healthcare more like HELLthcare am I right November 1, 2023 11:21 AM   Subscribe

Hi (US only) friends! It's health insurance decision season for most of us and we live in a grim dystopia where everything is expensive and nothing makes sense. Employer-sponsored benefits are something I know enough to be helpful about (I hope!) and I'm here volunteering my ability to speak the language, if you need it.

(Quick note: the mods gave me the okay to post this, but obviously this has nothing to do with metafilter. It's just something I'm offering to try to help my community in a way that I can. If you share something with me, that's just for the two of us. The mods and metafilter ultimately have nothing to do with it!)

So anyway, I know first hand that a lot of benefit stuff is confusing and scary. Even if you work someplace with a really good HR team, if you're unfamiliar with insurance a lot of folks don't even know what questions to ask to get the information they need. If you're staring at a benefit summary and starting to get panic sweats, or asking questions like this, please ask for help. You can ask me for help (memail please, keep it private), I'm right here. We can take a look together and figure out what makes the most sense.
posted by phunniemee to MetaFilter-Related at 11:21 AM (52 comments total) 51 users marked this as a favorite

Omg thank you so much for offering to help!

I am offered the choice of a high deductible plan or a standard plan, both from United Healthcare. For the high deductible plan I understand I have to pay out of pocket first until I reach a certain threshold of billed services, and then my insurance starts paying for things.

My question is: what prices am I charged for the billed services? I understand insurance companies get discounted prices as part of their negotiated contracts with providers. With a high deductible plan do I get charged the discounted price United Healthcare negotiated, or do I get charged a different price that say, an uninsured person would be charged?

Edited Oh crap, I didn't memail. Mods please delete if I broke the rules.
posted by jello at 12:57 PM on November 1, 2023


For the high deductible plan I understand I have to pay out of pocket first until I reach a certain threshold of billed services, and then my insurance starts paying for things.

Yup this is broadly accurate for HDHPs.

As long as you're staying in your provider's network, you will be paying (cash out of pocket) a negotiated rate for whatever care you get. (Except preventative care! Preventative care is free! Thanks, Obama!) Some plans have a deep cut network in addition to the overall network (sometimes called "choice" or "advantage" or whatever nonsense term they're using this week) where there are additional discounts on the negotiated rates. The only way to know about those is to read the fine print on your plan summary, but those can be really good cost savings so it's worth taking the close look.

If you do need to go out of network at any point* check your plan document closely. You won't just be paying a higher rate for the services, but you are probably beholden to a higher and/or separate set of deductibles and out of pocket maxes.

*Basically do not ever go out of network. If you absolutely have no other option for coverage in your area, call your insurance or better yet ask your HR team to have that conversation on your behalf. Most carriers are happy to work with out of network providers to get discounted rates or wrangle them into the network as long as they know about it first and get everything pre approved. You will (probably) have no luck doing this after the claims have already been billed.

Also. If you're getting an HDHP, get an HSA.
posted by phunniemee at 1:10 PM on November 1, 2023 [3 favorites]


Oh crap, I didn't memail. Mods please delete if I broke the rules.

I figured it was good and nonspecific enough a question someone else might have it too.

I just don't want anyone doxing themselves inadvertently here.
posted by phunniemee at 1:13 PM on November 1, 2023 [3 favorites]


Hi phunniemee! Thanks for doing this.

My general question is -- if you're someone with an expensive and continuing medical condition, are you better off getting healthcare from an employer or will ACA coverage typically be enough?

I've been hesitant to shift from freelance to standard employment because freelancing is so much more flexible. I could possibly return to a traditional employer, but probably not at the level or paygrade I had before I got sick. I still have my current healthcare (Medicare) for another year or so, but I'm trying to position myself for the best situation. Thanks!
posted by mochapickle at 1:17 PM on November 1, 2023 [3 favorites]


Oh ha, I missed the memail part but most of y'all know my whole deal already, so we're good.
posted by mochapickle at 1:18 PM on November 1, 2023 [1 favorite]


Thank you phunniemee!
posted by jello at 1:22 PM on November 1, 2023 [2 favorites]


are you better off getting healthcare from an employer or will ACA coverage typically be enough?

