Health Insurance: Vent

brij2006 · May 2016

Can I just bang my head against the wall regarding health insurance? This is getting out of hand and I need to vent.

My employer decided to put us on a high deductible plan with a "premium saver" added. So we pretty much have 2 plans to keep expenses down and still keep the overall lower deductible. The boss' son, who handles it, said it was an overall 5% decrease. So H and I decided not to take DD off of my plan to put her on her own during open enrollment.

Well, that premium savings is OVERALL. So in 2015 we paid $190 for DD's health insurance. When our renewal came out, we paid $221 for March. With this new plan, her premium is $250!!!!! A $60 increase from last year to this year.

What makes me even more mad is that when I said something to the boss' son, he told me I could buy her insurance elsewhere if I didn't like it. Jerk. He has 2 kids and another on the way, but the company pays for their entire plan, so obviously he didn't feel the hit.

On top of this, they still make me pay for her insurance out of pocket rather than out of my paycheck. So it isn't even like I get a tax advantage for this.

Thankfully H's open enrollment is in July, so we'll look at adding her to his plan. Which is $200/month but at least it's pre-tax, so we get a bit of an advantage. Although his deductible is $2,000 more than mine.

Health insurance sucks!

vlagrl35 · May 2016

wow that's a LOT for a baby! I feel like it would be cheaper if you bought her own individual plan - have you checked that out yet. Health Insurance is usually more expensive thru a company.

Xstatic3333 · May 2016

That is completely unfair. If you're both employed full time by the same company, you should have access to the same options as your boss' son. Yikes. If there are over 50 employees (I'm assuming there aren't) I'd even question if it's legal. Hopefully your H's insurance will be a much better option. Sorry you have to deal with that.

hoffse · May 2016

Yeah I'm questioning if this is legal also. I don't know enough about this area, but benefit plans usually have to be equally applied, unless you and your coworker are technically in different groups (ie: he is an owner of the company and you are an employee).

The cost actually seems kind of cheap to me, but that's because we're looking at $540/month for a plan with a $6,000 deductible once we start a family.... which is the overall cheapest option for us. Sigh.

brij2006 · May 2016

@vlagrl35 It is insane! The worst part is that now we're out of open enrollment for her to be able to get onto her own plan. So we're stuck until January, unless we put her on H's plan. Which scares me, because his deductible and max OOP is so high. It's $16k for family max OOP. 1 year of them both being sick, and it would break us.

His individual deductible is $3k and individual max OOP is $9k. That scares the crap out of me.

brij2006 · May 2016

hoffse said:

Yeah I'm questioning if this is legal also. I don't know enough about this area, but benefit plans usually have to be equally applied, unless you and your coworker are technically in different groups (ie: he is an owner of the company and you are an employee).

The cost actually seems kind of cheap to me, but that's because we're looking at $540/month for a plan with a $6,000 deductible once we start a family.... which is the overall cheapest option for us. Sigh.

****************
Is that just for the child, or for 3 of you?

brij2006 · May 2016

@xstatic333 We're a company of 12 employees.

hoffse · May 2016

brij2006 said:

hoffse said:

Yeah I'm questioning if this is legal also. I don't know enough about this area, but benefit plans usually have to be equally applied, unless you and your coworker are technically in different groups (ie: he is an owner of the company and you are an employee).

The cost actually seems kind of cheap to me, but that's because we're looking at $540/month for a plan with a $6,000 deductible once we start a family.... which is the overall cheapest option for us. Sigh.

****************
Is that just for the child, or for 3 of you?

****************************
It's Me + 1. H is separate. In total it will be around $700/month to insure all 3 of us, and H will have his own $3,000 deductible (it goes up a little each year). Hoping and praying that one of our employers changes something at the end of the year to provide a cheaper alternative.

Anyway, we are figuring we will need to save ~$7000-$7500 to have a baby.... of which $6K is the giving birth part. It's crazy.

