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Questions tagged [health-insurance]

For questions about health insurance policies, including relevant terminology, types of policies, how to evaluate a health insurance policy, etc. Questions should be tagged with a country-specific tag in most cases, e.g. "united-states" or "canada".

140
votes
15answers
30k views

For very high-net worth individuals, does it make sense to not have insurance?

Various types of insurance (health, car, life) protect you from relatively low probability but very expensive events in life (cancer, serious car accident, etc.) For the average person, it makes sense ...
12
votes
3answers
16k views

Comparing HDHP vs PPO Plans: Am I missing something?

It's that time of year at work that we're needing to renew our insurance carrier. HR decided to continue the two PPO plans we previously had available, while adding an HDHP + HSA plan. I've compared ...
16
votes
5answers
7k views

Which is better: Employer-sponsored HSA or opening an HSA individually?

So I know that: Employer-sponsored HSA's allow you to deduct contributions directly from your paycheck, pre-tax With individual HSAs, you must contribute using post-tax dollars, then deduct those ...
2
votes
1answer
879 views

Deduct Health Care Premiums for Family When Employer Only Pays for Me

My employer offers insurance coverage, pays a substantial amount for me, but pays nothing for my spouse or my children. The difference in cost is around $127/month for myself and $1,330/month if I ...
7
votes
3answers
1k views

Why do HSA qualifying plans have a max deductible?

In order to be eligible to make tax deductible contributions to an HSA account, you must have a qualifying HDHP (High deductible health plan). Among the requirements, is a deductible and max OOP ...
16
votes
3answers
50k views

Can I use an HSA to pay off medical debts incurred before the HSA was funded?

Let's say that in year A I had a medical insurance plan without an associated health savings account, and incurred some medical expenses (co-pays, deductibles). I didn't pay them that year; they may ...
13
votes
1answer
3k views

Does the Affordable Care Act (Obamacare) require insurance to be paid with pre- or post-tax dollars?

I would like to continue paying for health insurance with pre-tax dollars. But, according to this Washington Post article, buying healthcare through the Affordable Care Act (Obamacare) requires post-...
17
votes
2answers
11k views

Should there be a copay after “out-of-pocket maximum”

I have individual health insurance and have met my out-of-pocket maximum due to a surgery earlier this year. I saw my (in-network) PCP this week and was still charged the regular $30 copay. Should ...
3
votes
2answers
159 views

How can I make sure that I don't pay a copay that is more expensive than over-the-counter when buying drugs in the United States?

I read this comment written by Dilip Sarwate: It sometimes depends on the circumstances. If your doctor tells you to take one 81mg tablet of aspirin as a countermeasure against future heart ...
13
votes
4answers
5k views

Do health insurances never cover over-the-counter drugs in the United States?

My insurance told me that: As the [drug name] is available over the counter, it is not covered by your health insurance. This would be an out of pocket expense for you. Do health insurances never ...
12
votes
1answer
9k views

Can I use HSA money to pay for family member that isn't covered by an HDHP?

If I'm in an HDHP, but my wife is on a different plan (non-HDHP), can I use money from my HSA to pay for her costs until she reaches her deductible?
5
votes
1answer
91 views

What counts toward the insurance deductible: the amount that the medical provider billed the insurance or the amount the insurance billed the patient?

What counts toward the health insurance insurance deductible: the amount that the medical provider billed the insurance, or the amount that the insurance billed the patient? For example: the medical ...
5
votes
1answer
365 views

Do I have to wash money through HSA account?

I paid for my eligible health expenses from my regular account at the end of 2014 and beginning of 2015 because I did not have enough money on my HSA account. Now that I realize that I can contribute ...
3
votes
2answers
220 views

Canadian moved to US - Hospital charges for ER / ICU visit

Pretty new to US - came down from Canada recently. So, not used to the medical/insurance system here since everything is free up in Canada! My daughter had to go to ER a few weeks ago (in ambulance), ...
16
votes
2answers
11k views

how to deal with involuntary out-of-network charges

A covered family member had to be transferred to another hospital during an emergency medical situation. Both hospitals were in network, but the ambulance that the hospital insisted on using was out ...
12
votes
1answer
352 views

Why do insurance companies in the United States have an enrollment period?