I'll start by saying I'm largely ignorant of marketplace plans, so folks who want to know about that are going to be best served by calling a navigator. But! I have personally been on a marketplace plan, years ago.

The answer is: it depends. There's not, like, lesser care or lesser standards on marketplace plans. It's just different plans that cost different things. What does "enough" mean to you?

Some employer sponsored plans are absolute shit. Some marketplace plans are incredible. There's no way to know unless you're looking at the plan summaries, premiums, networks, and deducible costs side by side.
posted by phunniemee at 2:20 PM on November 1, 2023 [2 favorites]


Wait, can you get marketplace coverage if an employer offers insurance?
posted by mittens at 2:50 PM on November 1, 2023


>Sometimes. Maybe. It depends.
posted by phunniemee at 2:53 PM on November 1, 2023 [1 favorite]


If I can ask another general-ish question: If you are a person who needs to see a provider fairly frequently for a chronic condition (whether for mental health or something physical), does it definitely make sense to choose a (very expensive) no-deductible health plan over a high-deductible health plan? Or does the insurance-negotiated discount make it more complicated than that?
posted by Jeanne at 7:41 PM on November 1, 2023 [1 favorite]


You are a gem for offering to help with this!!
posted by Space Kitty at 8:19 PM on November 1, 2023 [9 favorites]


Now someone do this for staffing services/employment help. (I am still trying to find a FRICKIN' JOB and I've been searching since July)
posted by EmpressCallipygos at 8:36 PM on November 1, 2023 [6 favorites]


If I can ask another general-ish question: If you are a person who needs to see a provider fairly frequently for a chronic condition (whether for mental health or something physical), does it definitely make sense to choose a (very expensive) no-deductible health plan over a high-deductible health plan?

This is the magic question! This is the one I can probably help with. And it's not general at all.

If you want I can take a look at your plan summaries and costs and help organize the info in a way that'll let you compare them easier. (This goes for Jeanne and anyone reading.)

I'll need to see: the plan summaries for all your available plans, your premium costs, know how often you get paid, and if your job gave you an overall benefit summary that would be good to see, too.
posted by phunniemee at 4:41 AM on November 2, 2023 [2 favorites]


And it's not general at all.

Definitely plan-specific, as phinniemee says. I have worked at two places with HDHPs. Both of them deliberately set up their plans so that a HDHP for an individual is at most the same price as a traditional plan, and potentially cheaper if the person doesn't require a lot of care.
posted by saeculorum at 6:47 AM on November 2, 2023 [1 favorite]


I love you so much for posting this. My own current insurance-related SNAFU isn't something you can help with--and I have another friend who offers similar "let me explain what is happening in plain English" services anyway, for which I also love her--but it's such a kind thing to offer to do with your expertise, and I wanted to say so. These are complicated things with lots of spinny parts and they suuuuck to navigate.
posted by sciatrix at 12:08 PM on November 2, 2023 [10 favorites]


Got the wackiest notice from Blue people, that "shield" the company that did a scan plans to leave your plans network. "When this happens they'll be considered out-of-network".

Ok to get it out of my system, is BlueCross related to Blue Man Group? And as I had never heard of Shield while in the hospital, could it actually be S.H.I.E.L.D? But I digress, sorry...

When I got some kind of scan in the quite decent local hospital I certainly had no knowledge of the apparent subcontractor that owned the actual machine. And it was covered.

This was some kind of mass mailing, is it a greenmail threat to the shield company? An attempt to rile up the patients to complain to the hospital? A CYA notice in the case that many folks get big bills suddenly? How much fun to find out after reasonable insurance coverage that an expensive test this year is barely covered.

Happy to send the notice if you're interested phunniemee.
posted by sammyo at 3:06 PM on November 2, 2023


No idea what you're talking about but sure send me anything you want.

Carriers can change who's in their network at any time based on the little understood but widely accepted FYTW* contract clause, so this probably does mean your covered providers could change. Impossible to say without more context. You can, occasionally, succeed in pushing back.

