# Health Savings Accounts - Wage Works?



## daveswoodhauler (Nov 13, 2012)

Ok folks, employer is moving us to a High Deductible Plan for our Health Insurance, and I'll now have a HSA that will be administered through Wage Works. Does anyone have any experience with this setup? and could you comment on some likes/dislikes?

Do you find that most practices accept the Wage Works card? (Appears to be similar that to a VISA debit card) and how long does it normally take to get reimbursed if the provider does not accept the debit card?

Basically, we are moving from a HMO to either a PPO or High Deductible Plan...and every time I run the numbers the high ded plan works out in our favor...wondering what the drawbacks are and would love some real world examples.


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## Eatonpcat (Nov 13, 2012)

I have a Flex Spending Account (FSA).  The only down side to these plans IMHO is the use it or lose it policy.  Be careful how much you put into the account as expenses will most likely vary each year.  Another downside would be if you leave your job, My FSA credits a Visa with the total amount that you choose for the year, then I repay it (pre-tax) equally with a withdrawal from each paycheck throughout the year.  If you put $2,400.00 on it then find a new job in January, you would have to pay back the $2,400.00 out of your pocket.

Any practice/store that accepts Visa should be able to accept your payment card for all covered expenditures.

It works out well for me, but it seems that most people I know do not take advantage of this benefit!


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## daveswoodhauler (Nov 13, 2012)

Thanks Eaton. This is a HSA (a little different than a FSA) in that the monies aren't lost at the end of the year if they are not being used up. So, if you have $500-$1000 left over on 12/31, those moneys are then carried over to the next year.

I was mainly worried about the use of the debit card....i.e. my youngest son sees some specialists (pulmo/cardio) and those visits can run $400-$500 just for the office visit....just wanted to make sure that the provider would take the full amount on the wage works card vs me paying it via another source and then submitting for reimbursement.

Again, thanks for your input...much appreciated.


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## Beer Belly (Nov 13, 2012)

You asked....now pull up a chair, and get ready for some readin'. We recently agreed to an HSA in our new contract.....depending on how yours is set up...but I'll give you mine. There is a Single Plan....Married Plan (you and spouse), and a Family Plan...each carries a different Premium.....I'm in the Married Plan.....Single Plan has a $1,000 deductable that must be used before coverage is 100% (no out of pocket $$)....Married, and Family Plan has a $4,000 dedeuctable that must be met before 100% coverage (no out of pocket $$$).....our contract states that we pay _15% of the premium...and 50% of the deductable thru payroll deductions_....so right out of the gate, I have $2,000 in my HSA Account to use towards the $4,000....problem that some have run into, is if they had a bill that was more than what is the account...they had to quickly come up with the extra $$$....example: I have $2,000 in my HSA Account.....get hurt and go to emergency room for a broken leg....see my doctor...total of all bills come to $3,000...you gotta come up with the $1,000....some of our guys put in thier 50% at the begining of the year so that they have the full amount available. There are also 2 options...pay as you go with your debit Card, or wait for the Doctor Bill, then pay with the Debit Card....I wait for the bill....CIGNA (our carrier) will negotiate a price for services, the Doc will send you the negotiated Bill, then you write down your Debit Card number on the back of the Bill (should be a space for this), and send it in.....it's a lot easier to track your account this way (IMO). Is this change a Contracted change (union)????....in our first year, we had the employer put in 100% of the deductable amount, and payed it back thru payroll deductions (like a loan), so nobody would get stuck behind the eight ball the first year......and, whatever we don't use in the HSA account gets carried over......we only used $1,400, so we still had $2,600 in the account at years end, then the employer puts in another $2,000....so currently we have about $4,600 in the account (remember, after spending $4,000 in one year, everything is covered 100%...so we're $600 ahead)....we are trying to get ahead as much as possible...I think we can max out the account at $12,000.....if I get canned, leave, or retire, that account, with the $$ goes with me....it can only be used for Medical though...and can be used to supplement Medicare at retirement. This HSA was our best option, the PPO cost was skyrocketing, and the employer would have had to lay some people off to make it affordable if we stuck with the PPO.....I (President), and the negotiation team took a lot of heat for this...a lot of members were willing to lose about 4 guys....we (the team) did not want to put 4 families in dire straits....and we did get 10% raise over 5 years...yet, they still screamed.


