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Open Enrollment

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First, thanks so much for the many thoughtful (and kind!) comments on my budget post. When I saw the comment count shoot up it made me nervous to read through them, but almost everyone was really very kind and forgiving (and generous in offering support, tips, advice, etc.) THANK YOU!

Speaking to one of the common comment themes I saw – many people asked about my take-home pay. For a $95k salary, my take-home ($2440/biweekly) is pretty low. The reason for this is that I have a LOT of things withheld and/or paid from my check pre-tax. This list includes the following (all numbers from my most recent paycheck):

  • Medical insurance ($125.50/check)
  • Dental insurance ($52.28/check)
  • FSA – Health ($68.37/check)
  • FSA – Dependent Care ($136.75/check)
  • Retirement account (required and already investing at the lowest amount so no chance to reduce – $256.91/check)
  • Parking permit ($38.45/check)

Plus, of course, all my taxes as well ($552.13 from my last check).

If I added this all up correctly, that comes to a whopping $1230.39 taken from my check before it hits my direct deposit! WHOA! That’s a third of my check!

So the question came up – can I change some of these things so I can get back more money per paycheck. And the answer is – YES! Right now is my open enrollment period and I’d LOVE to have some help with figuring things out! Let me address things one at a time.

Taxes

I can likely lower my tax withholdings per check, but have opted not to make any changes right now. Taxes are not part of my open enrollment, so I can change those at any time. Based on what feels best to me (and many comments/advice I’ve received), I’m going to do our 2017 taxes ASAP once the new year hits. That will give us a better feel for how much we really owe and we can make adjustments accordingly. Given our huge tax debt (that we’ll be paying on for what feels like a lifetime), we’ve opted NOT to reduce our withholdings for the time being. We’re likely over-paying a little this year, but we feel okay with that – any extra money can go to help reduce the tax bill and we can re-adjust after the CPA has gone over everything.

Retirement, Dental, Parking

These are all pretty well “set” and cannot be changed. We have limited options for dental – I can decline the insurance, but we use it and need it. So it stays. In terms of parking, I live too far to walk/bike and don’t have anyone living nearby to ride-share with. So unless I switch up my Mom car for a motorcycle (never happening), this bill is pretty much “set” too. Retirement is required by my employer. I used to invest a full 10%, but have reduced down to the minimum (7%) already. No way to make this any lower.

Medical 

So here is where I could REALLY use some advice. Currently, we have a PPO plan and this entire year I’ve been thinking that, come open enrollment, we’d switch to a HSA. But when I started really doing some research to compare the two options, I think we’d end up spending MORE with the HSA. Yes, we’d save on monthly premiums, but the out-of-pocket costs and deductibles are much higher.  Here are some side-by-side comparisons I put together. What do you think?

Health Savings Account PPO 
Per-paycheck Premium $61 $150 (note: this is more than listed above because premiums are going up)
Overall Deductible In-network:

$1300/employee; $2600/family

In-network:

$500/employee; $1,000/family

Other Deductibles Non-preventive prescription coverage:

$1300/employee; $2600/family

None
Out-of-pocket limit In-network:

$2,000/employee; $4,000/family

In-network:

$1,000/employee; $2,000/family

Not included in out-of-pocket limit Premiums and health care not covered by the plan Premiums, drug co-pays, and health care not covered by the plan
Annual limit on what the plan pays None None
Costs for common services with in-network providers.

Primary care to treat illness or injury

Specialist visit

Other practitioner office visit

Preventive care /screening

Diagnostic (x-ray, blood work)

Imaging (CT/PET/MRI)

Mental health

Generic drugs

 

 

10% co-insurance

10% co-insurance

10% co-insurance

No charge

10% co-insurance

10% co-insurance

10% co-insurance

non-preventive: 100% until deductible is met. Preventive: $10 copay

 

 

$15 copay

$30 copay

$10 copay for OB/GYN

$15 copay primary care; $10 OB/GYN

No charge

No charge

$15 copay

$10 copay

 

I receive biweekly pay (26 checks/year). So the HSA annual premium is $1586. The PPO annual premium is $3900 (a difference of $2314). But if we’re having to pay $2600 for our family health deductible + $2600 for the prescription deductible (compared to a $1,000 deductible for the PPO plan), I think it’s just too much money out-of-pocket! (though, caveat, I’m no expert with healthcare – does the out-of-pocket max only apply to healthcare, or would that also include prescription coverage??)