*Fuck you, that's why.
posted by phunniemee at 3:17 PM on November 2, 2023 [3 favorites]


No question to ask -- just grateful that you're out here doin' the Lord's work, yo. 💪🏻
posted by wenestvedt at 7:10 PM on November 2, 2023 [10 favorites]


Mod note: Thank you, phunniemee! btw, this post has been added to the sidebar and Best Of blog.
posted by taz (staff) at 12:51 AM on November 4, 2023 [2 favorites]


I just have the metaphysical / existential question of whether it's ever possible to know, or even to feel with a reasonable amount of certainty, that you have made the right choice. Am I just stuck with this feeling of dread every year?

A few years ago we switched to the HDHP, which for whatever marketing reason Cigna insists on calling a CDHP. I was at a loss for how much money to put into the HSA so I just decided we'd contribute the exact amount we were saving by not choosing the PPO, which they insist on calling a POS. We had money left over at the end of the year, so the guess seemed as good as any in retrospect. We used the same formula again the next year, but eventually we dialed back our contribution so we'd have a little more take-home pay, which was meaningful. But it still never feels right.

Yes, I know that if we could afford to max out the HSA contribution there are tax advantages to doing that, but as long as I continue to be underemployed this is what we can do. Ah, dread.
posted by fedward at 11:14 AM on November 4, 2023


The way I look at it, you have to consider the annual cost: the total annual premium cost, and the deductible. If I have 2 plans to choose from:

$220/month premium + $5k deductible
Or
$0 premium + $8k deductible

These are so close as to be the same. So if I expect that I won't really use it, I would pick the one with no upfront premium cost. If I expect to use it, I look next at the out of pocket max and pick whichever is lower (or whichever is lower in the context of my dependents.)

The hard part is figuring out how much I can expect to spend. This year I needed surgery, so we knew we would hit the max immediately. Next year, who the hell knows. Will they quote me a price if I call and tell them the network and plan? Or is it a mystery? Like it's good to know that after the deductible they pay 80% but of what? There is supposedly a good faith estimate law here, but it doesn't apply to insurance, just doctors.
posted by blnkfrnk at 12:46 AM on November 5, 2023


I'm not planning on changing HMO's or any of that BS (it's still the cheapest), but I've never understood the flexible spending plan thing at all. So you stash your own money in an account that you have to totally spend on health care only by the end of the year? Why would you do this instead of just spending your own regular money on whatever you need?
posted by jenfullmoon at 10:41 AM on November 5, 2023


FSAs make more sense when you have somewhat predictable needs. For example, if you take a medication and you know how much it costs, you can put pre-tax money in the FSA to cover it. This may bump you into paying less in taxes because the pre-tax FSA money doesn't count.

Some places let you use FSA money for child care costs, so that can be a big saver-- child care is so expensive that making that cost be pre-tax makes a big difference for some people in taxes. Also, some employers will put money in your FSA as a perk, either matching what you do or just a set amount and obviously free money is nice. But yeah, if it's self-funded and you have no idea what your costs will be, why bother. HSA and FSA money works for stuff like sunscreen and tampons, technically "medical needs" so that is at least something.

An HSA is a better deal. You can't use it for child care, but you can contribute pre-tax money AND it rolls over and gains interest year to year AND you keep it even if you quit. Since your employer has to spend a certain amount per person on health insurance (thanks, Obama!) and the high-deductible plans often don't meet this minimum for cost, they will sometimes give you an FSA or HSA budget to get up to the minimum. Or they use it as an incentive for you to pick the plan they want you to pick.
posted by blnkfrnk at 10:53 AM on November 5, 2023 [1 favorite]


An example of health FSA: My glasses are $$$, so during years where there is a substantial change in Rx, I set aside $$$ in FSA for the year, make an appointment with my eye doc for January and barely miss the offset. However, I have had extremely lean years and can appreciate that not everyone’s cash flow or credit card could manage that. If I underestimate the expense, our family has more than enough copayments to get it back, but it can be a hassle.
posted by childofTethys at 11:51 AM on November 5, 2023


Ohhhhh, it's a tax thing?

