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Mr.Nobody  
#1 Posted : Wednesday, October 5, 2011 7:21:48 AM(UTC)

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Less than a week ago, I was still swinging between Aetna Open access and BCBS basic ppo+United vision.  After a bit research, I found that the HDHP+HSA might be a cost effective plan for me.

I'm in late 20s, no kids, generally healthy, never went to the doctor's for the past 6 years, so my insurance from graduate school only was used for eyeglasses since they have $100 per year reimbursement and you can virtually buy it from anywhere (online is what I did).  So I was thinking similar eyeglasses credit plus routine eye exam and some dental coverage (at least for cleaning) would be cool since I expect to use those at least every year.

Used the PlanSmartchoice tool, and got GEHA HDHP high up in the fit ranking, but a little bit lower than Aetna in terms of cost.  Considering both fit and cost ranking, these two are essentially the same.

I checked their brochures, and found that they are very similar in terms of coverage.

Aetna:  cheaper premium, has vision and dental coverage (to the extend I need) in addition to the HSA
but you need to pay higher coinsurance in hospitalization, board rate etc.
Same HSA contribution, they use JP morgan chase bank and no account maintenance fee. But people are complaining about the limited investment options?

GEHA: a little bit more expensive, limited to no vision and dental coverage (only  50% for cleaning), lower hospitalization coinsurance rate,  but you have to pay possibly higher for the drugs (25% instead of the fixed copay from Aetna)
They use HSA bank, and charge low balance maintenance fee.

I've seen people praising both plans, but wanted to have some personal experiences from you guys in terms of coverage, and customer service etc.  This is the first time I enroll the FEHB as a new employee, and also first time HDHP plan user, so any input/advice is appreciated.

TIA.


upandup  
#2 Posted : Thursday, October 6, 2011 9:48:02 AM(UTC)

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I think the HDHPs are a good value for many. The deductible isn't nearly as bad as it seems as long as you are disciplined enough to put aside money into your HSA. One thing to keep in mind about enrolling this late in the calendar year is that any deductible you need to meet will be null and void when January 1 rolls around. Do you have the $1500 to pay out should you get sick between now and January 1?

I have the GEHA HDHP. I used to have the United Healthcare HDHP (but that was eliminated last year). The plans are similar, but there are some coverage differences. I would check out the Aetna v. GEHA provider networks where you live. The main reason I selected GEHA over Aetna last year was that the local hospital does not participate with Aetna.

There is no low balance maintenance fee with the GEHA-sponsored HSABank account. GEHA provides vision coverage through EyeMed. You get a $5 co-pay eye exam and a $10 co-pay eyeglass benefit. http://www.geha.com/more_benefits_programs/vision_hdhp.html

The benefits are very similar. The major difference is that GEHA has 5% coinsurance up to $5,000 yearly catastrophic cap while Aetna has 10% coinsurance with a $4,000 catastrophic cap. For many medications, the 25% coinsurance is cheaper than the Aetna copayments. You are protected by the catastrophic caps even for prescription drugs under both plans.

Whatever you choose, you can change your mind during Open Season and have a new plan as of January 1.

As for vision coverage, if you enroll in FedVIP vision now, you can take full advantage of new eyeglasses for just a couple months of premiums. In Open Season, you can drop out if you want.

upandup2011-10-06 17:56:45
Mr.Nobody  
#3 Posted : Thursday, October 6, 2011 11:04:22 AM(UTC)

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Thanks for the input.  I just move to Silver Spring area a year ago, and since I never went to the doc's I do not have preference or knowledge at all about the "local hospital".

I've submitted the election form for Aetna before your reply.  I will take advantage of Aetna's free dental cleaning and eye exam.

A layman question, when making appointment with dentist or eye exam, do I have to ask if they take insurance beforehand (sometimes online info might be outdated).  And if they are listed in Aetna's provider page, I could just walk out free right?


