Making that final choice between health insurance plans is never easy. There's always that thought in the back of your head that's telling you, "maybe I'm missing something?" or "What don't I know about this plan?"
Don't worry, it's normal.
That's why I wanted help you sleep better tonight and go over line by line Medical Mutual's 4000 HSA (Silver) plan.
Click below to view the summary of benefits and follow along.
NOTE: The only difference is that if you buy this plan with a tax credit through Ohio's health insurance marketplace (or exchange) the word "Market" is used by Medical Mutual to tell the difference.
In-Network vs. Non-Network
The first thing you will notice is that there are two columns, one for in-network services and another for non-network.
You are ALWAYS going to want to do everything you can to "stay in-network." If you don't, you're setting yourself up for a much more expensive and unpleasant adventure.
Here you can see non-network limits are A LOT higher than in-network.
The (Market) 4000 HSA has a, you guessed it, has a $4,000 single and $8,000 family deductible.
Watch the video below for more detailed explanation on embedded vs. aggregate deductibles.
That is the amount of money you will have to pay, upfront essentially, before your plan kicks into the co-insurance.
Maximum Out-of-Pocket (MOOP)
The nice thing about HSA's with 0% coinsurance is that their deductible is their MOOP. That means the $4,000/$8,000 is all you will ever pay for you or your family's covered medical services during the benefits period (normally calendar year).
Or, to put it another way the MOOP is the bottom line number you need to be concerned with the most.
It's important to notice that your Non-Network MOOP is REALLY high like $100,000 and $200,000 high. That means the bills will keep coming until you reach $100,000 for a single person or $200,000 for a family.
This silver HSA has zero percent co-insurance, which means after you pay the deductible Medical Mutual will take care of the rest of covered, in-network, treatment for the year.
Except for non-network treatment which will have 50 percent coinsurance.
Medical Mutual has changed all of their deductibles to be embedded. In less fancy insurance terms that means split. Instead of your entire family working towards an $8,000 deductible, you'll now have two $4,000 deductibles shared by any combination of family members.
Overall Benefit Period Max
Like what data from all internet service providers should be, it's unlimited, or in other words your health insurance never runs out.
Medical Mutual will keep paying for as much covered medical treatment that you need for the year and lifetime of the policy.
Dependant Age Limit
After an Ohio law change this year, now some insurance companies have rolled back the age limit to match the federal limit, which is 26 years old.
That means you can keep your children on your health insurance until the end of the month they turn 26. Of course you are welcome to kick them off well before that, but that's entirely up to you.
January 1st, through December 31st.
It doesn't matter when your policy starts, your deductible and MOOP will always reset at the end of the year.
The 4000 HSA (Silver) will require you to pay for the full "discounted rate" for all doctors visits up to your deductible.
Again, watch the video for a more detailed explanation of the discounted rate.
From this point on you will notice that everything is pretty much split 50/50 between you and Medical Mutual for non-network treatment. With the exception of prescription medication and emergency room visits.
There are a host of preventative services outlined by the Affordable Care Act that have to be covered at 100 percent, before the deductible. In other words, free.
The preventive services that didn't make the ACA list will go towards your deductible and then into co-insurance.
Everything except non emergency use of the emergency room will apply to your deductible and coinsurance.
Non-emergency use of the emergency room is NOT covered. So, think twice before you run to the emergency room after your doctor's office closes for a sinus infection.
This covers stuff like hospital stays, maternity care and surgery. Everything under this category is going to be subject to your deductible and then covered in full after.
This is where things like your ambulance ride, hospice care and organ transplants are covered. Again, all of these services will go towards the deductible and then into co-insurance, which is zero percent.
It's important to note that only prescription medication filled through in-network pharmacies will be covered at 100 percent after your deductible. Again, a fancy way of saying "free after the deductible."
You will also pay for the full discounted rate, like doctors visits, for all of your prescription medications.
The Bottom Line
Health savings accounts really cut to the chase and simplify most of the process. Hopefully this breakdown gives you a decent understanding of what's covered and how the plan works.
If you want to know more about the actual bank account portion of HSA's you can read about that here.
Let's find out if this type of plan actually makes sense for you by taking a look at how you would need to use it.