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Wednesday, January 08, 2020

Health Insurance Bullshit

So, I ended up picking Regence (Blue Cross/Blue Shield) health insurance for 2020--HSA plan because that pens out the best by far. There was some confusion about whether it included an embedded deductible (individual deductible separate from family deductible), and one (just one) agent claimed Yes for all plans except No for the HSA plans. There seemed to be some sense to this because HSA rules say the (any) deductible can't be below a prescribed (by the IRS) minimum for family HSA plans--that is, an individual deductible might fall below the minimum deductible allowed for family HSA plans and this would disqualify it as an HSA compatible plan. However in this particular case the individual deductible is still over the family minimum so that doesn't apply.

It's an important question because it significantly changes the value of the plan--if one person ends up in the hospital, it's twice the cost uncovered ($10.4k vs. $5.2k) vs. having two individual plans for the same price.

Let me say that again: Two people can get separate plans and have $5k deductibles, or they can pay the same total for a joint plan with a $10k deductible, which is much much worse coverage for the same price. (The price for the joint plan is exactly the sum of the prices for the two individual plans.)

Normally the plans don't work that way, because it's obviously terrible, but apparently the HSA plans are handled differently, perhaps historically for the reasons I mentioned above (my best guess is their corp lawyers misunderstood the IRS rules).

But this is kind of insane -- nobody would buy the joint plan under those terms if they knew. And I had some reasons to believe this was being updated for 2020 (for instance, a federal rule about max out-of-pocket related to this came into effect in 2020). So I asked *again* and it was like pulling teeth to get a straight answer to a straight question (I actually started taking notes on "creative ways to answer a direct question without actually answering it" because the evasions were so clever or moronic, depending on what we assume, as to be comical either way).

Finally I took to just asking the same concrete exact scenario question over and over: For the $5/10k HSA plan in 2020, if only one person on the plan incurred $6k in expenses (in between the $5k individual and $10k family deductibles), would any of the amount over the $5k be covered? This is a yes/no question but it took, I dunno, five times and two representatives before I got a Yes or a No, and the answer was Yes. So, Yes, the HSA plan also has embedded deductibles just like all the other plans.

I also read my policy contract, of course, and the only mention of this issue says "The Calendar Year Deductible is available on a per-Insured and a per-Family basis. For the Family Calendar Year Deductible, one Insured will not contribute more than the individual Deductible amount." Which agrees with Yes. There is no verbiage anywhere in the policy implying anything else.

But of course--of course--the website and app (which are only available to me now that the policy is paid for and in effect--and outside the open enrollment window so that I can't change it) do NOT show an individual deductible, and when I inquired about this I am now told that No, the HSA plans do not have an embedded deductible.

I show them the correspondence where they told me otherwise before I made the choice. I show them the line in their own policy that implies otherwise. I ask them to show me anywhere in the policy that supports how they're actually treating it. They say: This is how it is, too bad. Some time later they sent me a quote from the policy mentioning that if I add new people after January 1 it might change my deductible--as if that were supporting their position...

So the question is: How does one handle this situation? Best I can tell, they've sold this HSA plan to however many people under one premise, but are providing something worth substantially less. Most people will never notice--they just accept/expect that their medical bills and insurance are a cluster-fuck of a nightmare and won't realize the nuance of how they're being screwed here. When they get that extra large bill they weren't expecting, they just accept that "that's how it is" because clearly the lawyers have hashed it all out and it's been looked over and well I guess they didn't read the fine print but that's how it is.

Well, I did read the fine print, and that's not how it is. So, how do I fix this?

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Simon Funk / simonfunk@gmail.com