What's even crazier is the cadillac plans are actually more expensive overall when you consider the premiums+OOP max.

hoffse · May 2016

Sorry, it got absorbed - short answer is that is for Me+1. H is separate. In total it will likely cost around $700/month to insure all three of us.

Also, these are the subsidized plans! The partners are paying about $1,100/month for a HDHP +1 plan. It's absolutely insane.

brij2006 · May 2016

hoffse said:

Sorry, it got absorbed - short answer is that is for Me+1. H is separate. In total it will likely cost around $700/month to insure all three of us.

Also, these are the subsidized plans! The partners are paying about $1,100/month for a HDHP +1 plan. It's absolutely insane.

Craziness! Does that at least include funds funneled into an HSA?

Ours is $885/month for the 3 of us, but my employer pays for 100% of mine. We both work for companies of less than 50 employees, so H's employer doesn't pay for a penny of his and DD's isn't covered at all either.

vlagrl35 · May 2016

This is making me thankful for our aca plan with blue cross. Our family max oop is 1k. We pay $90 a month premium. Before aca we paid $235 a month for a high ded plan of 17k for the family. Couldn't afford more. Insurance should not be the same price as a mortgage payment.

AprilZ81 · May 2016

brij2006 said:

@vlagrl35 It is insane! The worst part is that now we're out of open enrollment for her to be able to get onto her own plan. So we're stuck until January, unless we put her on H's plan. Which scares me, because his deductible and max OOP is so high. It's $16k for family max OOP. 1 year of them both being sick, and it would break us.
His individual deductible is $3k and individual max OOP is $9k. That scares the crap out of me.

I get that it sucks, but she would only have to be on his plan until January. Then you can reevaluate to see if it would be cheaper to put her on her own plan.

Also, while I understand no one wants to be looking at a $6,000 deductible for $9,000 OOP max also try to keep in mind that you guys are DEBT FREE. If one or both of them get sick or hurt you aren't going to lose the house, cars or your investments. This is what an emergency fund is for.

Any preventative visits (which a child's regular well child visits should be coded as) should also be covered 100% by the plan.

short+sassy · May 2016

No advice, unfortunately, but I really...really sympathize!

The choices at my work are a high deduct. plan with employee cost per month at $0 (self)/$37 (self/spouse)/$73 (family). But the deduct. is $6850 for the self/spouse or family. I spend $4K/year, out of pocket, just on medication.

Or, they do have a more traditional plan with copays for visits/Rxs, but the employee cost per month is $243 (self)/ $540 (self/spouse)/ $1018 (family)...and that's even with the company contributing more than half for the monthly premium!

It's just an ugly situation, no matter how you slice it. But, I just always tell myself, "It is what it is, and it could be worse." Oh well. The only thing that gives me some sanity is I max out my HSA, which saves me about $150/month in taxes, plus than I don't have to "budget" in my medication...because my HSA contribution is already taken out of my income before I receive it.

brij2006 · May 2016

AprilZ81 said:

brij2006 said:

@vlagrl35 It is insane! The worst part is that now we're out of open enrollment for her to be able to get onto her own plan. So we're stuck until January, unless we put her on H's plan. Which scares me, because his deductible and max OOP is so high. It's $16k for family max OOP. 1 year of them both being sick, and it would break us.
His individual deductible is $3k and individual max OOP is $9k. That scares the crap out of me.

I get that it sucks, but she would only have to be on his plan until January. Then you can reevaluate to see if it would be cheaper to put her on her own plan.

Also, while I understand no one wants to be looking at a $6,000 deductible for $9,000 OOP max also try to keep in mind that you guys are DEBT FREE. If one or both of them get sick or hurt you aren't going to lose the house, cars or your investments. This is what an emergency fund is for.

Any preventative visits (which a child's regular well child visits should be coded as) should also be covered 100% by the plan.