Thank you both for the explanation, that makes more sense.
posted by jenfullmoon at 11:54 AM on November 5, 2023 [1 favorite]


Some FSAs will also pre-load your account at the beginning of the calendar year, so you can use it immediately and it pays itself back from your payroll deduction. So you have $$$ in your FSA in January, can use it immediately to meet your deductible, and then the rest of your year is cheaper. Different places do it different ways.

If you are in a double income family where Spouse 1 has crap insurance but a good FSA plan, and Spouse 2 has great insurance but no FSA, you can cover both spouses with the good insurance and max the FSA to pay for stuff. But yeah, if you're one person and you don't have predictable medical needs (a medication you know you will take and pay for, glasses every year, kids who for sure need sports physicals once a year etc.) then the FSA doesn't make sense.
posted by blnkfrnk at 12:57 PM on November 5, 2023


I see there is a question about marketplace plans above-- I can sort of speak to this having used one for a while. My situation was that post-ACA, my employer at the time looked at the cost of offering insurance and the cost of paying the fine for not offering insurance, and paying the fine was cheaper. So I was full time but didn't get insurance at all, so the marketplace was my only option.

Marketplace plans are the same insurance plans that you get through insurance, but you can buy them with a combination of a credit (which impacts your taxes) and your own money. I bought a bronze plan with Kaiser, which was comparable to the insurance that I had at my previous job. I paid $50 a month, and used the government credit to cover the rest of the premium (roughly $180 a month, I think.) You qualify for this credit based on your income, and you choose how much you want to pay. When you do your taxes, if you have a marketplace plan, you either get money back (if you qualify for the entire credit and chose to pay more during the year) or you pay them back if you make more money and thus no longer qualify for the credit. In my situation, I got a better job later that doubled my income, so I had to pay back my entire premium credit, which was not ideal!

I don't quite understand how it works, but your state decides how much the credit is-- basically, whether they participate in marketplace reimbursement from the feds, which some states decline to participate in, thanks a lot assholes. The ACA established a floor for what plans must offer-- which is why preventative care is free-- and your state's insurance regulator and government can exceed that floor, which is why in CA you could get gender affirming care covered by your insurance pre-ACA. (This is, incidentally, why I know about insurance.)

If you are a freelancer, the marketplace can be not too bad, depending of course on where you live and what the plans are like. If you are confident that you know how much money you make as a freelancer, enough that you can work with a marketplace plan calculator to figure out how much of the credit you should use. I know the marketplace is a godsend to some freelancers, and I know others who work part time somewhere for the insurance.
posted by blnkfrnk at 1:18 PM on November 5, 2023 [1 favorite]


Some FSAs will also pre-load your account at the beginning of the calendar year, so you can use it immediately it pays itself back from your payroll deduction. So you have $$$ in your FSA in January, can use it immediately to meet your deductible, and then the rest of your year is cheaper. Different places do it different ways.

I think you are thinking of health savings account (HSA), not health FSA rules. It’s true that some employers contribute to employee HSAs, and it’s true that some employers front load those contributions. It’s also true that an employee can’t access HSA money until someone (employee/employer puts it there.

Health FSAs are different, and the difference is the main advantage of a health FSA. To contribute to an HSA, you have to be enrolled in a high deductible health plan, and you’ll have to meet that (high!) deductible before the plan pays for anything (except preventive services). So, for people first using an HSA, they won’t have any/a lot of money in there, so the deductible costs can be extensive. Under the Code, ALL health FSAs have to operate such that an employee’s full election is available on the first day of the plan year, even though the employee won’t have contributed their full year’s contribution via salary reduction yet. This is called the uniform coverage rule. If I elect $3000 in my health FSA (whether or not the employer also contributes) and my plan year starts January 1, and on January 2 I have surgery, I can use the whole $3000, even though I’ve contributed only 1/12th or 1/24th of that at that time. If I quit on January 3, my employer can’t go after me for the money. On the flip side, if an employee contributes to the health FSA for months/all year and never uses it, they don’t get anything back.