Mr.Nobody  
#4 Posted : Thursday, October 6, 2011 1:02:23 PM(UTC)

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A closer look, GEHA seems to have more generous vision coverage than Aetna, though less dental.   They have up to $70 out-of-network full set
glasses allowance (per two years because of the frame allowance is for
every 2-year), up to $110 contact lense from out-of-network. Up to $100
frame in-network frame allowance. Also you only have to pay $55 top for contact fitting. Compared to that, Aetna only offer free eye exam, and $100 credit toward glasses/contacts every 2 years, no other out-of-network allowance.

How is GEHA's out-of-network vision reimbursement
work out, can I purchase contacts online and get reimbursed or they
need you to go with local shops (some claim forms ask for signature from
the vendor).



upandup  
#5 Posted : Thursday, October 6, 2011 2:08:38 PM(UTC)

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Yes, you should always verify with a provider that they are in-network. Also, when getting a routine physical, make sure to remind the staff/physician to code the visit as a routine physical to ensure it is paid at 100%.

The Aetna dental benefit is at 100%, but it includes only in-network providers and excludes fluoride treatments for adults. The GEHA benefit is at 50%, but is available out-of-network and includes fluoride treatments. It also provides a scheduled (flat-rate) benefit for fillings--it's a small benefit, but a benefit nonetheless. With both GEHA and Aetna, dental services not covered but provided by participating providers are repriced at the network rate (according to information from both plans). 

The Eyemed Out-of-Network claim form for the GEHA HDHP is found at: http://tinyurl.com/6fmemx

Aetna offers a Vision Discount program for contacts/eyeglasses if you use a participating provider (also through EyeMed), but the $100 eyewear reimbursement is also available for out-of-network providers (reimbursed directly from Aetna). The Aetna Eyemed rates can be found at https://www.eyemedvision...lans.emvc?execution=e1s3

Both the GEHA and Aetna plans offer good information including substantial FAQs on their websites:



upandup2011-10-06 22:30:32
Mr.Nobody  
#6 Posted : Thursday, October 6, 2011 9:30:08 PM(UTC)

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Thanks a lot for all those useful info.

So for GEHA, essentially I should be able to get at least $110 of online contacts per year, plus a $100/$45 (in/out of network) glasses frame per two year and $45 lense per year.  But for Aetna, everything add together is only $100?

I think last time I checked, Aetna's vision claim form asked for vendor signature, which is not very feasible for online purchase.

Also what kind of investment option for higher balance HSA account that GEHA have? I've seen people complaining about Aetna's JP Morgan chase regarding limited/low return funds.

BTW, you also mentioned that I could enroll a Vision plan now and immediately take the advantages (whole year) and then possibly drop it during open season?  I'm a new employee, and 11/10 is my 60-day from start, if I'm not wrong, the open season is 11/14 (how long did it last? and is it applicable for me, a new enrollment less than 30 days ago by then)? So I could still do as what you mentioned?


phauser  
#7 Posted : Friday, October 7, 2011 2:25:06 AM(UTC)

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My spouse and I both changed to Aetna HDHP two years ago and plan to stay with this plan next year.  I also considered GEHA HDHP and Mailhandlers Consumer Option (which is a HDHP).  We are both in our 50’s and in good health.  I’ll share why we decided to go with Aetna over GEHA, but your circumstances are probably entirely different.

 

All our doctors and hospitals, and our dentist are in the preferred PPO network for Aetna.  I think they are in the GEHA network also, but with GEHA, the network may change in the future, and it depends on the region you live in.  If you read through the brochure, you will see the many different networks GEHA uses for the different regions, and those networks do change from time to time.  At least with Aetna, you stay with the same network.  

 

The premiums, pass-though amount, and deductible are the same or near identical with Aetna and GEHA.  The differences are that the catastrophic amount is $1000 greater for GEHA but the co-insurance is 5% with GEHA and 10% with Aetna.  But remember, if you are really healthy, you will probably not meet the $1500 deductible so the co-insurance amount will not come into play.   