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## Eatonpcat (Nov 13, 2012)

Wish I had an HSA!

I would call the doctor and ask if they accept it, but cash is cash, so they should.  Good Luck


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## Beer Belly (Nov 13, 2012)

One thing about the HSA is that you get to see what it really cost to see the doc....before, all ya did was pay a $25 deductable....or $5 for Meds....now you'll see $300 for a 10 minute office visit....or $150 for 30 day supply of meds...they say it's supposed to discourage people from going to the doc because thier nose is running


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## daveswoodhauler (Nov 13, 2012)

Thanks for the info Beer Belly...real good stuff.

Basically, The High Ded has a $2700 fam ded/$9100 max out of pocket...then the plan pays 80%

Problem with the PPO is that the premiums are more than double ($3100 more) the cost of the HIgh Ded, and the PPO also has a fam ded of $1200ded/$7600 max out of pocket..Another issue with the PPO is that copays don't go to the ded, so since we have appx $400-$500 in copays yearly, the difference on the deductible is only about $1000 difference between the two. (Also, both plans just cover labs/xrays at 80%)

For this year, I downloaded all my claims from the health carrier, and created a spreadsheet of the bill amount/contract amount, etc....every way I ran it was working towards the high ded plan. Only drawback I saw was not having enough funds in the plan at the beginning of the year, or having an out of network ER visit, etc..

My plan for this year is go get as much $$ into the savings account that I can, and hopefully by next year I can work our way up to having the max out of pocket in the plan and trim back on next years deductions.

I originally didn't like the idea of switching from the HMO, but then again I can also understand that folks needs to be more congnicent of the cost before going to the Er with a hangnail and a Dr's visit for every runny nose as you said.

Again, thanks for the real world info


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## Beer Belly (Nov 13, 2012)

daveswoodhauler said:


> My plan for this year is go get as much $$ into the savings account that I can, and hopefully by next year I can work our way up to having the max out of pocket in the plan and trim back on next years deductions.


This is a good plan.....I intend to pack away as much as possible. The only thing I swipe my Debit /HSA Card for is perscriptions.....can also be used for some over the counter stuff....my Wife and I also were able to get eyeglasses covered


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## Beer Belly (Nov 13, 2012)

The extra $$$ above the deductable can also be used for Dental.....like I said earlier...I have about $4,600 in the account, which means, if need be, we can spend $600 on Dental...another reason for building it up, you use the extra $$$ for stuff not normally covered under the policy...as long as it's medical...can't buy a new saw


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## Beer Belly (Nov 13, 2012)

Also, I have heard of some doctors not taking Debit Cards (some may require payment upon service....I have never run into that though)....you can also go to the bank that holds the account and withdraw cash....in my case, I'd go to Chase Bank....keep good records and you'll be fine. During negotiations we argued that this was a transfer of burdance (due to bookkeeping)...but we could not ignore the additional cost of the PPO to our members, and the fact that layoffs would happen to offset the employers cost increase.


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## brian89gp (Nov 13, 2012)

Most doctors around here will have reduced rates for non-insurance payments, sometimes half of the cost if you used insurance or even more. If you don't have many medical expenses (ie, you have close to no chance of hitting the deductible that year), you might consider paying the non-insurance rate with your *Debit Card* and not claiming insurance at all. The high deductible health insurance plans attached to most HSA accounts do absolutely squat for you until you hit the deductible, if you have no chance of hitting the deductible that year then pay the reduced cash-only rate since hitting 95% of your deductible by paying inflated insurance claim bills just means you got to pay that much and nothing more.

One thing to keep in mind, once the medical office knows you have insurance and especially if they have your paperwork already, they are obligated by law to ALWAYS charge the insurance.  So find out if they have reduced cash rates before you decide to give them your insurance information.