My thought is that we’d be better to stay in the PPO. It also scares me to think of paying 10% of any imaging, diagnostic, etc. We’ve been lucky thus far (knock on wood), but we have young kids – broken bones are a given at some point, right?

Those more experienced than I am – thoughts?

Flex Spending Accounts

The dependent care account contributions will decrease in 2018 and even moreso in 2019. Right now, we still have hefty monthly bills. Our girls are in kindergarten and, though half-day kinder is state-subsidized, the state does not cover the costs of full-day kinder. We pay that. The total was actually right about $1,000/month, but we paid out of our FSA a huge chunk for one of our kids’ entire semester of tuition (for which we received a discount). We’ve been paying the remaining costs out-of-pocket (the dependent care FSA was depleted months ago).  For next year, we’ll only have one semester worth of full-day kinder costs (the second half of the year they’ll advance to first grade – totally free!), plus the costs of care for summer and after-care, as needed. (Note: several people have suggested that hubs take over childcare so I just wanted to address that here:  hubs does handle the bulk of childcare. Where we live, half-day kinder is 8:30-11:30am. Hubs is in classes full-time that extends well beyond that timeframe. The full day kinder program is 8:30-3:00pm. Currently, hubs gets the girls at 3:00pm every day except Wednesday – his long day – so we pay very little in “after care” at the present time. Just one day per week. This arrangement is unlikely to change for the rest of the academic year).

Bottom line, we should be able to lower the amount of FSA money withheld for dependent care for next year, thus increasing the size of my take-home pay.

The health care FSA is entirely dependent upon whichever medical plan we choose. If we get the HSA, we’ll use the health savings account. If we keep the PPO, we’ll keep a flex spending account for medical expenses. This year, we put $1750 in our health FSA and it was not nearly enough. If we keep the PPO, we’ll increase our health FSA contributions probably to about $2250-ish (though I’d need to crunch numbers first).

So the big question is…..HSA or PPO (with a FSA)? Pros and cons? What are your thoughts and why?

Ashley

Texan at heart; Arizonan on paper. Lover of running, cheese, camping, and family (fur-family included!). Blogger, motivated to get out of debt YESTERDAY! Follow along with my journey!

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58 Comments

  • Reply Tammy |

    My advice: Do not change your PPO! Your premiums are a bargain and you have excellent coverage! The amount you will save on the premium will be wiped out witha couple of minor illnesses.

    We pay almost $500 every two weeks and our health insurance is terrible. I hope you realize how fortunate you are to have such low cost coverage!

    I think you’re on the right track but consistency and a plan are key. Good luck!

    • Reply Katie |

      100% agree. Ashley, you have really good coverage. Our premiums for our family of four are 3x as much per year, and our deductibles and co-pays are higher. Keep what you have.

  • Reply Laura |

    HSA are usually a good deal for people who don’t need health care very often. Which is rarely true for a family with young kids. My employer had an “informed coverage “ calculator during open enrollment where you could estimate what you would be out of pocket with each plan depending on average number of doctor visits per year, prescriptions, etc.
    My brother and I have the same employer. He is young, healthy, has no kids and rarely needs to go to the doctor for more then preventative care. In my family 2 of us have chronic illnesses that require medication and regular doctor visits. HSA was the best deal for him, PPO was the best choice for me.

    • Reply Kerry |

      Exactly–HSAs work when you have a low need for health care and have the ability to plan out what you need, save up, and choose providers.Essentially you stockpiling cash in your low-use years to save towards future expenses. You have great flexibility, but they are a bad financial bet unless that flexibility works for you. Just having kids, even relatively healthy kids, makes it a bad bet. How many times did you take a kid to the doctor for an infection or something weird in the last year? Plus your husband has weird health too!

    • Reply Cory |

      From the research I have done and explained well in a comment below. Hsa plans are good for both extremes. Healthy people that rarely need care and people who are going to spend more than the out of pocket. It sounds like Ashley’s family may fall in that second category so it’s worth the time to prob look at your 2017 expenses and do a comparison of how much it would have cost with both plans to guess which plan will be best in the future.