Dependent care FSAs (sometimes called DCAPs) are separate programs with different rules. For a dependent care FSA, like an HSA, you can’t spend the money until you contribute to the account.
posted by Pax at 2:04 PM on November 5, 2023 [1 favorite]


FSA's are generally a bad idea, since you have to spend all the money on medical-related expenses during the year, and if you don't you lose it. Who wants to manage that, unless you have high recurring health expenses- those people are doing it anyways.

HSAs are fine, but they are only available for high deductible plans. They are really more of a tax play than an insurance play. HSAs exist to help high-income people save a bit of money in taxes.
posted by The_Vegetables at 8:47 AM on November 6, 2023


FSAs are generally a bad idea, since you have to spend all the money on medical-related expenses during the year,

Not always. Be sure to read the fine print. My FSA lets me carry over as much as $500 to the following year. So much better than ones I have had in the past which were use or lose plans.
posted by aught at 3:11 PM on November 6, 2023


Thanks, Phunnimee!

I have a choice between a BCBS PPO plan with FSA, and an HDHP plan with HSA. The plan-choosing software runs a comparison for me on my expenses from last year. According to that, the HDHP is less expensive by about $2k/year, on ~$25k in what they calculate as use.

I'm a medium user? I have a yearly cardiac MRI, I have a chronic/autoimmune disease that means I see rheumatology 2-4x/year, ophthalmology 1x/year, dermatology, and kidney consult soon, on top of regular primary care.

Despite the difference in cost, I've stuck with the PPO and pre-tax FSA due to my perceptions of red tape, basically. With the PPO, I deal with the FSA, which takes a list of prescriptions from Xpress Scripts and co-pay receipts that I can print out from my Epic/MyHealth app once a year, and I'm set.

My understanding is that with the HDHP, I will end up paying many more things out of pocket and getting reimbursed through the HSA. That seems like it is constructed with room for them to say "oops, denied" or "paper work incorrect, no money for you" or similar, and that's assuming I kept up on all of the administration/paperwork. Like, the "executive function theft" thread, where the more obstacles they throw at you means you are less likely to follow through and actually get your money back once spent. In theory it's less expensive, but I'm wary that in practice it is not, all it takes is one test or event to make that theory very wrong. Also more referral baloney, which is another opportunity to say "mistake, denied" or "out of network" etc.

Am I wrong? I'm willing to pay some extra to have less red tape ....

Another question: my husband is intending to retire next year at age 54, and so I'll be covering him on my plan. Can we have different plans within that? He's the "barely uses healthcare" person, so I feel like the HDHP would work out for him.
posted by Dashy at 7:29 AM on November 8, 2023


I mean, here's an example. I got the Covid booster on the first day it was available, and it wasn't on my insurance's formulary yet. So I paid out of pocket, $191.

I called my prescription manager. Phone tree, etc. They told me I can get reimbursed, and said they'd send me a form that I need to send back with the receipt.

I've lost the receipt, not a thing I keep usually. So I call CVS this morning, and after 15 painful minutes I didn't have to spend, they emailed me something that looks like a receipt.

I went to fill out the form, complete with all the numbers to fill in, and at the bottom I see: section to be filled out and signed by pharmacist, and NPI number!! So now I should go to CVS, in person, wait, etc..

Is this worth $191? I do not have time or bandwidth right now. By the time I do, I may well be "too late in filing", rejected?

If this is life with an HDHP, I'm sticking with PPO.
posted by Dashy at 8:08 AM on November 8, 2023


I just have the metaphysical / existential question of whether it's ever possible to know, or even to feel with a reasonable amount of certainty, that you have made the right choice.

no!

Am I just stuck with this feeling of dread every year?

yes!

But understanding all the benefit options you have and trying to make an "okay" choice will make it marginally better.


Like it's good to know that after the deductible they pay 80% but of what?

