Highmark Blue Cross Blue Shield provides comprehensive qualified high deductible plans in Western Pennsylvania. As “HSA-friendly” plans, the PPO 1700 and PPO Embedded 2700 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. Both options are available with or without federal financial aid.
As a guaranteed-issue Exchange policy, applying for coverage only requires a simple five-minute application to be completed, and a face-to-face meeting is not necessary. Coverage is offered in the selected 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.
The Health Savings Blue PPO 1700 and Embedded 2700 plans are available in the following counties: Allegheny, Beaver, Bedford, Blair, Butler, Cambria, Erie, McKean, Somerset, Venanago, Washington, and Westmoreland.
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 have more control over your treatment than ever before. If you change companies (For example, Highmark to UPMC, or Highmark to Aetna) you can continue with the same savings account, while only changing the HDHP (High Deductible Health Plan).
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. Deposits that are applied for the prior tax year can be made through April 15th (or later, if the 15th occurs on a weekend).
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. However, you can not tax-deduct premiums paid for the purchase of Medicare Supplement, Advantage, or Part D prescription drug plans.
What’s covered? other than the obvious (major medical, office visit and prescriptions), 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. However, it is expected that several changes and enhancements will be made when the Trump Administration plans are formally effective in 2018.
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, to ensure that you are IRS-compliant.
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. The minimum family deductible is $2,600. The maximum allowed out-of-pocket expenses are $6,550 and $13,100 respectively.
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 Highmark BCBS provider network must be used to secure the largest negotiated discounts.
The discounts may range from 5%-20% (office visits) to as much as 50%-85% (lab tests and other diagnostic expenses). For major surgeries or long hospital confinements, it is not uncommon to see tens of thousands of dollars “repriced” from the original bill. Often, treatment for a chronic condition that requires an overnight stay will also cost much less by utilizing carrier network savings. Prescriptions will also cost less, although the savings is not substantial for generic and preferred non-generic drugs.
What Counties Must I Live In To Purchase Coverage?
Allegheny, Beaver, Bedford, Blair, Butler, Cambria, Erie, McKean, Somerset, Venanago, Washington, and Westmoreland (As previously noted).
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.
Health Savings Blue PPO 1700 – Individual deductible is $1,700 with family deductible of $3,400. The single and family out-of-pocket maximums are $3,250 and $6,500. Coinsurance is 10%. Most HSAs feature 0%, 10%, 20%, 30%, 0r 50% coinsurance. Therapy and rehab services are covered along with occupational and speech therapy. There is a 30-visit limit for rehabilitative services, and a 20-visit limit for chiropractor visits.
Pediatric vision and dental services are included. After deductible has been met, there are no out-of-pocket expenses for frames, lenses, exams, cleanings, and basic restorative services. Prescription drug coverage (mail and retail) is subject to 10% coinsurance after the deductible is met.
Health Savings Blue PPO Embedded 2700 – Individual deductible is $2,700 with family deductible of $5,400. The single and family out-of-pocket maximums are $6,500 and $13,000. Coinsurance is 20%. Therapy and rehab services are covered along with occupational and speech therapy. There is a 30-visit limit for rehabilitative services, and a 20-visit limit for chiropractor visits.
Pediatric vision and dental services are included. After deductible has been met, there are no out-of-pocket expenses for frames, lenses, exams, cleanings, and basic restorative services. Prescription drug coverage (mail and retail) is subject to 20% coinsurance after the deductible is met.