      At my employer the hsa “silver” plan premiums are half the Ppo. I pay $105 per biweekly paycheck. Family of 4 that is relatively healthy. On average we probably have $1000 out of pocket expenses. A broken bone or a few trips to the doctor. One year my wife was in the hospital for like 6 weeks and we hit the $10,000 deductible. That wasn’t fun but since I generally save about $2500 a year on premiums it has been worth it.

      At any rate I would encourage you to run your 2017 expenses as if you had an hsa to see which ends up being more cost effective.

  • Reply Jax |

    Does your employer give you money for your HSA? As a single person, my employer contributes $1600 each January to my HSA, and $3,600 to people with family care. If they do contribute, does that make a difference in out of pocket costs?

    Did you hit your deductible last year? That’s also something to think about if you’re considering switching. Yeah,the unexpected can happen, but if you came no where close to your deducible last year you might not need a lower deductible this year.

    • Reply Ashley |

      My employer does not contribute to an HSA (or FSA for that matter). We have hit our deductible every year since I started working there.

      • Reply Laura |

        That is more reason to keep the PPO then. I really think you would spend more with the HSA.

        • Reply Ashley |

          That was my thought, but I’m no expert so I wanted to get some reader input. 🙂
          Thank you!!!

  • Reply Joanna |

    Are you sure you have a separate RX deductible? We’ve done HSA’s for years and its always been the same deductible. I’d look into that, it makes a large difference in this case.

    • Reply Ashley |

      Yep. Just double-checked. The separate deductible is for “non-preventive prescriptions.” I don’t know what would be considered “preventive”??? I think every prescription we’ve had has been in reference to some health ailment, not a preventive measure (e.g., antibiotics, etc.)
      Oh….upon second thought, would birth control be “preventive”??? I used to take that, but since hubs had a vasectomy I no longer have that prescription.

      • Reply Laura in CA |

        My son’s Preventative asthma inhaler (Flovent) was provided free of charge by our PPO insurance not subject to deductible or Co-Pay. The year before we started treatment with it, we had 3 urgent care visits with breathing treatments (Albuterol) + one time he needed a shot. I was proactive and never needed the ER, but other people we know weren’t so lucky. The year after we starting using the Flovent, it was no visits other than his regular annual appointment. I think it saved the Insurance Company $$ to encourage use of the daily inhaler. BTW, my son is now 13 and doesn’t need the inhaler anymore. We only have the rescue inhaler which we rarely use.

      • Reply Kate |

        I bet also like prenatal vitamins or fluoride for the kids’ teeth if you don’t have it in the water. Probably any “preventive care” mandated covered by ACA.

  • Reply Deb |

    I would consider keeping the PPO. My family just moved from Virginia to Florida and we used a PPO in Virginia. Now that I have a new employer that gives employees the option of both your choices, we keep with the PPO. The reasoning being is that even through it is a higher premium to be paid, we have to see doctors on a regular basis, get meds for chronic conditions, and still manage on a one income budget. We have not meet the deductible for this year, since I got it in October, but the deductible has been raised for 2018. We will be required to continue to pay a certain amount for procedures if ordered until we hit the max limit out of pocket on the PPO and then the PPO will pay for everything 100 percent. I can tell you that we have used this new PPO and only paid a small co payment for doctor visits. Our medications were covered through a mail order 90 day service for a 10 dollar cost (I filled three of my meds and two for my oldest daughter) for a total of 50 dollars.

    I did have to take my DD to the hospital a few days ago for abdominal pain. My co-payment for the ER was 200 dollars. I can tell you that I am very nervous about the hospital bills when they come in since we did not meet the deductible or the family max out of pocket.

  • Reply Marzey doats |

    I suggest maybe you rethink the childcare issue. If your husband can’t make his class schedule fit with the half-day kindergarten, perhaps he should drop down to part time for a semester. Many full time programs offer leave/flexible attendance for family property sdues, which this is. With 20/20 hindsight it obviously did not make sense for your husband to stop earning income while childcare is such a major portion of your budget. If he starts up again next fall you won’t have added childcare costs and the budget will balance better. Perhaps he can take a few online courses for credit to keep up.

