Medical BCBS vs. Aetna HDHP

KnockKnock

Active Member
Messages
142
I recently recommended Aetna over BCBS to a coworker, and it just came up in chat, so I thought I'd share my opinion in case anyone else finds it helpful.
Aetna HDHP
Self: deductible $1500, out of pocket max $4000, HSA $62.50, cost/pp $70.09, actual annual cost $1072.34
S+1: deductible $3000, out of pocket max $6850, HSA $125, cost/pp $151.57, actual annual cost $2440.82
Family: deductible $3000, out of pocket max $6850, HSA $125, cost/pp $154.60, actual annual cost $2519.60
*After the deductible, you pay 10%

Having an HDHP qualifies you for an HSA, and the listed amounts are automatically deposited monthly. So while you're paying your premiums every pp, they're essentially reallocating some of your money into the HSA for you, so it's not really a cost.

BCBS Standard
Self: deductible $350, out of pocket max $5,000, cost/pp $113.16, actual annual cost $2942.16
S+1: deductible $700, out of pocket max $10,000, cost/pp $257.81, actual annual cost $6703.06
S+1: deductible $700, out of pocket max $10,000, cost/pp $271.95, actual annual cost $7070.70
*After the deductible you pay 15%

As you can see, BCBS is substantially more expensive as far as premiums are concerned. The "catch" with an HDHP is that you pay all of the costs you incur up to your deductible before insurance contributes. However, there are still things that are covered in full without having to pay towards your deductible like regular physicals, eye exams, dental cleanings (more on this later), and other preventative care things.

Examples: My wife and I just had our daughter, and throughout the pregnancy she received several ultrasounds. The insurance negotiated rate for an ultrasound was $450 and we had not yet met our deductible, so each time I paid $450. If I had BCBS they would've been covered in full.

For my wife's delivery the hospital billed us the insurance negotiated rate of $11,000. We had already made several payments to contribute towards our deductible, so we didn't pay this full cost, but had we not yet paid anything, this would've cost us $3,800. $3,000 to hit the deductible, then we only pay 10% of all charges after that. If we had BCBS it would've been covered in full.

Doing some math: on a family plan, if I pay 2519.60 in premiums, $3800 for a baby delivery, and $135 for 3 (90% off) ultrasounds = 6454. Still $600 less than the premiums for BCBS. Obviously, if you don't go to the doctor much you'll be saving much more.

On a family HDHP plan, I would have to be billed $18,515 in medical charges each year to end up paying the premiums of BCBS.

NEXT LEVEL: Because you're paying hospitals directly, you can ask for "Paid in Full" discounts when you pay your bill. Our hospital does 37% off on bills over $500, I pay with my rewards credit card, and then get reimbursed by the HSA.
An HSA is a tax-advantaged account, so after you max your TSP you can put another $6900 in the HSA tax free.
Aetna HDHP has solid dental and vision benefits included, so you could consider cancelling your separate dental and vision insurance.

Please review the Plan Brochures and do research into which plan is best for you before switching and blaming me for any problems you encounter.
 
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Justin

Member
Messages
15
There is also BCBS Basic in which there are no deductibles and there are flat fees for services instead of percentage copayment amounts. I have had BCBS Standard varying with Basic over the years and they've paid everything with very little trouble including multiple surgeries and hospitalizations. Aetna from what I have been told has been known to nit pick claims and give people more of a hard time, so for the piece of mind I would rather pay the extra money for something more reputable in my opinion.
 

Justin

Member
Messages
15
Also the BCBS Standard Out of Pocket MAX For A Single Plan is- $5000
BCBS Basic Out of Pocket MAX For A Single Plan is-$5500
 

breakaway2000

Forum Sage
Messages
1,693
I enjoy any conversation that gets people talking about important items we don't talk about as much as we should (Life Insurance, Health Insurance, TSP, etc). For how important each aspect is, the agency provides little to no time discussing the pros/cons of each. The resources are available, but you're essentially on your own to figure it out. As with any insurance, everyone's needs (and their acceptable risk) varies tremendously. I wouldn't expect a family with 8 kids and a single guy who never gets sick to both discover the same plan is the most cost effective for them. I would, however, encourage everyone to research every so often to find out what fits there current needs and conversations like this are a great start. It's so easy to get into a plan when you're single, get married, add a spouse, add kids, 20 years go by and you don't realize how much you could've saved by switching as your life changes. I sincerely appreciate the time you spent to kick this off, great idea.

For a complete comparison of every available plan, people can visit...
Healthcare : Compare 2018 Plans - OPM.gov

The vast majority of people have BCBS basic, which I believe is a far better plan then BCBS standard. To compare that with your example above...