 

Another area that is really hard to compare is the negotiated rates for both plans.  Until you meet the deductible, you will be paying the full negotiated rate, so that is important. And after you meet the deductible, you will be paying a percentage of the negotiated rate (we always use in-network PPO doctors).  Since we have had BCBS and NALC plans in the past, we can tell that in most cases, the Aetna negotiated rates seem a little higher than the BCBS and NALC negotiated rates.  But I do not know about the GEHA negotiated rates, so I really couldn’t compare them.

 

For prescriptions, Aetna is better for our needs.  We have a few meds that are brand name and are rather expensive, so after the deductible is met, we prefer the Aetna co-pay to the GEHA 25% percentage.  But if you use only inexpensive generics, GEHA would probably be better.

 

Our routine dental checkups are paid 100% by Aetna.  (We use an in-network dentist.)  We also have FEDVIP Metlife Standard Dental insurance which covers the same preventive benefit.  If we have additional dental expenses, such as a crown, Metlife applies the amount that Aetna provided for the preventive dental benefit toward our expenses on the crown (it’s all part of the coordination of benefits between the dental plans).

 

We also get the FEDVIP VSP vision insurance every two years.  The additional $100 that Aetna gives us allows us to get progressive bifocals or more expensive frames, at no additional cost.  We use a local optometrist, but I think there is a way to have Aetna reimburse you for online purchases, also.    

 

Aetna has a very generous physical therapy, occupational therapy, and speech therapy benefit, much more generous than GEHA.  At our age, that is becoming more important.

 

GEHA does have a chiropractic benefit where Aetna does not, but we have never used this service and do not plan to.

 

Before we chose a plan, I called both Aetna and GEHA and asked lots of questions.  Both companies were very helpful in answering my questions. 

 

Both are excellent plans, so I don’t think you will be sorry either way.  We love having an HDHP with HSA.  I did a cost comparison to see what we would have paid under BCBS standard and basic, and NALC, and Aetna saved us from $1500 to $3000 for the year, if you include the tax savings.

 

By the way,   you are not limited to having a single HSA, as long as the total amount contributed to all HSA’s does not exceed the limit established by the IRS law.  We found that our local credit union offered an HSA account, and established one there.  It earns a little more interest than Chase and there are no regular fees.  The contributions that Aetna makes for us go into the Chase account, and we make our additional contributions into our credit union HSA account.   And as much as possible, we use the Chase account to pay for our medical expenses, and use our credit union account only as an emergency, and we let that account accumulate.  We like having the HSA at our local credit union, because during open season, we could change to a different HDHP plan (like GEHA or Mail Handlers), and keep the HSA at the credit union, and not have to worry about transferring the funds. Many banks and credit unions offer HSA accounts, and some have investment options.

 

upandup  
#8 Posted : Friday, October 7, 2011 4:03:42 AM(UTC)

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Mr.Nobody wrote:
So for GEHA, essentially I should be able to get at least $110 of online contacts per year, plus a $100/$45 (in/out of network) glasses frame per two year and $45 lense per year. 


No. It's EITHER contacts or lenses/frames.
upandup  
#9 Posted : Friday, October 7, 2011 4:07:12 AM(UTC)

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Mr.Nobody wrote:

Also what kind of investment option for higher balance HSA account that GEHA have? I've seen people complaining about Aetna's JP Morgan chase regarding limited/low return funds.


As phauser indicated, you can have another HSA at a provider of your choice. I make a free trustee-to-trustee transfer periodically from HSA Bank to my primary HSA with my credit union. In addition, I make tax-free payroll deductions to my credit union HSA every pay period.

Aetna and GEHA both offer very solid HDHPs. Last year, when I was forced to switch due to the United HealthCare HDHP ending, it was a close decision...until the local hospital announced they were leaving Aetna's network. That made the decision for my particular case quite easy. The Mail Handlers program seems to me to be less desirable, though some may like the predictable copays after the deductible is met.



upandup2011-10-07 12:14:38
OUtside  
#10 Posted : Saturday, October 8, 2011 6:53:23 AM(UTC)

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Quoted from the post of phauser:

‘If we have additional dental expenses, such as a crown, Metlife applies the amount that Aetna provided for the preventive dental benefit toward our expenses on the crown (it’s all part of the coordination of benefits between the dental plans).’

