WWMD - Health Insurance

brij2006 · June 2014

H's employer had a meeting this week regarding their health insurance plans. They switched them to a higher deductible plan effective June 1st. We're now contemplating changing him to the insurance plan through my employer.

Here's the options....

We could keep him on his plan. He pays $184/month (both medical and dental) and his employer pays the rest. The individual deductible & max OOP is $3,000/$6,700. Family deductible & OOP is $6,000/$12,700. His employer will pay for the first $1,500 of his deductible, and the individual expenses would apply to him since he's on that plan alone.

Or we could change him to my plan. Cost is $240/month which includes medical and dental (my employer pays for 100% of my cost). The individual deductible & max OOP is $1,000/$3,000. Family deductible & OOP is $2,000/$5,000.

Here's my hesitations to adding him to my plan...

1. We will likely be going through fertility treatments in the future that will easily go to the Max OOP on my plan. Without him on my plan that is $3,000 instead of $5,000.

2. If we were to get pregnant then it is $5,000 max OOP instead of $3,000 for the birth of a child.

The pluses....

1. We wouldn't have to worry about his insane deductible and max OOP if something were to happen.

2. A family plan would mean adding a child to our plan would not cost us anything. To where right now it would bump one of us to a family plan (likely mine) then we would have a family and individual deductible to worry about until we can combine them.

3. If we find out he has a fertility issue and they bill any treatment under his plan, then it would be denied since he does not have fertility coverage. If he's under my plan then all of our procedures and testing would go under the same plan and coverages.

What would you do? I'm having the person who handles our insurance take a look into the ACA rules for moving a spouse to your policy even if his employer offers it (unless anyone knows how this is handled under the new laws).

One of my other thoughts is to keep us on separate policies until we have a child, then add him.
FWIW he's a pretty healthy person with no issues. The last time he went to the Dr was in 2006 to get antibiotics.

vlagrl29 · June 2014

I think if your company offers insurance then you can't get on aca, but I could be wrong. Also what does your company charge to add a spouse? Is that also covered 100%? If so I would move to your plan

maple2 · June 2014

Do you know if the birth of a child is a qualifying event for your husband to cancel his policy? I know you would be able to add him and your child to your policy at that time, but I've never looked into qualifying events for cancellation. Without taking into account the fertility treatment, I would probably go that route if DH could cancel his insurance at that time.

How much would it cost to determine whether DH has fertility issues? Would you be able/willing to wait until open enrollment to transfer him to your insurance for coverage if that turns out to be the case? I don't have any sense of what is involved in fertility treatment. Can he just get tested without undergoing any treatment? How much would you would end up paying for a fertility diagnosis that his plan wouldn't cover. If it is a relatively small amount and you would be willing to wait until he could get on your plan to pursue treatment, I would stick with you current arrangement. If the costs would be significant, however, and/or if you don't want to put off fertility treatments until he could switch to your insurance for coverage of the treatments, then I would go ahead and switch him now.

Xstatic3333 · June 2014

Honestly, I would move him over now because I am risk-averse and would prefer to pay more for the lower OOP max. I know you guys also mentioned you're not keeping a big e-fund while you get debt free, so that's a major consideration for me here.

I'm on my H's insurance even though my employer offers it. The new ACA rules haven't changed anything there, except that some companies are starting to no longer offer spousal coverage.

FTR, you can still buy a plan off the exchanges if your employer offers one, but you're not eligible for subsidies. That makes it a not-so-great deal for most people.

brij2006 · June 2014

@vlagrl29 This isn't through the Marketplace. It would be through my employers group insurance.

She re-ran the numbers with his specific information and it would cost $336 a month to add him to my plan. He currently pays $184 with the higher deductible and OOP.

@maple2 We don't believe that he would have any fertility issues since we've technically been pregnant 3 times already. It would also be at least 2 years before we use the fertility coverage. So we could hold off on adding him until we begin treatment again (hopefully we won't need to). The cost for his test would have been $350 when we were paying 100% OOP (wasn't covered by my prior insurance plan).

@xstatic3333 We have to wait until my 3/1/15 open enrollment period in order to add him. You are also correct that we do not have a big e-fund anymore since we're head deep into debt payoff mode.

vlagrl29 · June 2014

$336 seems like a lot for 1 person even though you are not having to pay anything for yourself. With him being so healthy, and if he is anything like my DH, he rarely goes to the doctor. My thought is to keep him on his plan at his job.

mssm2012 · June 2014

I'd keep individual plans for now, reevaluate every year at open enrollment to make sure it still makes sense. After you get pregnant, switch to your employer's family plan when you're able (which will be either open enrollment or at birth, depending on time of year).

Since he's healthy, staying on his plan is likely the cheaper option. It's $56/mo less, plus he gets the $1500 employer contribution (presumably in an HSA that he gets to keep if he doesn't use it), and most cover preventative care at 100% with no deductible. Your actual risk exposure is less than $900 to meet his $3k full deductible, IF he got sick/injured. Total OOP max is higher, but it doesn't seem likely that he'll even hit anywhere near the deductible.

If he spends less than $1500 (employer HSA contribution), you'll get to keep that money for future medical expenses. That's a nice perk!

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