Aetna HDHP (High Deductible Health Plan)
Self: deductible $1500, out of pocket max $4000, HSA $62.50 a month, cost/pp $70.09, actual annual cost = (70.09*26) - (62.50*12) = $1,072.34
S+1: deductible $3000, out of pocket max $6850, HSA $125 a month, cost/pp $151.57, actual annual cost = (151.57*26) - (125*12) = $2,440.42
Family: deductible $3000, out of pocket max $6850, HSA $125 a month, cost/pp $154.60, actual annual cost = (154.60*26) - (125*12) = $2,519.60
*After the deductible, you pay 10%

For everyone, a HSA (Health Savings Account) is tax free so for most of us, the money you can put in should save you ~28% on taxes. Aetna will put $750 into your HSA yearly for a self plan and $1,500 yearly for a family plan. The money will carry over year to year if you do not use it all.


Blue Cross Blue Shield - Basic
Self: deductible None, out of pocket max $5,500, cost/pp $73.72, actual annual cost = 73.72*26 = $1,916.72
S+1: deductible None, out of pocket max $11,000, cost/pp $171.84, actual annual cost = 171.84*26 = $4,467.84
S+1: deductible None, out of pocket max $11,000, cost/pp $180.98, actual annual cost = 180.98 *26 = $4,705.48

With BCBS basic, like Justin said above, there is no deductible and everything has a fixed dollar amount. Urgent Care? $35 Emergency room visit? $125. Hospital Inpatient Cost? $175 Outpatient Surgery? $200

We'll use the pregnancy example above as my wife and I loved this plan while having kids.

AETNA = $2,516.60 Premiums + $3,800 deductible/labor +$135 ultrasounds = $6,454.6
BCBS Basic = $4,705.48 + $175 Inpatient Hospital Cost when your wife goes into Labor + $0 for every doctor's visit/ultrasound/anything related to the pregnancy = $4880.48

BCBS Basic savings = $1,574.12

With a bunch of kids and what feels like I'm narrowly missing emergency room visits daily, I've enjoyed the fixed cost, no-deductible aspect of the BCBS basic plan. When my oldest was little she once grabbed a straightening iron one of her aunt's left out one Christmas. We iced it, didn't look too bad and we're doing the 50/50 dance on whether to bring her in. At the end of the day, no matter what the cost, it's $125, let's take her in. For the record, she would've been fine as we would've done the same treatment at home, but we took her in and after the initial intake, treatment, and follow up, the bill they sent was an outrageous 5k. For me, and I'm well aware each person is different, I enjoy the peace of mind that BCBS basic brings. If it was just my wife and I, AETNA HDHP sounds awesome and you can save a bunch of money especially if your HSA can roll over for a few years.

Also, unless your plan has an HSA you can contribute to, I highly encourage everyone to contribute to a FSA (Flexible Spending Account). Money goes in pre-tax and you can use it on medical expenses, co-pays, etc. You can contribute a total of $2,650 a year [EDIT: (Thanks @KnockKnock) and up to $500 unused funds] will carry over to the following year. Your funds are eligible on Day 1.

Ex. Open season is Nov/Dec. You request to put in the max of $2,650.
Jan 1 - The $2,650 of tax free money is available in full on day one.
They then deduct $101.92 (2,650/26 pay periods) per paycheck for the year.
 
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KnockKnock

Active Member
Messages
142
I also think BCBS Basic is MUCH more attractive than Standard, but my post was getting a bit long and I knew someone would bring it up!

I also want to add that while not all conditions last 10 months, my wife's pregnancy did. The timing of it was important because her due date was 1/6/18 and your deductibles and limits with Aetna restart every calendar year. So all through 2017 we were paying all costs for ultrasounds, urinalysis, an ER visit, etc., and it totaled around $2,500. Then 12/31 became 1/1 and all of our balances were reset to $0. So when Babygirl came along in 2018, we started all over with the $3,800 bill described above (and more).

The HSA rollover saved the day because in the 3 years I've had the plan we might've had to pay $50 for a visit somewhere in there.
 

KnockKnock

Active Member
Messages
142
Also, unless your plan has an HSA you can contribute to, I highly encourage everyone to contribute to a FSA (Flexible Spending Account). Money goes in pre-tax and you can use it on medical expenses, co-pays, etc. You can contribute a total of $2,650 a year and unused funds will carry over to the following year. Your funds are eligible on Day 1.
I think only $500 rolls over, but you can spend it on contacts, contact solution, glasses, band-aids, and all sorts of other things to easily blow through any amount you're about to forfeit.
 
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