    • Reply Ashley |

      I appreciate the suggestion, but we’re not interested in changing up hubs’ school schedule at this point. A full-time load (15 course hours) cannot possibly fit within a 3-hour window (really only 2 hours after commute-time). That would literally be one class on MWF, and one class on T/Th, so 2 classes per semester rather than 5-6. His degree program (for engineering) is already a lengthy one, we feel compelled to get it going and complete rather than drag it out for any longer than necessary. Respectfully, I refuse to believe we can’t make it work on a $95k/year salary. Things must change (absolutely!) but I don’t think dropping out of school after just barely beginning is the right move. We only have one more semester at this point (Spring) with the girls in Kinder. Things will be tight, but we’ve got to make it work.

      • Reply Maureen |

        I totally agree with this. You can and will find a way to make it work for one more semester. Yes, it’s hard and will continue to be hard. This has been covered at length here in other comments over your last few posts, but if you could find a way to increase your income by $500-$1000 a month (PT jobs, you babysitting, etc.) without increasing the expenses to receive that income (taxes aside) then it will help right the ship. I also think that FT kinder was the better option. AND most people haven’t addressed the wonderful education your husband is getting practically free! That itself is amazing! You have to struggle with the budget now, but at least you are not taking on more debt for him to receive his education.

      • Reply Marzey doats |

        You have to make the decision that is right for your family. But there is nothing magic about a 95k income for four people that *should* strech to cover whatever you need it to. You have a house, significant student debt, significant IRS debt, and significant child care expenses. Your student debt payments are not even included in this budget. If you want your husband to stay in school full time (and taking a leave is not dropping out) then you may just have to accept that you will be extremely financially stressed over the next year.

  • Reply Andrea |

    With two young kids and pasty history of your husband’s unexpected medical problems–I would lean towards keeping the PPO. Do you only have one PPO option or are there multiple providers to choose from?
    One question I had related to medical costs is how the plans cover therapy? At a minimum, you should be able to get reimbursed for it from your FSA, so I would definitely max that out if you’re planning to continue therapy. Even though it lowers your take home salary, you get all the money back. So it’s not really reducing your take home pay, just shifting when you get it, right? (At least for 2018–I realize that money is already exhausted for 2017).

    Switching to dependent care FSA–I don’t get why it would be lower in 2018. You still have 5 months of kindergarten to pay for at $1000 a month right? That’s $5000 and not even getting into the cost of any summer camps or extended care you might need. Based on your number above you’re only putting in $3550 a year so you’re still spending well above that. My dependent care FSA limit is $5000 a year. I don’t know if yours is the same, but if it is–you should still be maxing it out for 2018. Otherwise you’re just leaving money on the table in the form of a lost tax deduction.

    Of course–all of the FSA benefits could be upended if the various tax reforms go through.

    • Reply AS |

      Do a little homework on the Dependent Care Spending Account before you lock it in. I recall it’s a pre-tax deduction “so that both parents can work”. I don’t know if it’s permitted as a pre-tax item if the spouse is a student.

      • Reply Laura |

        I just looked at the FAQ on mine and it said both you and your spouse much work or look for work unless your spouse is a full time student. So they may be ok there.

    • Reply Ashley |

      Our FSA dependent care limit is lower than yours – we’re maxing it out currently. We can use it while hubs is in school full-time.
      In terms of therapy, I tried to submit receipts to our FSA manager and was told mental health care is a non-qualifyed expense. It’s covered by our PPO health insurance, but I cannot use the FSA to be reimbursed for the copay (which is $15). That has to come out-of-pocket.

      • Reply Laura |

        I hope everyone who told you you should stop
        your expensive therapy sees this. A $15 copay is very reasonable even if you can’t run it through the FSA.

      • Reply Andrea |

        Wow–that’s crazy that your health insurance covers it but the FSA doesn’t consider it a qualified health expense! At least it’s only the $15 co-pay.

      • Reply Emily N. |

        That doesn’t make any sense at all! We get reimbursed by our FSA for my husband’s therapy, and I’ve used it myself in the past with a different employer/plan. And I’m pretty sure that the rules for what’s covered by an FSA are set by the government, not by any specific plan. I’d highly recommend looking into this further.

        • Reply Kate |

          We also have both had therapy costs reimbursed. I think “mental health care” is clearly laid out as a benefit in our Fsa. I would challenge that.