Can you explain this further?

Other dental plans I have looked at definitely don’t do this.

Instead they say that if the fehb plan offers dental benefits, the fehb plan pays first, leaving the dental plan paying second towards the net expense.

But if a dental plan were to give a credit for preventive on a future dental expense, that is as if the subscriber is receiving the benefit twice, once paid by Aetna and once paid by Metlife. In a way, then, both insurance plans would then be paying first.

phauser  
#11 Posted : Saturday, October 8, 2011 8:07:13 AM(UTC)

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OUtside,
 
This is how Metlife has handled coordination of benefits when my FEHB plan was BCBS basic and also when it was Aetna.  It has worked out great.  I’ll give an example:

 

During the year I have 2 dental checkups/cleanings.  On each, Aetna pays 100% of its negotiated rate, which is $68 in this example, so the dentist receives $68 from Aetna.  Metlife would also have paid 100% of its negotiated rate, which is $78 in this example, so Metlife sends an additional $10 to the dentist (evidently the dentist can go with the higher rate, so the dentist is paid a total of $78).  I will see in my statement from Metlife that I have accumulated $68 toward coordination of benefits, which is the amount that Aetna paid.  At this point, I do not receive this benefit, but I know it is there for later use in the year.  After I have my second checkup/cleaning, the amount is now $68 x 2 = $136, in the coordination of benefits balance.   Then if I have another dental expense, such as a filling, root canal, crown, etc, Aetna pays nothing (since it only pays for preventive dental expenses), and Metlife pays its advertised % of its negotiated rate, which in this example we will say is 35% of $200 (or $70), and I am responsible for the remainder of $130 .  But when Metlife processes this claim, it will send a check to the dentist for $70 plus the amount that has accumulated due to coordination of benefits in that calendar year, but not to exceed its negotiated rate.  So in this example, Metlife sends a check to the dentist for $70 plus $130 = $200.  $6 remains in the coordination of benefits balance.  I am not billed for this additional dental procedure because the dentist has been paid the full $200.

 

Now if the order of the procedures are reversed, where my non-preventive dental procedure occurs before the cleanings/checkups occur (and nothing has accumulated toward the coordination of benefits), I will be billed by the dentist for the percentage of the negotiated rate Metlife does not pay ($130).  And when a cleaning/checkup occurs later in the year, Metlife will send a check for $10 to the dentist, and then reimburse me directly for the amount that I paid previously to the dentist, up to the amount accumulated due to coordination of benefits (I will receive $68).  And when I have the 2nd checkup/cleaning, I will be reimbursed an additional $62.  It works out to be the same.

 

At the beginning of the year, the coordination of benefits balance starts over, so if all you have in a year are cleanings/checkups, the accumulated coordination of benefits balance cannot be applied to dental work in the following year.  So when there are no additional dental procedures in a year, you do not reap this benefit.  But in years where you have fillings or crowns, etc, this is a nice benefit.

 

The first time this happened, I didn’t understand and thought Metlife made a mistake.  I definitely did not see this as an advertised benefit.  But this is the 4th year now that I can tell this is exactly what is happening, and it worked this way when I had BCBS Basic with Metlife, and Aetna with Metlife.  And it has worked the same for my spouse who has a separate individual FEHB and dental plan.   I don’t know if other dental plans handle coordination of benefits the same as Metlife.

OUtside  
#12 Posted : Saturday, October 8, 2011 12:57:44 PM(UTC)

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Thx very much for the explanation, I’m making a note to check this plan out during open season.

Their brochure speaks to the extra $10 part of your example, it says when both fehb and Metlife have a benefit, then the Metlife allowance is the one that is used.

On the credit for the preventive care, let’s say that Standard has a premium for Self and One of $50 per month =$600 per year.

If subscriber and spouse both go for 2 preventive care visits paid by Aetna at $68, that means 4 x 68 = $272 would be available as a credit for future work, about 45% of the dental premiums paid for the year.

In other words, if subscriber has any work at all other than preventive care, subscriber can recover nearly half of his premiums paid just like that.