They will not quote you anything. Not really. But over the past two years the big providers have started to assume they're going to eventually be held accountable for more costs under the no surprises act and some have made this information slightly more accessible. Most plans will have a call in line for members where you can at least ballpark some anticipated costs. If you don't know this phone number and can't easily find it, your HR should be able to get it to you.


due to my perceptions of red tape, basically

I can't speak to anyone else's plan, but at my work we offer 2 HDHPs and 1 PPO, and they are all on the exact same network with very quite nearly the exact same coverage. The only difference is when and how they are paid. Same tape, different expense, so to speak. Dashy, if you send me your plan summary documents and premium cost schedule by email/memail I can take an extra look at this for you.

Another question: my husband is intending to retire next year at age 54, and so I'll be covering him on my plan. Can we have different plans within that? He's the "barely uses healthcare" person, so I feel like the HDHP would work out for him.

No you have to choose for your whole family.


If this is life with an HDHP, I'm sticking with PPO.
Not to be glib but it sounds like this is life with a PPO...
posted by phunniemee at 8:15 AM on November 8, 2023


What I mean is -- if I have to battle to get reimbursed a lot more with the HDHP than with the PPO -- which I think is the case? -- I'll pay extra for the PPO because I expect to lose that battle frequently.
posted by Dashy at 8:33 AM on November 8, 2023


With an HDHP there's no reimbursement*, you pay for the medical costs you have. You can pay with your HSA debit card or pay cash and then reimburse yourself from your HSA account later on in the year. Your HSA isn't insurance, it's a debit card attached to a healthcare-costs-only bank account that you fund.

What this has meant for me on an HDHP in practice is I usually don't pay anything at all at the actual doctor's office; they submit the claim to my insurance, the insurance negotiates what they think those services should cost with my provider, then my insurance sends me an EOB. On this document it shows what was billed by the doctor, what insurance paid, and the remainder leftover that I owe my doctor. My doctor then bills me for that remainder, and I pay for it with money that I've put into my HSA.

*What happened with your covid shot is your insurance hadn't added it to their prescription formulary yet, and your experience of this reclaiming would have been exactly the same PPO or HDHP.
posted by phunniemee at 8:45 AM on November 8, 2023 [1 favorite]


Right. I think I actually have a health insurance question now.

So: I was laid off in July. I had the option to choose COBRA to continue my health care coverage, but I opted to continue my dental care ONLY - I had some dental work coming up that I needed covered, and I assumed that my job hunt would be relatively quick (the last time I'd gone looking for work, I was only unemployed six weeks).

However, my job search has been taking a bit longer, and I have been effectively uninsured since July 17th.

Now - I am currently interviewing for a couple positions. All offer health insurance, but in one instance, the health benefits wouldn't kick in for 3 months. So I'm realizing that I need something for the interim. Maybe.

So - what the HELL do I do? Is it possible to sign up for some kind of "interim" insurance? What is the best option for someone who is middle aged but generally healthy, and just needs to cover things like COVID vaccinations and "what if a piano falls on my toe" kinds of accidents, and only for a few months?
posted by EmpressCallipygos at 9:07 AM on November 8, 2023


Empress, are you eligible for a marketplace plan? Go check. Thanks, Obama!
posted by phunniemee at 9:43 AM on November 8, 2023


If this is life with an HDHP, I'm sticking with PPO.

FWIW our HSA gave us a debit card to use at point of sale, which is exactly as convenient as using an FSA debit card. Also, since the HSA is "your" money and not a benefit, at least with our specific HSA the reimbursement doesn't seem to require receipts at all. Maybe we just haven't requested a large enough reimbursement to trigger the receipt requirement, but 100% of our reimbursements since we switched to the plan have been without receipt.

And if you're going to ask, those reimbursements have all been for eligible items purchased with another payment method. For us this happens most often at Costco, where you can only pay with an HSA or FSA at the pharmacy counter. If we can't pay at the pharmacy (if it's closed, if the line is too long, or if we just forget) and we go through the regular checkout with eligible items, they'll be marked as eligible on the receipt, but we can't pay directly with our HSA or FSA card. In those cases I'll log on and request a reimbursement for the eligible total, and we have never had to upload a receipt.
posted by fedward at 10:20 AM on November 8, 2023 [1 favorite]


Are there any healthcare plans that cover IVF for people who don't have a physical impairment that prevents PIV sex?
posted by corb at 12:38 PM on November 8, 2023