Yeah but see, the problem with this is that we only make so much money. 2 years of meeting the max OOP and there goes a ton of our savings. Or if H were to get sick and not be able to work, then we wouldn't have that income to cash flow any of it. In order for us to remain debt free, we have to continue putting money aside so that we don't have to take out debt again whenever we replace vehicles or upgrade something. So our budget is usually still pretty tight.

I know this is a worst case scenario type of thing and the likelihood of us meeting the family max OOP is low, but it still makes me very nervous. Right now with her on my plan, our family max OOP is $5k, and $3k for individual. That's doable. $16k would kill us. Heck, even $9k for the individual OOP would be hard if there was a sickness and we lost 1 of our incomes.

vlagrl35 · May 2016

Also, when we had the super high deductible plan several years ago our insurance agent suggested we buy another plan that basically covers all but $100 of that 17k max OOP. I want to say that premium was $50 a month. It made me feel better that we wouldn't have to come up with 17k if there was a life changing health event. We'd only have to pay $100 of the ded.

brij2006 · May 2016

vlagrl35 said:

Also, when we had the super high deductible plan several years ago our insurance agent suggested we buy another plan that basically covers all but $100 of that 17k max OOP. I want to say that premium was $50 a month. It made me feel better that we wouldn't have to come up with 17k if there was a life changing health event. We'd only have to pay $100 of the ded.

That's what my plan just switched to. It's a high deductible plan with BCBS then we have a "premium saver" plan to take care of the smaller stuff up to the deductible.

vlagrl35 · May 2016

Just looking at Blue Cross online there are cheaper plans for kids - less than $200 a month. To buy an individual plan not in the marketplace do they really have an open enrollment period? It use to be that you could sign up whenever you wanted.

brij2006 · May 2016

vlagrl35 said:

Just looking at Blue Cross online there are cheaper plans for kids - less than $200 a month. To buy an individual plan not in the marketplace do they really have an open enrollment period? It use to be that you could sign up whenever you wanted.

Unfortunately yes, unless it's a "life event." We can't get her on her own plan until January 1st. We're Illinois too, so it's usually BCBSIL. I know when I looked into it last year, they offered one that was cheaper but it only covered doctors in Illinois. We're near the Iowa border (her pediatrician is there), and we travel often. So to not have insurance in other states, is a no-go for me.

vlagrl35 · May 2016

brij2006 said:

vlagrl35 said:

Just looking at Blue Cross online there are cheaper plans for kids - less than $200 a month. To buy an individual plan not in the marketplace do they really have an open enrollment period? It use to be that you could sign up whenever you wanted.

Unfortunately yes, unless it's a "life event." We can't get her on her own plan until January 1st. We're Illinois too, so it's usually BCBSIL. I know when I looked into it last year, they offered one that was cheaper but it only covered doctors in Illinois. We're near the Iowa border (her pediatrician is there), and we travel often. So to not have insurance in other states, is a no-go for me.

yeah we have a plan that is nation wide in case we are traveling and need it. That is so bizarre to me that there is an enrollment period even if you aren't in the ACA. That really does suck. In december I would start shopping around for her- until then put her on your DH's plan.

brij2006 · May 2016

vlagrl35 said:

brij2006 said:

vlagrl35 said:

Just looking at Blue Cross online there are cheaper plans for kids - less than $200 a month. To buy an individual plan not in the marketplace do they really have an open enrollment period? It use to be that you could sign up whenever you wanted.

Unfortunately yes, unless it's a "life event." We can't get her on her own plan until January 1st. We're Illinois too, so it's usually BCBSIL. I know when I looked into it last year, they offered one that was cheaper but it only covered doctors in Illinois. We're near the Iowa border (her pediatrician is there), and we travel often. So to not have insurance in other states, is a no-go for me.

yeah we have a plan that is nation wide in case we are traveling and need it. That is so bizarre to me that there is an enrollment period even if you aren't in the ACA. That really does suck. In december I would start shopping around for her- until then put her on your DH's plan.

