Another insurance question...

AprilZ81 · November 2015

My open enrollment started today and I'm starting to crunch number to see if it is better to be on two different plans or on one family plan (especially since we are TTC).

I have the choice between two different plans

Plan A has a lower premium, $2000 deductible (individual) and $5000 out of pocket max (individual)

Plan B has a higher premium, $1500 deductible (individual) and $5000 out of pocket max (individual).

I'm figuring "worse case scenario" since we will be undergoing infertility treatments (likely not covered) and hopefully having a baby in 2016. I've never seen two plans with the same out of pocket max but different premium prices. Usually if you pay more for a plan you have a lower deductible and a lower OOPM.

In this case why wouldn't I choose the lower cost plan? The deductible is only $500 different and if I'm pregnant I'm going to hit that easy. If I'm not pregnant I'm going to be out of pocket for treatment and I'm otherwise a healthy person who is a low usage person.

ETA: The differences in the premiums is $460, so I would be paying $460 more to get a $500 less deductible but the same out of pocket max. It really doesn't make sense.

julieanne912 · November 2015

I would ask if the treatments are covered, I know the plan I ended up going with covers 80% of them, and another covers on a case by case, depending on the treatment.

And, I agree with you.... I feel like $500 difference in deductibles is not that big of a deal to be paying more in premiums. Can you put that $500 in an HSA so it's at least pre-tax?

Nat009 · November 2015

I may be reading your question incorrectly, but I always find it much less expensive to be on a separate plan vs. a family plan with a SO (assuming that both are employed). Also, you will want to look at the numbers for you plus a child to really gauge what your OOP will be for a delivery. For example, my SO is on his own plan through his employer and I carry myself and daughter through my own employer. It's so less expensive this way!

We are currently in open enrollment for a new provider and it's a pain to sift through the options

Also, hoping that insurance will help cover some cost of the fertility treatments!

AprilZ81 · November 2015

julieanne912 said:

I would ask if the treatments are covered, I know the plan I ended up going with covers 80% of them, and another covers on a case by case, depending on the treatment.

And, I agree with you.... I feel like $500 difference in deductibles is not that big of a deal to be paying more in premiums. Can you put that $500 in an HSA so it's at least pre-tax?

I have lots of follow up questions for HR next week. lol They sent this out at 4:00 on a Friday afternoon, not a great move on their part.

Unfortunately I don't have access to an HSA. DH does and I was hoping it would turn out to be cheaper for us to be on his plan but it isn't if we assume worst case scenario.

More calculations:

If we each are on our own plan the worst case scenario is $5,480 (premiums, OOP max, minus HRA and HSA contributions).

If we are on the same plan the cost is $7228.

If I throw in a child the cost for us to be on the same plan is $7580. I know the minute the baby is born it gets its own hospital bill for testing, room & board, pediatrician, etc. So while the cost to HAVE the baby is "known" to an extent I have no idea how to calculate the baby's cost.

The last time I checked my doctor's bills for prenatal care & labor and delivery would be less than our OOPM, so I'm tempted to risk it for the ease of being on one plan. DH's plan doesn't change in regards to deductibles and OOPM between employee+spouse and employee+family so it would be really easy to add the baby to his plan and call it a day.

This makes my head hurt.

AprilZ81 · November 2015

Nat009 said:

I may be reading your question incorrectly, but I always find it much less expensive to be on a separate plan vs. a family plan with a SO (assuming that both are employed). Also, you will want to look at the numbers for you plus a child to really gauge what your OOP will be for a delivery. For example, my SO is on his own plan through his employer and I carry myself and daughter through my own employer. It's so less expensive this way! We are currently in open enrollment for a new provider and it's a pain to sift through the options Also, hoping that insurance will help cover some cost of the fertility treatments!

I'm on DH's plan now because I was laid off between March & September. DH had a large HRA so our current treatments (doctor visits, blood work and ultrasounds) are being paid for by the HRA but we haven't met the deductible yet. Since he still has a healthy amount in his HRA we decided to keep me on his plan at least until January 1st in the hopes of getting one or two more cycles in before I'm on my own plan (with limited HRA funds).