Yes there are health plans in existence that cover IVF for more broad diagnoses of infertility. You'd need to read your plan summary carefully, and call your insurance provider, to know if/to what extent/cycle limits/which specific costs of IVF are covered by your actual plan (or a plan you're considering).
posted by phunniemee at 1:03 PM on November 8, 2023


Sorry for the dummy questions, but: if my HSA issues me a credit/debit card (my FSA did, so I expect this would be the same), then I enter that card # on my prescription manager and my copay billing instead of my regular credit card, and that's how most of it gets taken care of, no applying for reimbursement with correct forms and procedures and receipts and all?

If that is true (thanks, fedward), then I might try the HDHP.
posted by Dashy at 5:44 PM on November 8, 2023


An HSA is just a bank account. It's a bank account with extra rules, but it's ultimately a bank account. You will get a debit card and a website. If you have money in your HSA account, you can pay for your medical expenses/prescriptions with the debit card. If you don't have money in your HSA account, you can pay for your medical expenses/prescriptions by whatever means you choose--and then later in the year, when you have more money in your HSA account, you go into your online banking website for your HSA account and reimburse yourself for your prior expense from your own HSA funds.
posted by phunniemee at 6:06 PM on November 8, 2023


It's the administration of the rules that is the crux of it for me.

If I get "please submit more information and signatures and a unicorn" for every expense, that's a ... dealkiller. But if I charge a copay/drug and it just goes through because they can see what it was, I'm good.

My FSA I deal with once a year, where I upload a list of copays from the past year that I download from my Epic, and they pay it. Sometimes they kick it back to be formatted differently, but I deal with it once in January, done. So there is some kind of administration behind it.

If that becomes an ongoing headache of "please add a signature you have to go get, a receipt you have to spend 15 minutes on hold for, and a fairy, and mail it to a special address in the next 10 days" on a weekly basis for every expense to actually realize the $$ difference for the HDHP .... I'll pay the extra $2k up front and call it good.

Maybe I'm asking a question that can't ultimately be answered.

I really appreciate your work here, phunniemee.
posted by Dashy at 6:19 PM on November 8, 2023


I'm sure the experience varies based on what company services your HSA. For the one my company uses, the process is you take a picture of the receipt with your phone, upload it to the baking website under the "reimburse myself" tab, and then unless it's very obviously not a medical expense, you get a check in the mail 2 weeks later.
posted by phunniemee at 6:53 PM on November 8, 2023


Ultimately, an FSA is likely more of a hassle than an HSA, but it’s tough to have an HDHP/HSA in the first year, because you won’t have any money in there to pay your out of pocket costs. The administrative issues related to the underlying health plan (the HDHP or PPO) should really be similar, as phunnimee pointed out. With an FSA, there are tax code substantiation rules for expenses (much easier now for POS transactions with a debit card!), whereas with an HSA, you (the taxpayer) are ultimately responsible for whether the expense is permitted or not, but in practical terms that just means that CVS or your doctor’s office will accept the card at the time of service and you won’t have any other substantiation/receipt issues after that (unless you get audited by the IRS).

This is all because an FSA is a employer-sponsored group health plan, but - for better or for worse, as someone explained above - an HSA is an individual taxpayer’s bank account, the concept created mostly for people with money to have another tax shelter. An HSA can be useful (it rolls over if you don’t use the money, the money is yours, not your employer’s, etc.), but if you have high regular expenses (and, at the beginning of each year), you may be paying a lot of up front out of pocket costs before you contribute enough to pay yourself back.
posted by Pax at 5:31 PM on November 12, 2023 [1 favorite]


I talked to a colleague yesterday who said our FSA and HSA are run by the same people, and that the HSA is genuinely painful, he's always having to go get receipts and re-enter things. So, PPO it is.
posted by Dashy at 7:12 PM on November 13, 2023


I have these two other HSA accounts from past employers, both of them with balances in investment accounts and a little bit of a minimum balance static just in the HSA account, rotting away (or perhaps growing! wheee!). I am scared to think about what to do with this. I hate financial paperwork. But.... what should I do with these accounts? Can I roll these HSAs over into my current employer provided HSA account, somehow? Or can I claim my current year's (or maybe even some other past year's) medical bills against the balances in these accounts even though these accounts were funded for some totally different year's medical expenses?