          • Ashley |

            Hmmmm, thanks for the heads up! I know for a fact my therapy receipt was declined for reimbursement as an “ineligible expense”, but that was when I went to therapy the first time (about a year and a half ago). I stopped going for several months and only started back again in July or August-ish timeframe. I hadn’t even tried to submit a receipt since then, so I’ll definitely reach out to figure out what the deal is and try to get reimbursed in the future. Currently, both of our FSAs are empty (for health + dependent care), but if I can be reimbursed in the future then it will affect how much I have pulled from my check for open enrollment!

  • Reply Margann34 |

    I think you should keep the ppo because you do not have cash reserves to cover the entire HSA deductible at once. If you had a broken bone or unexpected surgery, it would really put you in a bind.

    • Reply Joe |

      Great point from Margann.
      I also don’t think that this is the place to save money. Peace of mind that comes with removing uncertainty counts for a lot.

  • Reply Been There Done That |

    Keep what you have. That is a very good rate in today’s market for a family. My husband works for a hospital, and he is 100% covered for anything as an employee. However, for me, we have to buy a “family” plan, which is about the rate that you pay. I’m not complaining, though. In the past year we have been billed for thousands with breast cancer treatments and surgeries. A recent hospital stay was $45,000, and that is not even the surgeon’s bill! (We also received a $3000 grant for chemotherapy, which was applied to our $4000 annual deductible.) I know how blessed we are. Don’t switch. If you are hit with something major in your family, a hospital will always work with you in paying off the deductible amount.

    • Reply Ashley |

      Holy crap! That’s absolutely terrible to have such a huge financial burden in addition to the stress and burden of fighting cancer, itself! Thoughts are with you – I hope you’re kicking cancer’s butt!!!

  • Reply debtor |

    I think that given your family situation (especially the fact that you have TWO kids in that age range) you should not get an HSA. The HSA is best for people (like) me who rarely go to the dr. It allows you time to build up you savings in case the rare emergency hits. For reference, I go to the hospital once a year for a physical and pay nothing since it’s covered under the health plan. So i spend none of the money in my HSA and it keeps rolling over. Once in a while, I’ll use to for random things like foot insoles or designer glasses :). Children = multiple drs. visits so I def. don’t think it’ll be worth it. On top of that, even though your hubby is well now, I’d still have some lingering concerns being as nothing was ever diagnosed so better to be comprehensively insured.

    Did you ever respond to what the line item for health was in your budget? Still confused by that especially since it looks like your therapy is covered by your insurance.

    FSA is pre-tax right? Then i’d definitely increase it for next year.

    Sadly, I don’t think there’s a ton you can change with the open enrollment. Kinda seems crazy that your company FORCES you to contribute to retirement. Has anybody else ever seen that? Seems like an infringement to me.

    Sooooo, i definitely think you should put your loans on forbearance. Yes it will cost you more in the long run if you don’t pay on it right now but you have more of a cash flow issue than anything else. It sounds like you have credit card debt now too so it would allow you to focus on that. You can request it for up to a year. By the end of that, some of your other costs will have gone down so you can double down on the loans.

    • Reply Ashley |

      I haven’t fully addressed the medical, except to say that my “budget” post was really kind of knee-jerky – it was our expenses from October, but not necessarily a monthly norm (and the medical shouldn’t always be that high, though we do have new medical bills we didn’t use to have. Sigh). I’ll speak more to it when I do a full debt post.
      In terms of retirement, Maureen is correct. I work in higher education, so some type of retirement is required. Many people opt for a pension but I declined it and opted to go with a more traditional retirement account. My reasoning for that is that I want to control my own money. With the pension, if I don’t retire from an Arizona State School system, I lose the money. With my retirement account, I have to be fully vested (5 years), but then I can take the money with me wherever I go. I love my job and hope to stay here for a very long time, but as my very first full-time post-grad job, the odds of retiring from here are quite slim.

  • Reply csdx |

    I’d check whether the deductible/out-of-pocket for prescriptions is seperate from the rest, usually it’s not but it is possible. But it sounds like the amounts you pay for prescriptions do get included in the max oop. Definately see if you can get all that clarified

    Here’s my thoughts on the math, 2 scenarios (with the above assumtions):
    1 you just hit the deductibles (HSA level) so $2600 in medical and $2600 in prescriptions

    PPO cost: 3900 (premium) + 1000 (deductible) + 200 in copays (rough guess based on overall costs = $5100
    HSA cost 1586 (premium) + 4000 (max oop < (2600+2600)) – 1000 (tax savings at 25%) = $4586

    Scenario 2 Hitting max OOP costs
    PPO cost: 3900 (premium) + 2000 (deductible) + 100 (drug copays not included in the max oop) = $6000
    HSA cost 1586 (premium) + 4000 (max oop) – 1000 (tax savings at 25%) = $4586

    Also note that if your employer allows you to contribute directly from your paycheck into an HSA you're able to save an addition ~8% for FICA taxes as well.