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## daveswoodhauler (Nov 13, 2012)

Thanks for the info Brian. Have a family of 5, and in the last 3 years we would have hit both the deductible on the PPO and High Ded program for each of last 3 years. Also good tips on the rate for "non insurance"...good to know.


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## Beer Belly (Nov 14, 2012)

According to the papers from CIGNA that I get with the EOB, they _claim_ a negotiated discount of 30-60%......I like your idea if I know I can save the $$$ on a bigger discount....never thought of that


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## ironpony (Nov 14, 2012)

and it all starts..........
people getting free health care now, still get it
people who are paying for it will pay more and have to figure out how to manage and be responsible
local company laid off 55 people yesterday.
our premiums went up 30%
I am on my wifes coverage(huge company) because Its alot cheaper than what I can get.


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## Eatonpcat (Nov 14, 2012)

ironpony said:


> _and it all starts.........._
> _people getting free health care now, still get it_
> _people who are paying for it will pay more and have to figure out how to manage and be responsible_
> local company laid off 55 people yesterday.
> ...


 
Well said!


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## Beer Belly (Nov 14, 2012)

ironpony said:


> and it all starts..........
> people getting free health care now, still get it
> people who are paying for it will pay more and have to figure out how to manage and be responsible
> local company laid off 55 people yesterday.
> ...


 30% increase is the exact number our guy used during negotiations....just not sustainable...thats why we took the HSA and saved a few jobs, but like I said, we all took a lot of heat from our members, and come January, I'll likely be voted out of office (which is fine, doing this stuff 9 years...I've had enough). As far as feeloaders (I'll make this quick...don't care for politics), I know a few who cannot find work, who have family to worry about, and I know a few genuine freeloaders......without knowing them personally....how would you tell the difference of who is deserving ????.....I don't mind reaching out my hand to those in need, but they also have to be deserving. _*Note to Moderator: If this is too political, please feel free to remove*_


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## ironpony (Nov 14, 2012)

we raised our deductables to 12000 per family, yes you read that right 12000
have a company funded HSA so our employees are protected, we the company cover the deductables. calculated risk deductables vs premiums
we are trying to do the right thing for them however if premiums increase much more, which they will, I am not sure how we are going to handle it.


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## shmodaddy (Nov 14, 2012)

daveswoodhauler said:


> Thanks for the info Beer Belly...real good stuff.
> 
> Basically, The High Ded has a $2700 fam ded/$9100 max out of pocket...then the plan pays 80%
> 
> Problem with the PPO is that the premiums are more than double ($3100 more) the cost of the HIgh Ded, and the PPO also has a fam ded of $1200ded/$7600 max out of pocket..Another issue with the PPO is that copays don't go to the ded, so since we have appx $400-$500 in copays yearly, the difference on the deductible is only about $1000 difference between the two. (Also, both plans just cover labs/xrays at 80%)



Oh my god I shall never complain about my insurance again .


Sent from my rooted and eclipse running X2--thanks nitro--  if im posting on here I'm probably supposed to be working! I can't help im addicted to HEARTH.COM!


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## Beer Belly (Nov 14, 2012)

ironpony said:


> we raised our deductables to 12000 per family, yes you read that right 12000
> have a company funded HSA so our employees are protected, we the company cover the deductables. calculated risk deductables vs premiums
> we are trying to do the right thing for them however if premiums increase much more, which they will, I am not sure how we are going to handle it.


 $12,000 !!.....are you saying that they need to spend $12,000 in medical cost before Insurance kicks in ????....HOLY CRAP .....the company pays 100% of the deductable ???...great for the employee, hard on the company


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## lukem (Nov 14, 2012)

I switched to a HSA a few years back and like it.  The first year is the hardest, but once you build up a balance in the account it is easy peasy. 

