Highmark Blue Cross Blue Shield provides comprehensive qualified high deductible plans in Western Pennsylvania. As an “HSA-friendly” plan so it can be used in conjunction with a Health Savings Account, Health Savings Blue is a perfect Marketplace fit for the self employed, families or individuals that want quality coverage at a reasonable price.
As a guaranteed-issue Exchange policy, applying for coverage only requires a simple application to be completed, and a face-to-face meeting is not necessary. Coverage is offered in the 17 counties of Western Pa during Open Enrollment periods. However, you can also qualify for a Special Enrollment Period that may allow you to apply for a policy at any time throughout the year.
How Does It Work?
An HSA is one of the best tools available to help pay for future medical, dental, and vision expenses, and get a tax deduction at the same time! Premiums are usually lower than a”comprehensive” plan, and you’ll have more control over your treatment than ever before.
No funds are ever “lost” if you don’t use them in time, and a debit card helps manage how and when you pay for qualified expenses. Another big advantage is that you receive the tax deduction for your contributions, even if you have not yet spent the money on approved expenses. For example, if you have an extremely healthy year with no medical expenses, you can still benefit from tax savings.
Once you reach age 65, your funds can continue to pay for Medigap plan coverage, or you can supplement your retirement income. You can also have your claims automatically paid electronically, or simply review the details before any money is dispersed.
What’s covered? other than the obvious (major medical, office visit and prescription), there are hundreds of treatments that are fully deductible. Some less-than-obvious and more obscure examples are: artificial teeth, birth control, breast pumps, guide dogs, hearing aids, lead-based paint paint removal, oxygen, sterilization, vasectomy and weight-loss assistance. A complete list can be found in this IRS publication on approved expenses.
These types of policies must conform to the Affordable Care Act guidelines, so the mandated “10 Essential Benefits” (EHBs) are included along with specific coverage that the State of Pennsylvania requires. For example, maternity and newborn expenses are always covered, although if non-preventative, a deductible may apply.
Also, you may qualify for the Advanced Premium Tax Credit (APTC) that reduces the premium. However, for Silver-tier contracts, too large of a subsidy through cost-sharing, may reduce the deductible to the level that the contract becomes ineligible for HSA status. We can review those circumstances with you.
Deductible And Preventive Expense Options
There are numerous deductible options. For example, if coverage is for just one person, you may select a deductible as low as $1,300 or as high as $3,400. The family deductible range is $2,600 to $6,800, although the maximum out of pocket costs are higher. As you may expect, a lower amount will result in higher pricing, since there is less potential out of pocket cost to the customer and more for the insurer.
All preventive treatment is paid in full with no copays, deductibles, coinsurance or waiting periods. A full list of covered items is available through the Department of Health and Human Services or we can email you a complete listing. Most other treatment is provided at negotiated repricing, meaning that until the deductible is met, you receive a substantial discount in cost, courtesy of Highmark.
The discounts may range from 5%-20% (office visits) to as much as 50%-85% (lab tests and other diagnostic expenses). For major surgeries and or long hospital confinements, it is not uncommon to see tens of thousands of dollars “repriced” from the original bill. Often, treatment for chronic conditions that requires an overnight stay will also benefit from these reductions.
What Counties Must I Live In To Purchase Coverage?
Allegheny, Armstrong, Beaver, Butler, Fayette, Greene, Indiana, Lawrence, Crawford, Erie, Mercer, Westmoreland, Forest, Potter, Clarion, Elk, Venango, McKean, Warren, Somerset, Jefferson, Huntingdon, Clearfield, Centre, Bedford, Cameron, Washington, Blair, and Cambria.
NOTE: HSA plans in Pennsylvania (all parts) are offered by many other carriers, including UPMC, Aetna and UnitedHealthcare. Also, although these contracts are available in Delaware, (Coventry also offers plan in the state), we are focusing on the Pa options only.
PPO 3400 – $3,400 deductible with a maximum out-of-pocket expense of $6,350 per year. The coinsurance on this plan is 30%, so once the deductible is met, the policy will pay 70% of covered expenses. Paid premiums and network-negotiated discounts do not count towards the deductible or maximum out-of-pocket expenses. This is a Bronze-tier contract.
PPO 2750 – $2,750 deductible with a $4,000 maximum out-of-pocket expense per year. Coinsurance is only 20%, which results in savings on smaller claims. This policy is also classified as a “Community Blue Flex” contract, which keeps premiums the lowest of all of the Highmark HSA plans.
The “Community Blue Flex” feature offers owners of the policy two in-network choices instead of one. Costs are better controlled and the number of available providers is still high. The two options are available on most submitted claims.
“Enhanced Value” is the cheapest choice with lower cost-sharing. Typically, the majority of treatment, including office visits, diagnostic testing, inpatient and out patient surgery can utilize this option. “Standard Value” offers fewer choices and is more expensive. However, in specific situations, the price difference may not be substantial and you may prefer this option.
PPO 2500 – $2,500 deductible with $3,500 maximum out-of-pocket expense. Coinsurance is a low 10% and this plan is more expensive than the previous two policies. Like the previous option, the PPO 2500 is a Silver-tier contract, and is eligible for “cost-sharing,” which can reduce the deductible. However, HSA-eligibility may be impacted.
PPO 1300 – Gold-tier contract with low $1,300 deductible and $2,300 maximum out-of-pocket expense. Naturally, it is the most expensive plan and may not be your best choice if there are no existing medical conditions at the time of enrollment.
February 3 2015 – Since Open Enrollment ends in 12 days, after the 15th, these plans will not be able to be purchased unless you have a qualifying life event, such as divorce, moving to different area, losing group benefits, reaching age 26, and several other situations. April 15, 2015 is the deadline for contributing funds that count for the tax year 2014.