    Also the big assumption is that the $2600 deductible for presciption drugs counts toward you max oop for the HSA plan. If it doesn't than add an extra 2600+ to the HSA cost estimates.

    • Reply csdx |

      Also I’ll add that I’m the HSA plan shouldn’t be very scary because of the max out of pocket caps. Consider that, if you take the difference in premiums ($89) and your health FSA ($86) amount and instead put it into an HSA, you’d be doing $175 per pay check or ~$4500 per year, which is already more than your maximum out of pocket costs for the year.

      • Reply Kerry |

        That’s how it should work, but since Ashley is considering it specifically to lower her pre-tax deductions and increase her take home pay, I see that never being funded and leaving her with just more healthcare bills. Those bills are a given because of the age of her kids, unfortunately.

        • Reply csdx |

          Hmm if you wanted to skip the deductions, instead you can just funnel the money in an out on an as needed basis. E.g. whenever you get a medical bill, deposit that amount into your HSA then pay the bill with your HSA funds. You won’t realize the tax breaks until the end of the year, but you’ll have the funds in the mean time and there’s no worry about overfunding or losing money like you would with a FSA account.

          • Angie |

            You’d also be missing out on the 7.6% FICA tax break. HSA’s should be funded from paycheck deduction whenever possible for this reason.

    • Reply Lucy |

      I’m in agreement with you, csdx. We have similar plans offered, and even with an emergency surgery this year which caused us to hit our max OOP, we still came out cheaper than what we would have had we gone with the “Cadillac” PPO plan.

      As for being afraid of initial expenses, check and see how soon you can tap into your FSA. We can utilize our entire yearly amount starting Jan 1, even though it has not yet been pulled from our check.

      As for prescriptions, it sounds to me that with the HSA , your OOP expenses would count toward your overall deductible (that’s how ours works) but of course you’d want to check that with your plan administrator. I’m on BP and thyroid meds and they are counted towards our deductible. Like in your case with the PPO, there is a separate deductible to meet for prescriptions.

  • Reply Taira |

    I would not advise anyone with small children to use an HSA. I have 3 littles, they are 2, 4 and 5. We have a PPO, and no one in my house has any actual medical or health conditions. My 5 year old is in full day kinder and has brought everything under the sun home. I have been to the doctor or walk in care 6 times in the last 10 days with someone sick. I have a pile of prescriptions for the kids and everyone has a follow up scheduled. We max out our out of pocket every year usually by May at the latest. I would have piles of med bills to pay out of pocket if we had an HSA with all the germs my kids pick up.

  • Reply Pam E-P |

    I agree with csdx. My company (also in education but a private institution) offered a high deductible plan with HSA last year and I nervously switched. They put $500 in the HSA and I had withheld (pre-tax) the difference from the premium I was paying when I had the PPO + the money I was putting in an FSA. No difference to my monthly budget, but I now have money built up for future medical expenses. I definitely felt like I was gambling in the first year, but we’re in open enrollment right now and I decided to stick with the HSA plan. I no longer have dependent children, so my deductible is only for me, but I am fairly healthy, and even though I’m not young, I still like the thought of building up my HSA specifically because it doesn’t expire. There IS a max out of pocket with my plan, so even if something catastrophic happens, it’s not as though I’m uninsured. Maybe something to think about when you have a funded EF. You would have to have the discipline to consider the premium savings allocated and have it automatically deducted to your HSA. My husband had the same opportunity last year, but because there was no difference in premiums between the PPO and the HSA, it didn’t make sense for him to change.

    • Reply Ashley |

      This is an interesting point. Reading some of the comments above made me second-guess, reconsidering the thought of an HSA. But I like your thought to maybe wait until we have a funded EF (currently our “EF” is credit cards. We’ve got no spare cash on hand anywhere). That’s probably the scariest.
      If we can change our financial picture a bit to have a little less debt and some more $ in an EF by next year, perhaps the HSA would be the best option at that time. But yeah….with absolutely no spare cash on hand the thought of possible big out-of-pocket expenses is frightening.