Normally with health insurance in the United States, you can only change the coverage you're getting during a single multi-week period in the year. That is unless there's a life qualifying event such ...
7
votes
1answer
1k views

Is accident insurance worth it for my kids who play sports

I'm evaluating options at my job for insurance and an optional insurance offering is accident insurance. I'm looking at this for my kids who play sports in school and on club teams. It's $170 a year....
6
votes
4answers
13k views

“$100 Copay before deductible/40% Coinsurance after deductible”

I'm shopping for health insurance. (U.S., federal exchange, I'll be losing COBRA which is a qualifying life event.) One of the plans describes its emergency room costs as: $100 Copay before ...
6
votes
1answer
924 views

HSA qualification and contributing with multiple HDHPs?

So I've read the IRS publications and I'm still kind of confused. I have single coverage on my employer's health plan with a qualified HDHP and along with an HSA. This is pretty clear cut. I am ...
5
votes
1answer
1k views

HSA/FSA, changing health plans mid year, concurrent coverage

My family is on the HDHP offered by my employer which has both an HSA and an LPFSA. The plan is on a calendar year (Jan 1 - Dec 31). We want to move to the plan offered by my wife's employer which not ...
5
votes
2answers
592 views

Expensive Pre-Tax Health Plan or Cheaper After Taxes Private Insurance

I currently have two options for health insurance, and I'm having trouble figuring out which one will actually save me more money. Option 1: Employer sponsored Health Insurance for Family $1,330/...
5
votes
3answers
373 views

Bill to expect after receiving basic emergency services at out-of-network hospital

Edit: follow-up question w/ resolution info and another billing-related concern. Recently I broke a finger while playing sports. The finger was clearly broken/disformed. Also I received a minor head ...
4
votes
1answer
104 views

What is a “cash carrying patient”?

I read on https://www.ccapta.org/mpage/MoveInsurance (mirror): Physical therapist services may be obtained without a physician’s referral if you are a cash carrying patient, receiving treatment for ...
4
votes
4answers
11k views

Is “premium tax credit repayment” deductible as health insurance cost for self-employed?

Under the ACA, you estimate your income for the year when signing up for a health insurance plan via the exchange. If you are eligible for a subsidy, it is calculated based on this estimated income, ...
4
votes
1answer
848 views

Switching From Employee to Independent Contractor

I've read a few different questions on here regarding the breakdown of employee vs independent contractor, but my situation has details that are quite different, hence, the question. When I was hired,...
4
votes
5answers
3k views

Is this HSA too good to be true?

I am grandfathered into this PPO plan which we have one more year before they get rid of it. I think the HSA plan is better now for me but wanted to check. Is this HSA plan better for me? If I ...
4
votes
1answer
14k views

Can I pay past expenses using an FSA opened midyear?

In my old job I had a HDHP and HSA. Midyear, I started a new job and switched to a standard insurance plan and an FSA. Can I submit receipts for expenses from January to the FSA that I just opened in ...
3
votes
2answers
342 views

Is the co-pay the same regardless of where the drug is purchased in the United States?

In the United States, with a given US-based health insurance and for a given prescription drug, is the co-pay the same regardless of where the drug is purchased? In other words, I have insurance X ...
2
votes
2answers
1k views

Choosing between an HSA and PPO

I need to choose between a PPO and HSA plan offered by my employer and it seems like the "obvious" choice is the HSA plan but I fear that I am missing something that will come back to bit me later. ...
2
votes
1answer
125 views

Health care billing concerns

Over the past year I had my first experience with health care billing issues other than just paying my monthly bill. Something happened billing-wise recently that concerns me. I'd like to get feedback ...
1
vote
0answers
88 views

When to take inherited IRA to save taxes given low income year with Marketplace premium tax credit?

Summary: Taking a $12k distribution from an (inherited) IRA this year has a nice 10% income tax rate, but effectively additional 14% "tax" due to Healthcare Marketplace (not advanced) premium tax ...
1
vote
2answers
124 views

Does paying a medical provider in cash count toward one's insurance deductible?

When paying a medical provider in the United States, the patient can either pay them cash or have them bill the insurance (which in turns may send some of the bill to the patient). Paying cash is ...
1
vote
1answer
5k views

Dual coverage and HSAs

Both my wife and I are currently (2015) covered as dependents under our parents' health plans. I'm 100% sure that both plans are HDHPs. I'm currently in open enrollment for my employer, and I want to ...
1
vote
1answer
1k views

How common is “pass-through” health insurance? [closed]

I am doing research about how health insurance works in the United States. I plan to post my findings on my personal web site. I have heard it said that some companies that provide health insurance ...
1
vote
1answer
345 views

compromise between 100% insurance and no insurance? (long term view)

Assume you can get private health insurance for different premiums, and they cover any directly health related costs (hospital stay, needed medicines, physiotherapy etc.) up to a maximum amount. It is ...