I was going to suggest this was somehow working through your health savings account, but you mentioned BC Basic, as well.

Pretty interesting…

phauser  
#13 Posted : Saturday, October 8, 2011 1:58:46 PM(UTC)

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OUtside,
 
With Self plus one membership, each person has his/her own coordination of benefits accumulation -- it is not added together.  Still good, though.  I have looked online at all the Metlife info and OPM info on how coordination of benefits is handled, but can find nothing to explain the details.  And I have seen nothing written by others on Fedsoup to explain this.   2008 was the first year that I noticed this happening, where coordination of benefits resulted in an additional payment toward my non-preventive dental work.  That year I had BCBS standard, and benefited an additional $57 toward my non-preventive dental work, which was the exact amount that BCBS standard paid toward my preventive dental expenses. 
Snezz1e  
#14 Posted : Saturday, October 8, 2011 6:20:01 PM(UTC)

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I currently have Aetna HDHP and am debating if I should switch to GEHA HDHP.  After some research here what I have so far. 

First premiums. With Aetna's larger premium increase for 2012 compared to GEHA there's not much difference.  About $70 but when you factor in the tax savings since premiums are paid pre tax it's really $50.  Also worth noting is Aetna has raised premiums $3-4 every year while geha has not raised it for 09/10/11 and only raised it $2.20 for 2012. I know you could always switch from year to year but if you want consistency Aetna may cost more than GEHA in another year.

Next Vision.  Aetna's $100 every 2 years vs. GEHA $100 ($110 - $10 copay) every year.  Assuming you maintain the same plan year to year Aetna's average benefit is $50/yr and GEHA $100/yr.  One reason I chose Aetna for 2011 was lower premium plus once I use vision for this year I was planning on switching to GEHA the following year.  GEHA cover's dilation I'm not sure if Aetna does or not.  I have FEDVIP coverage as well which covers it since my contacts cost $200+ per year.  It's also nice knowing what you will pay under GEHA for other items such as frames or contact fitting. 

Dental.  GEHA pays 50% for preventative, Aetna pays all.  GEHA has a dental tool to look up negotiated rates for your area.  Assuming your an established patient and only need exam and cleaning the negotiated rate is about $100.  Twice a year would be $200 with you being responsible for $100.  GEHA does cover extra stuff that Aetna doesn't. 

Preventative Care.  Aetna states 1 routine physical exam every 24 months.  GEHA doesn't mention a 24 month limitation.  Also I think Aetna's negotiated rate for preventative care is higher then normal.  I went to see a doctor for routine check-up and he ordered a blood test.  That was covered under preventative care.  However the follow-up to discuss the lab results was not covered.  It was billed as preventative care follow-up and the negotiated rate (fully taken out of my HSA) was $93 for a 5 minute discussion.  My mom went with me as well for both appointments for her routine check-up.  The negotiated rate for her was less than $50.  My triglycerides were slightly higher than expected (152) so he wants another lab test and follow-up.  At $93+lab costs I don't think I will be coming back since I can just have a health screening done at Walgreens Take Care Clinic for $65.    I think GEHA would have much better negotiated rates for two reasons.  From what I've read a lot of people say GEHA has a smaller network and some of their doctors are not on it.  This must mean they are providing lower reimbursements for the doctors not to accept them.  The other is the 5% copay after deductible.  For them to afford that they must have lower negotiated rates I think.  If anyone on GEHA HDHP could provide some information on their negotiated rates that would be helpful.

I think I will switch to GEHA for 2012.  It will cost me an extra $50 in premiums and $100 in dental but will save me $100 in vision (since I can't use aetna at all next year).  I think the extra $50 is worth the better vision coverage, lower copay, and hopefully better negotiated rates.



upandup  
#15 Posted : Sunday, October 9, 2011 5:50:48 PM(UTC)

