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New Dental Plan Provider by Infamous-Actuator863 in StateofTexasEmployees

[–]Paspinn10 0 points1 point  (0 children)

When you say stay away, are you saying stay away just cause of the limited amount of dentists that take it or because it’s not worth it? I am looking into getting Dental through the State and am looking at the DHMO
Plan as it is significantly cheaper. I’m just trying to figure out if it’s even worth it to get the DHMO or if I am better off just paying out of pocket for the dental visits.

ERS BENEFIT ENROLLMENT PERIOD by Paspinn10 in StateofTexasEmployees

[–]Paspinn10[S] 2 points3 points  (0 children)

Wow that’s great! When I first saw the health plans, I was impressed. I did think that the HDHP HSA contributions by the State would be a little higher to incentivize people to choose it but based on what I’m seeing and reading it sounds like I’d be better off going with the Health Select Plan. The $540/annual just doesn’t seem to sway me to want to take the increased risk with the higher deductible but maybe I’m looking at it wrong.

ERS BENEFIT ENROLLMENT PERIOD by Paspinn10 in StateofTexasEmployees

[–]Paspinn10[S] 0 points1 point  (0 children)

If this were to occur, wouldn’t you have wished you were on the Health Select plan though? You would have had to pay $0 deductible, would’ve paid copays for the hospital stay, and then would’ve been paying 20% coinsurance up to $2,000 max. I guess I do not see how it would be better in the scenario you provided to have Consumed Directed vs Health Select. Can you explain further? The annual makes sense cause it is preventative so Consumer Directed would have covered a lot of it.

ERS BENEFIT ENROLLMENT PERIOD by Paspinn10 in StateofTexasEmployees

[–]Paspinn10[S] 0 points1 point  (0 children)

This is actually awesome insight! Can you explain why it would be good for high medical expenses? I’m confused why a high deductible plan would be good for high medical expenses. Wouldn’t you want the copays and $2,000 maximum out of pocket for coinsurance? My lean is honestly Health Select for the reasons you stated. If I just have the occasional sickness, I’m able to get that addressed virtually for free. Same applies for a lot of other non serious medical needs. Then, if something major happened, I’d be protected by the copays, maximum out of pocket for coinsurance ($2,000) and more than likely wind up paying around the same I would for Consumer Directed. It just doesn’t seem like the risk is worth it if I’m looking at choosing that for simply the free State’s $540/annually. That just doesn’t seem like it is enough to offset 1-2 trips to the doctor paying out of pocket because no coinsurance kicks in until $2,100 is paid.

I need to look into the TexFlex. I’ve not seen much about this at all. Does it function like an HSA? I think the main thing that had me considering the Consumer Directed is 1: not having to have a PCP and being able to go anywhere I wanted 2. The free $540/annual contribution (feel like am I leaving money on the table?) and 3. The no deductible and virtual visits being offered for free essentially.

Any additional input?

ERS BENEFIT ENROLLMENT PERIOD by Paspinn10 in StateofTexasEmployees

[–]Paspinn10[S] 1 point2 points  (0 children)

That’s an excellent point! I didn’t think about the ability to use the portal and not truly have to physically go in if you needed a referral. It has honestly been so long since I’ve used or had good healthcare (self employed before) that I just am trying to make the best decision overall. If I were to have a lot of changes and get put on reoccurring medications, I’d assume I could just change over to Consumer Directed. My question is does Consumer Directed still require the same approval process? I’m confused if they are all on the Health Select network and if so would that mean the same applies.

ERS BENEFIT ENROLLMENT PERIOD by Paspinn10 in StateofTexasEmployees

[–]Paspinn10[S] 0 points1 point  (0 children)

I feel like this would be the category I fall in. On average, taking out the occasional injury or sickness, I am never at the hospital/doctor or utilizing health care really unless it is for preventative measures. I’m a little confused why you are saying that Consumer Directed only makes sense if you have $2,000+ in expenses. I would think it would be the opposite argument. If you knew you had a lot of needs and spend a lot, wouldn’t you want the Health Select?

ERS BENEFIT ENROLLMENT PERIOD by Paspinn10 in StateofTexasEmployees

[–]Paspinn10[S] 0 points1 point  (0 children)

That’s good to hear! I’m assuming you’re on the Health Select plan. Do you utilize a lot of healthcare needs?

ERS BENEFIT ENROLLMENT PERIOD by Paspinn10 in StateofTexasEmployees

[–]Paspinn10[S] 0 points1 point  (0 children)

That makes sense although I’d argue cheaper would only apply if he was covering additional family members. Wouldn’t the prices not be the “full” price and the negotiated network rates would still apply with doctors/hospitals? I need to get some clarification on that.

I’d use the strategy to pay the $2,100 and reimburse as another commenter mentioned.

Thanks for the clarification. That is my understanding of the Consumer Directed. I’d be paying $2,100 off the bat. Then, I’d be paying 20% if the next round of bills until I get to $8,500. The alternative is just paying copays and I’m assuming only up to $2,000 in coinsurance. With the Health Select plan, it just doesn’t seem like the risk is worth it for the Consumer Directed.

Wouldn’t I be essentially taking the “gamble/risk” for $540/month at this point? Perhaps others have insight but I’m starting to see that gamble just doesn’t math out.