DH's plan doesn't cover the cost of Clomid (but it is cheap) or other medications and has a $2,000 lifetime max benefit for IVF (one round of IVF is at least $12,000) which is better than nothing but still a joke.

I will follow up to see what (if any) infertility treatments are covered on my employer's plan, but I'm guessing none. The open enrollment package included a letter stating how the company's health care expenses increased 25% over the last year due to increased usage. They feel it is "only fair" that employees share the burden of the increased costs. In order for us to get funds into our HRA we have to do biometric screenings, get a physical, get a flu shot and a bunch of other invasive testing or programs (like a financial wellness workshop or wellness coaching programs). All that time and hassle and we can only earn $500 max... Looking at the list I would be willing to do the stuff to get me up to about $300 and then I start mentally flip off HR because no one except my husband and doctor needs to know this stuff.

vlagrl29 · November 2015

if the max OOT is the same on both plans go with the cheaper premium. I would make sure to check all the benefits of each plan - doc co pays, specialist co pays, ER, UC, Chiro, Physical Therapy and maternity benefits. There has to be some minor differences in each plan.

vlagrl29 · November 2015

health insurance usually doesn't cover infertility treatments - even the best plans I'm looking at on the marketplace don't cover it. so expensive. I had a friend that was trying infertility treatments but it was just too much so they ended up adopting a child a couple years ago. GL with your insurance

AprilZ81 · November 2015

vlagrl29 said:

if the max OOT is the same on both plans go with the cheaper premium. I would make sure to check all the benefits of each plan - doc co pays, specialist co pays, ER, UC, Chiro, Physical Therapy and maternity benefits. There has to be some minor differences in each plan.

According to the sheet they gave us it is all the same after I meet the deductible, 20% coinsurance. That is one of the reasons I think that there is an error in the sheet. If the OOPM is the same and the benefits are the same except for the deductible, why would anyone choose the higher premium plan?

Last year I was on this same plan (same employer) and when I did the math the higher premium plan was cheaper in the long run if we got pregnant because the OOPM was lower. I'm wouldn't be surprised if there was a typo on the document.

formerlyGDaisy09 · November 2015

I'd clarify that there aren't any typos on the documents. if there are no other differences (FSA/HSA?, copays?) I think the lower premium plan is a no brainer.

brij2006 · November 2015

I would go with the higher deductible plan, but would also ask for the breakdown summary of what this plan covers. It would say in there whether or not IF is covered. And by saying it that way, you aren't exactly telling HR that you're going through treatment, if you don't want them knowing.

FWIW, our employer completely re-wrote our health insurance to include IF 2 years ago because I was vocal with them about it. Granted we are a small company, but their agent who handles our group plan sent out a unanimous survey about what we wanted to see our health insurance plan cover. After open enrollment was done, we had our new plans and IF was finally covered. So it can pay to be vocal about it, since it isn't the norm to find IF coverage on a group plan.

Erikan73 · November 2015

Based on what you wrote, it looks like when it comes to the medical bills, you're going to be paying the same amount out of pocket no matter what plan you go with. How fast you get to the $5,000 is determined by which plan you pick. If you go with the higher deductible, you'll get to the max faster. If I were in you situation I would go with higher deductible if you'll be saving money on premium. And maybe create your own type of FSA account. Open a checking account for medical bills. Each paycheck put a set amount direct deposited into that account that you are comfortable with. Then when you have medical expenses come up you'll have the money already put aside to pay for the bills.

AprilZ81 · November 2015

Erikan73 said:

Based on what you wrote, it looks like when it comes to the medical bills, you're going to be paying the same amount out of pocket no matter what plan you go with. How fast you get to the $5,000 is determined by which plan you pick. If you go with the higher deductible, you'll get to the max faster. If I were in you situation I would go with higher deductible if you'll be saving money on premium. And maybe create your own type of FSA account. Open a checking account for medical bills. Each paycheck put a set amount direct deposited into that account that you are comfortable with. Then when you have medical expenses come up you'll have the money already put aside to pay for the bills.

This is my plan if we end up on two different plans. I confirmed that the out of pocket max is not a typo, the only two differences in the plans are the premiums and deductible.

The good news is that we already have the money set aside for delivery costs so it really is all about finding the best way to minimize our overall expenses for the three of us (assuming we have a baby in the plan year).

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