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Snezz1e wrote:
 From what I've read a lot of people say GEHA has a smaller network and some of their doctors are not on it.  This must mean they are providing lower reimbursements for the doctors not to accept them.  The other is the 5% copay after deductible.  For them to afford that they must have lower negotiated rates I think. 
I don't think either of these things explain anything. GEHA's network is a national patchwork of various networks (Coventry/First Health, United HealthCare, and GEHA's own PPOUSA network represent the bulk of the country, but there are other networks as well). Sometimes this does mean that they have lower negotiated rates due to their ability to pick and choose networks for different states, but this is certainly not always the case.


upandup  
#16 Posted : Monday, October 10, 2011 3:14:12 AM(UTC)

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Aetna's HDHP (and CDHP--but that plan has gotten expensive) brochure is out: http://custom.aetna.com/fehbp/pdf/2011FedBrochure-AHF.pdf

Plan changes are fairly minor, but should always be reviewed by members:
• Infertility services - The Plan requires preauthorization of in network infertility services.  In network benefits also requires members to access care from Aetna's select network of Plan infertility providers.  
• Durable Medical Equipment (DME) - The Plan now covers certain bathroom equipment such as bathtub seats, benches, and lifts.  
• Mental health - The Plan does not cover services in half-way houses.  
• Mental health - The Plan does not cover educational services for treatment of behavioral disorders.  
• Service Area Expansions - We expanded our service area as follows:
phauser  
#17 Posted : Monday, October 10, 2011 3:34:18 AM(UTC)

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Mr.Nobody  
#18 Posted : Wednesday, October 26, 2011 11:52:55 PM(UTC)

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Finally got my insurance setup with Aetna HDHP, now two questions:

1. Do I need to call Aetna to set up the HSA account or it's taken care of automatically?

2. My coverage started on 10/09, how much I should put into the account to maximize tax benefit in addition to the 62ish bucks that got transferred into the account every month?

Thanks.


phauser  
#19 Posted : Thursday, October 27, 2011 2:15:10 AM(UTC)

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Aetna will automatically set up the HSA account with Chase.  This is the account they will contribute the $62.50 monthly.  If you wish to additionally contribute to this Chase account, you do not need to do anything, except set up payroll deductions, or follow Chase’s instructions for direct contributions.  Aetna will send you all the info on the Chase HSA account, but you can always call Aetna with questions.  If you wish to set up a separate HSA at a bank or credit union of your choice, then you will need to do that yourself.

 

My understanding, after reading the IRS guidelines, is that you are allowed to contribute the full/maximum annual amount to your HSA, IF you stay with a HDHP the following 12 months.  Read about the last month rule and testing period in the IRS guidelines. http://www.irs.gov/publications/p969/ar02.html#en_US_2010_publink1000204045

If you plan to switch to a non-HDHP plan for 2012 (or become ineligible for some other reason), then you would need to prorate your contributions for 2011.    There are some examples at this link that will help.  I copied a little text that deals with the last month rule and testing period.

 

Last-month rule.   Under the last-month rule, if you are an eligible individual on the first day of the last month of your tax year (December 1 for most taxpayers), you are considered an eligible individual for the entire year. You are treated as having the same HDHP coverage for the entire year as you had on the first day of that last month.

Testing period.   If contributions were made to your HSA based on you being an eligible individual for the entire year under the last-month rule, you must remain an eligible individual during the testing period. For the last-month rule, the testing period begins with the last month of your tax year and ends on the last day of the 12th month following that month. For example, December 1, 2010, through December 31, 2011.

 

 

The maximum amount you can contribute for 2011 is $3050 for self-only or $6150 for family.  Then you subtract the amount contributed by Aetna.  So if Aetna contributes for 2 months to your HSA in 2011, your maximum contribution amount (for self) would be $3050 – ($62.50 x 2) = 3050 – 125 = $2925.  If you are over 55, then you can contribute an additional $1000.  Of course, this will apply only if you plan to stay with a HDHP the following year.  

davidg1982  
#20 Posted : Thursday, October 27, 2011 4:01:24 AM(UTC)

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Does the government contribute anything to the HSA account? Just wondering.
My current employer contributes to my HSA as a way of balancing out the PPO and HSA plan. So if people benefit more from the HSA then you can sign up for the HSA, but if HSA doesn't then you can go PPO.

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