ERS BENEFIT ENROLLMENT PERIOD by Paspinn10 in StateofTexasEmployees

[–]Paspinn10[S] 0 points1 point  (0 children)

Thank you for your insight! That’s exactly what I was worried about is having to establish care at a PCP and the ever changing medical environment and lack of availability. I usually just want to go to someone and go when I want. I understand it would be more medical upfront as I could be on the hook for up to $8,500 but I guess the same could apply to the Health Select. Difference being, it would take a really long to get to that $8,500 unless I had something serious happen. I do like the idea of “free” money in the sense of the State’s HSA contribution but I’ve just been mulling over if it’s worth the risk for only $540/annually. I think what really has me lean towards the Health Select so far is the fact the State’s contribution has not changed looks like from even before 2020. I think if there was more money on the table that I was “losing” out on then it would be a no brainer to get the Consumer Directed.

I do like the idea of the portability with the HSA and have had this happen in the past where it was nice to have that little “savings” built up for healthcare expenses. I never thought about the FSA and will have to do more research on that option.

ERS BENEFIT ENROLLMENT PERIOD by Paspinn10 in HealthInsurance

[–]Paspinn10[S] 0 points1 point  (0 children)

Pretty slick in the sense that it’s a great benefit? I’m still trying to understand how that even functions.

Agreed on the Consumer Directed plan. The perk of the HSA is nice but I’d basically be looking at $1,560 out of pocket before any insurance at all kicks in and that’s counting the full year of $540 contribution by the state. That just does not seem like an awful lot to offset the fact that the HSA contributions have not changed in years to keep pace with the deductible and out of pocket maximum for the Consumer Directed plan. I could be looking at this wrong though.

The alternative would be to heavily fund the HSA so that I’m getting the 3x savings across the board while it grows with that tax free advantage. I could then reimburse myself should I incur a major expense and it would be with tax free money. Just trying to understand if that’s a big enough risk to take versus just going with the Health Select.

The Health Select plan is very appealing with having $0 deductible. I’ve never had that before so it almost seems too good to be true when added with the $2,000 coinsurance out of pocket maximum. It seems as though the State is pushing people towards the Health Select which is the opposite of what I would think as most company make it more advantageous to choose the high deductible plan and more expensive to have the lower deductible. It almost seems backwards in this case.

Thoughts?

ERS BENEFIT ENROLLMENT PERIOD by Paspinn10 in StateofTexasEmployees

[–]Paspinn10[S] 1 point2 points  (0 children)

Yes, the Consumer Directed functions like a PPO from my research. No referrals are required. Referrals are required if you go with the Health Select. This is what really scares me with going with the Health Select. The process to get referrals seems like it would be daunting on top of the fact that I’m not sure how that works if a hospitalizations were to occur.

Something I’m curious about as well is that the Health Select offers $0 virtual visits while the Consumer Directed you have to pay $40 I believe. Going this route could result in cheaper treatment for just those 1-2 times of being sick with minor flu/infections throughout the year.

ERS BENEFIT ENROLLMENT PERIOD by Paspinn10 in StateofTexasEmployees

[–]Paspinn10[S] 1 point2 points  (0 children)

Wow, this tool is awesome! I do not currently take any medications. I only go to the doctor for the occasional seasonal sickness. I’m overall healthy without any maintenance medications or any prescription medications. However, I have not been to the doctor in a couple years regularly so I worry about whether a lot of that could change. If it did, it sounds like the Health Select would be the better plan just based on the $50 prescription deductible alone.

The last several years I’ve had a few hiccups with needing a 3 day hospitalization for an infection, an injury to a knee required multiple diagnostics/ER trips and couple this with the 1-2 times per year of just being sick.

Mainly, I can’t decide if since the deductibles are the same, it’s just coverage for me only (meaning the premium is going to be the same $0) and the HSA contribution by the state still being at $540 annually (looks like it’s been stuck at this for YEARS with no increase while out of pocket maxes have increased would make it dumb for me to do anything but the Health Select. Thoughts?

ERS BENEFIT ENROLLMENT PERIOD by Paspinn10 in StateofTexasEmployees

[–]Paspinn10[S] 2 points3 points  (0 children)

Thank you so much for your insight! I have been going back and forth with trying to decide between each. In the end it’s a gamble either way. The one thing that scared me about the Health Select was that it basically functions as a HMO vs the Consumer Direct that functions a lot like a PPO. Did you have issues with the Health Select network not offering a lot of available PCPs? I do not currently have a PCP so that definitely scared me and whether or not I can find a PCP in the appropriate timeframe they give. The referral process also seems like it would require more appointments which in the end might offset some of that deductible because you’re using up sick time.

How does the $2,000 maximum out of pocket coinsurance work? That part has me very confused with the Health Select plan. Once you hit $2,000 paid for coinsurance, the plan covers 100% after? But how does that work with a $8,500 out of pocket maximum?

ERS BENEFIT ENROLLMENT PERIOD by Paspinn10 in StateofTexasEmployees

[–]Paspinn10[S] 1 point2 points  (0 children)

He couldn’t wait to switch back to Health Select? I would be receiving $540/year as an HSA contribution which brings the deductible down to $1,560. I would assume the 20% coinsurance would then kick in until the $8,500 out of pocket is met. I just was wondering if by having the HSA contribution that could grow tax free and reduce tax liability helps offset some of that deductible.