  • Reply Pam E-P |

    I should also add that I have access to a service called Teladoc where I can essentially Skype with a doctor for prescriptions and small stuff like colds and allergies.

  • Reply Lucy |

    I realize your post is about health insurance, but do you have any type of disability insurance available through your employer? With you currently being the sole provider for your family, you might want to look into it.

    • Reply debtor |

      good point – although some places won’t let you enroll after being a new hire without a full screening.

      • Reply Ashley |

        I do have disability as an option, but I’ve always declined it in the past. My job is incredibly flexible so unless something were to happen that influences my cognitive functioning, I think I’d still be able to work from home and continue earning a paycheck. For example, I worked from the hospital bed before/after giving birth to my kids. I know there are always exceptions to the rule but, in general, the vast majority physical issues (broken bones, surgery recovery, illness, etc.) would NOT prevent me from being able to complete my job duties. It would have to be something incredibly major and/or something that distorts my ability to think correctly and I just think the odds are incredibly low (knock on wood!)

        • Reply Carrie |

          I realize that there is possibly very little that may cause you to be disable however if I were you and the sole income provider of your family I would add the disability insurance during open enrollment. Insurance is a necessary evil. It is there just in case – I would rather be covered than not. Just something to consider. . .

          • Lucy |

            I agree with you! The insurance is generally not that expensive and it provides an extra layer of security. Even with low odds of needing it, you just never know!

  • Reply Been There Done That |

    I see a lot on here about not having an HSA if you have young kids. But really, all of us are one thin line away from a medical disaster whether we are young or old! We absolutely cannot take good health for granted. I breezed through life with hardly a cold, natural childbirth etc. but got hit with breast cancer at a fairly young age and with no family history. Fortunately, we have good health insurance with a yearly deductible of $4,000.

    But with a year of treatments, two major surgeries and several minor ones, we are approaching the half million dollar mark. Yes, you read that right. And I still have another year of hospital visits and some minor surgeries, although not quite so intense. It’s unbelievable what medical costs are these days. I talk to many patients who are not only struggling with the medical costs but just living–how to pay the mortgage, buy food, take care of kids etc. Thankfully, I am not in that position. So please do not assume that just because you are an adult who is rarely ill that it will not come knocking at your door!

    • Reply Ashley |

      This is so scary! My kids (twins) were born 8-weeks premature and ended up in the NICU for 28 and 30 days, respectively. The bill for that one-month stay was $500,000. At the time, I was a graduate student making nearly nothing and hubs’ job wasn’t paying as well as it did in more recent years, so we qualified for a low-income program that forgave the vast majority of the charge. But I remember originally seeing the bills rolling in and freaking out that we’d have to declare bankruptcy, etc. Medical bills are no joke!

  • Reply Meg |

    Your dental insurance seems pretty high to me, especially compared to your PPO. Do you get enough of a value for it? Do you have or need vision insurance?

    • Reply Ashley |

      If it were just me I’d say the dental insurance was not necessary. But with the entire family (plus hubs’ still playing catch-up on dental issues from years past with no insurance), I definitely think we use it enough for it to be of value.
      We do NOT have vision insurance because I did not find it to be of value. I had it the first year, but I’m the only one who uses it and it felt like I basically got nothing out of it (I’d written a post about it a couple years back). I opted out at the next open enrollment and just pay out-of-pocket for my annual vision check-up and glasses/contacts prescriptions (and I can use my health FSA to reimburse those expenses).

  • Reply Walnut |

    Stick with your PPO. Your cash position is too precarious right now to risk a big medical bill.

    • Reply Ashley |

      That’s kind of my thought, too (and something Pam E-P pointed out). If I had an EF it might be a better option, but since we have no cash any unexpected medical bills could really be a big burden. Definitely something to consider during next year’s open enrollment (assuming we’ve righted the ship and have an EF by then)

        • Reply Ashley |

          True, but if I switched to an HSA I’d need to be contributing at a higher amount than I am currently. My current contributions wouldn’t even come close to meeting the out of pocket max for an HSA. (currently contributing $1750-ish/year vs. needing to contribute $4,000/year).

So, what do you think ?