Or do I have to keep the paperwork from these minor accounts forever and hope to access the balances someday when I reach retirement age??
posted by MiraK at 1:00 PM on November 14, 2023


Can I roll these HSAs over into my current employer provided HSA account, somehow? Or can I claim my current year's (or maybe even some other past year's) medical bills against the balances in these accounts even though these accounts were funded for some totally different year's medical expenses?

You can do either of these things.

It's probably easiest to just roll the old ones into your current HSA and have one ecosystem. There should be a form on your current HSA website, or that your HR has handy. It will be annoying, but for approximately 30 minutes and then you will be done.

Strongly recommend you move the money out of those old HSAs if they're no longer employer sponsored. The fees for non employer sponsored accounts can be hefty.
posted by phunniemee at 4:19 PM on November 14, 2023 [1 favorite]


oooh, oooh, I have a question!

I get my insurance through my husband's employer (not an HDHP) and have opted out of insurance with my employer. We meant to start contributing to an FSA through his employer this year, but we messed up and missed the open enrollment deadline. My company is still in open enrollment and I don't see anything that says I need to get my health insurance from my company to use their FSA (just that I can't get an FSA if I have an HSA/HDHP, of course). If I were to try to open an FSA through my employer while getting my insurance through his, would that be an issue? If so, would I be able to pay for his health expenses through that FSA or just mine?

Slight twist: we are expecting a baby in February so will have a special enrollment period then during which I expect we could (probably?) start contributing to an FSA. Would that be easier? If we went that route, we wouldn't be able to retroactively cover expenses prior to birth, though, right?
posted by mosst at 6:48 AM on November 17, 2023


You need to ask your employer. It's not technically required to be enrolled in order to contribute to an FSA, and my company allows it, but your company might have an enrollment dependency. Can't know unless you ask.

Your baby will allow you to add that FSA on as part of the qualifying life event. I don't know if you can use the funds retroactively (probably, but I'm not a tax guy and really don't know the nitty gritty FSA rules).
posted by phunniemee at 7:35 AM on November 17, 2023


You don't have to wait for the baby to enroll in the FSA through your husband's employer. Your own employer's open enrollment period is a Qualifying Life Event that basically reopens the enrollment period for his insurance. His HR/benefits people may make some noises at you since it's more work they weren't expecting, but this is the price they pay for having such an early open enrollment period. My wife and I have done this: after I got a new job we stayed on her plan until her next open enrollment period, and then we declined in favor of signing up for my employer's insurance at their later open enrollment. And then it turned out that my employer's insurance was going to be a worse deal, and so we asked her benefits people and they said, "absolutely, you can sign up now," and that was that.
posted by fedward at 8:16 AM on November 17, 2023



My company is still in open enrollment and I don't see anything that says I need to get my health insurance from my company to use their FSA (just that I can't get an FSA if I have an HSA/HDHP, of course). If I were to try to open an FSA through my employer while getting my insurance through his, would that be an issue? If so, would I be able to pay for his health expenses through that FSA or just mine?

Slight twist: we are expecting a baby in February so will have a special enrollment period then during which I expect we could (probably?) start contributing to an FSA. Would that be easier? If we went that route, we wouldn't be able to retroactively cover expenses prior to birth, though, right?


Just in case anyone is still reading! IRS rules (and likely your and your husband's plan rules) would allow you to enroll in your health FSA without enrolling in the medical plan, and virtually all health FSAs are designed to allow reimbursement for expenses for the employee, spouse and dependent children. As phunimee said, the birth of your child (congratulations!) would likely allow you to start contributing to an FSA (the IRS rules don't require it, but virtually all plans allow it), but you wouldn't be able to use the FSA funds for expenses incurred before the period of coverage (i.e. starting with the birth of your child).
posted by Pax at 8:01 PM on November 26, 2023


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