Why HSAs plans are the way to go...w/o the actual HSA

What is an HSA compatible plan and why do I need one?


First, when The Health Insurance Shoppe recommends an HSA compatible plan, we are recommending the actual health plan design more so than the actual Health Savings Account (HSA) that you have an option of opening.


Traditional plan designs have 5 common elements:

• Plan Deductible
• The amount of money the insured must spend before the insurance carrier is to begin paying any portion of future medical expenses covered under the plan.

• Out-of-Pocket (OOP) Expense Limit
• This is the amount the insured must meet after their deductible before the insurance carrier is to begin paying 100% of remaining calendar year medical expenses covered under the plan.
• The OOP is paid by a percentage, your plan's coinsurance.  You either will pay 20%,30% or 50% after the deductible has been met, which is applied towards the plan's OOP.

• Office Visit Copay's
• Fixed dollar amount the insured must pay the provider at time of visit.
• Copay does not apply to the plan and will always be applied even if the plan is satisfied.
• Copay will only cover consultation and any vaccine or flu-shot that is given.  The copay will not cover any additional lab work, diagnostic tests or X-rays.  These are all deductible expenditures.

• Preventative Care
• This is a male and females annual physical (includes all diagnostic tests and lab)
• Females annual OB/GYN that includes an annual mammogram and papsmear
• Covered under a copay

• Prescription Drugs
• Depending on insurance carrier, plans may have copay's for prescriptions drugs
• If the plan has a copay, it will usually be for generic drugs and the plan will then subject the insured to a separate $500 or $1,000 Rx deductible for Brand Name and Preferred Brand Name drugs before a copay will begin to apply
• The copay will not be applied to the plan
• If the plan does not have a copay, the discounted cost of the prescription will be applied towards the plans deductible

HSA plan designs have only 3 of the above elements, Deductible, Prescription Drugs and Preventative Care.  There is no OOP because these plans are offered with 100% coverage after the deductible is satisfied.  Your preventative care will be covered at either 100% by the insurance carrier or under a copay, just like the traditional plans.

As for physician services (office visits) these will be applied towards your deductible at the discounted rate.

Prescription Drugs will be applied towards the plans deductible and then covered at 100% after.

Second, HSA plans are 30-40% lower in cost than traditional plans.  You can take the savings in premium and place 50% in your sock drawer, and you would have more than enough money to cover to office visits, when not having a copay.

Not to mention that if you decide to open the HSA you can pay for your medical expenses tax-free!!!

Please take a look at the attached link to view a comparison of an HSA plan and a traditional plan in an hospitalization scenario.

Hope this info helps in making a decision on what plan to choose when applying for health insurance coverage.

-The Shoppe