My employer deposits $XXX at the beginning of the plan year, and kicks in some extra if we have an optional biometric screening, take an optional online health assessment, etc.  Then I have another $XXX taken out of my paycheck each month.  I'm to the point now where I should never have another "true" out of pocket expense because my HSA balance now has enough to my yearly out of pocket maximum (and I'm usually no where near hitting the maximum).  If I have a lot of medical expenses in one year, I'll have to kick in a little extra to get back to where I started, but shouldn't be in a crunch from a cashflow perspective.  In the end I am spending slightly more health insurance out of my check each year (HSA has lower premiums but I contribute some extra) but I get to keep what I don't use...basically forever.

I have a debit card that draws from the HSA account that I pay everything with.  If someone doesn't except the HSA debit card you just go to the ATM and get some cash to reimburse yourself.  There's a form you have to fill out afterward, but I've never had to do it (never not been able to use card). 

One benefit is that HSA contributions are tax advantaged....you don't pay taxes on what goes into HSA...and don't pay taxes on what comes out as long as they are qualified medical expenses.  If you're like me and don't enjoy paying taxes this is nice, although it doesn't really amount to a ton of savings.


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## lukem (Nov 14, 2012)

brian89gp said:


> The high deductible health insurance plans attached to most HSA accounts do absolutely squat for you until you hit the deductible


 
Actually, the company that carries your HDHP usually negotiates some pretty nice discounts with health-care providers.  Even though you have to pay out of your pocket, you aren't paying "street-price" for your health care as you might be if you are un-insured.


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## Eatonpcat (Nov 14, 2012)

I'm confused!


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## ironpony (Nov 14, 2012)

Beer Belly said:


> $12,000 !!.....are you saying that they need to spend $12,000 in medical cost before Insurance kicks in ????....HOLY CRAP .....the company pays 100% of the deductable ???...great for the employee, hard on the company


 


yes that is how we handled it, 18 employees 12 on health care
calculated risk, all employees deductable vs premium payments
last year we came out ahead


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## flyingcow (Nov 14, 2012)

I am self employed, business is a S-Corp.. My "company" pays the family premium. $800 an month. plus a $5000 deduct set up as an HSA. It's works good so far. Still sucks, this used to be what we called a catastrophic policy.
But i do like my HSA.


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## MasterMech (Nov 15, 2012)

Lucky to be employed by a company that pays most of our premium.  I pay $38 a week for medical plus peanuts for dental and LTD.  $3K family deductable on the medical, company pays first $1500 of that via a HSA.  That second $1500 is up to the employee but I think most here would agree that's pretty manageable.  Plan covers 100% of preventative and other "well" care regardless of wether the deductable has been met or not.



flyingcow said:


> I am self employed, business is a S-Corp.. My "company" pays the family premium. $800 an month. plus a $5000 deduct set up as an HSA. It's works good so far. Still sucks, this used to be what we called a catastrophic policy.
> But i do like my HSA.


 
That kind of expense is exactly what keeps me from going to FT self-employment.  One day I'll get fed up with the rat-race tho.  ...


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## daveswoodhauler (Nov 15, 2012)

shmodaddy said:


> Oh my god I shall never complain about my insurance again .
> 
> 
> Sent from my rooted and eclipse running X2--thanks nitro-- if im posting on here I'm probably supposed to be working! I can't help im addicted to HEARTH.COM!


 
Correction, we have a $2700 ded...then coinsurance kicks in where the plan pays 80% of most items....then, we cap out at the $9100


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## shmodaddy (Nov 15, 2012)

Jeez guys im sorry.  We have a ppo insurance through my union. $800 family deductible then 90/10 in network. $3000 max out of pocket.   This is the only insurance I have ever had and didn't really realize how good I got it.

 Seven days after our deductible  renewed we met it  when my 3 year old daughter stuck a small rock in her ear and had to have it surgically removed.  

I truly feel for you that have huge deductibles like that.   Not sure but it seems as though it  would almost be better to pay cash and negotiate your bill yourself with the hospital. 

Sent from my rooted and eclipse running X2--thanks nitro--  if im posting on here I'm probably supposed to be working! I can't help im addicted to HEARTH.COM!


