There is some preventative care that is covered under HSA without meeting the deductible. https://www.healthcare.gov/coverage/preventive-care-benefits/

Nothing like running the numbers in these scenarios. I’ve found that at the employers I’ve worked for if you hit that level of spend HDHP is the way to go, but i don’t think I’ve ever seen a plan option that capped OOP at 500.

My out of pocket for this year is $500 because I am on PPO. That is actuals based on what I spent not an amount that is capped at that amount.

Oh I just noticed your spend is mostly prescription - you really need to look at what the prescription benefit is with the HDHP and what your spouses scripts are.

I’ve been HDHP at three different employers and the drug benefits have been very different.

Surgeries at all three usually ended up favoring HDHP as all of my plans usually had some level of coinsurance (e.g. 20% coinsurance is going to hit OOP max of $6k that was applicable across the board so then you just have lower premiums).

I spend a lot on healthcare, but I value the fact that HSA is tax free on growth too! I always do HDHP no matter how much my health costs are going to be, since the tax benefits on growth + pretax savings are greater than a few hundred difference upfront, and the upper limit is bounded by OOP max.

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