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## daveswoodhauler (Nov 15, 2012)

shmodaddy said:


> Jeez guys im sorry. We have a ppo insurance through my union. $800 family deductible then 90/10 in network. $3000 max out of pocket. This is the only insurance I have ever had and didn't really realize how good I got it.
> 
> Seven days after our deductible renewed we met it when my 3 year old daughter stuck a small rock in her ear and had to have it surgically removed.
> 
> ...


 Just as an example, my wife had a medical event last December of 2011 and was hospitalized....got sent home after 5 days just before xmas and the surgery was scheduled for Jan 2012. Had we been on this plan in 2011 and 2012 we would have paid $9100 out of pocket in Dec 2011, and then another $9100 in Jan of 2012. Yup, it sucks.


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## brian89gp (Nov 15, 2012)

lukem said:


> Actually, the company that carries your HDHP usually negotiates some pretty nice discounts with health-care providers. Even though you have to pay out of your pocket, you aren't paying "street-price" for your health care as you might be if you are un-insured


 
Yes, they do. But many medical offices charge more up front for insurance paid visits, they don't call it that though, they call it "cash payment discounts". Many times it was either a $150-200 insurance paid visit, or $75 cash payment visit. Another more recent one was $270 for insurance paid, or $130 for cash payment. The insurance company does usually negotiate it down from there, but it is usually still higher then the cash payment amount.

Your mileage may vary though, this is just what I have observed at the medical offices around here.


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## raybonz (Nov 15, 2012)

And I thought my insurance was expensive! I do work for a massive company so I am sure that helps!

Ray


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## flyingcow (Nov 15, 2012)

MasterMech said:


> Lucky to be employed by a company that pays most of our premium. I pay $38 a week for medical plus peanuts for dental and LTD. $3K family deductable on the medical, company pays first $1500 of that via a HSA. That second $1500 is up to the employee but I think most here would agree that's pretty manageable. Plan covers 100% of preventative and other "well" care regardless of wether the deductable has been met or not.
> 
> 
> 
> That kind of expense is exactly what keeps me from going to FT self-employment. One day I'll get fed up with the rat-race tho.  ...


 
It's where I am, I am lucky to have a biz that can pay the health ins. FWIW..... I am on a local school board, the board chair actually. Also I am on the neg committee facing off with the teachers Union. Fun Times.........had by all.


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## daveswoodhauler (Nov 16, 2012)

raybonz said:


> And I thought my insurance was expensive! I do work for a massive company so I am sure that helps!
> 
> Ray


 I don't think its due to the size of the company, as I probably work for the 4-5th largest company in the nation in my field (Insurance).


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## Swedishchef (Nov 16, 2012)

Wow. Those numbers are scary to me. I guess it makes me appreciate the medicare system we have in Canada. My wife has a C-section 3 weeks ago. WE (they wanted me to stay too in order to bond with the newborn) stayed at the hospital for 4 nights (and I even got to eat their cafeteria food for free) and it cost me nothing (directly). Just my annual income tax (which is a total of 34%)....I don't think I would be able to save $15000 for deductible incase we got sick.

Andrew


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## jebatty (Nov 19, 2012)

> Just my annual income tax (which is a total of 34%)


 
I think many people want to have their cake and eat it too. Choice may be this simple: pay higher taxes and get good medical care "free" or at a low cost and complain about high taxes; or, pay lower taxes and pay for high cost medical care through the nose and then complain about the high cost of medical care. Alternatively, shut up and be satisfied that you have a roof over hour head, food to eat, and good medical care.


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## Swedishchef (Nov 20, 2012)

Jebatty: I agree 100% with your statement. I currently reside in the most taxed province in Canada. Yet there is a provincial prescription plan for those who can not afford third party ones, we have government subsidized daycares at $7 a day, $150 a month per child as a government subsidy, tuition for some of the best Universities in Canada (located in Quebec) cost $2200 a year. As you said, you can't have the cake and eat it too. In Canada it is simply "how it is". We are used to high tax rates and the pretty decent social programs that come with them. Every once in a while I will say "You know, I am not on welfare, I have never been on Employment Insurance, I do not get any advantages  or get any of my money back that I have paid in the past 20 years". And then we had 2 c-sections and I shut up 

A


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