Yeah, he looked into it and his open enrollment isn't until October. So she would only be on his for a few months and then we could move her to her own plan.

smerka · May 2016

brij2006 said:

AprilZ81 said:

brij2006 said:

@vlagrl35 It is insane! The worst part is that now we're out of open enrollment for her to be able to get onto her own plan. So we're stuck until January, unless we put her on H's plan. Which scares me, because his deductible and max OOP is so high. It's $16k for family max OOP. 1 year of them both being sick, and it would break us.
His individual deductible is $3k and individual max OOP is $9k. That scares the crap out of me.

I get that it sucks, but she would only have to be on his plan until January. Then you can reevaluate to see if it would be cheaper to put her on her own plan.

Also, while I understand no one wants to be looking at a $6,000 deductible for $9,000 OOP max also try to keep in mind that you guys are DEBT FREE. If one or both of them get sick or hurt you aren't going to lose the house, cars or your investments. This is what an emergency fund is for.

Any preventative visits (which a child's regular well child visits should be coded as) should also be covered 100% by the plan.

Yeah but see, the problem with this is that we only make so much money. 2 years of meeting the max OOP and there goes a ton of our savings. Or if H were to get sick and not be able to work, then we wouldn't have that income to cash flow any of it. In order for us to remain debt free, we have to continue putting money aside so that we don't have to take out debt again whenever we replace vehicles or upgrade something. So our budget is usually still pretty tight.

I know this is a worst case scenario type of thing and the likelihood of us meeting the family max OOP is low, but it still makes me very nervous. Right now with her on my plan, our family max OOP is $5k, and $3k for individual. That's doable. $16k would kill us. Heck, even $9k for the individual OOP would be hard if there was a sickness and we lost 1 of our incomes.

Want a little cheese with that whine? I get that your company is not treating you right and you have a right to be pissed. But MOST people would be in dire straits if they were hit with two OOP maximums and lost one income. Anyone would be in crisis mode at that point. And frankly you are in a way better position to handle that kind of situation than probably 99.9% of your peers. For a little perspective, we hit our $5,200 OOP max on March 9th this year. And that will continue to happen every year for the foreseeable future. We've planned for that now that we have an autism diagnosis and it sucks, but we have other stuff to worry about.

CuriousKiddosMama · May 2016

ok, you seriously need to consider Samaritan ministries or one of the other health share ministries again. We signed up and just went active May 1 with our membership. Our membership is $405 a month for the 4 of us. We are responsible for bills up to $300, but after that, they pay. And any discount you get goes towards your $300 that you are supposed to pay (so you get rewarded for negotiating a discount). A couple big things: preexisting conditions are not covered. So that doesn't work for many. Also preventative health care (your yearly physical, vaccines) are not covered. So we budget for that. But my pediatrician charges his patients without insurance $40-50 a visit, instead of the $100+ he bills insurance so you get a huge discount. Vaccines are our biggest bill coming up, and I'm going to a community health clinic for those. They get you a big discount on the vaccines you need for your kiddos.

And there is no open enrollment period, so you can change any time. Done a lot of research, and we decided to go for it. Honestly depending upon where my husband ends up employed next, we may not go back to traditional insurance. Our premiums have never been that low- the extra we save every month way more than pays for physicals each year.

We also did go with what they call brothers keeper- or something like that- basically the part that pays you if your bills end up being over $250k after the discounts. That is like $200 a year for the 4 of us, and we don't pay that unless it is needed by other members.

cupcait927 · May 2016

I totally get that it sucks that you have a high deductible but it could be so much worse. H and I have a $12k deductible (which is also our OOP max). However, you need to keep in mind that under healthcare reform, the most an individual can pay in a year is either $6,550 (or thereabouts - I can't remember exact numbers off the top of my head). So even with your high OOP max, if one of you on that plan gets sick, you can't pay more than $6,550. Yes, there's always a chance that someone catastrophic could happen to everyone on the plan at once but those odds are incredibly low. I work in health insurance and providing coverage for employers and let me tell you, there are a lot of employers that treat their employees a lot worse when it comes to insurance coverage.

brij2006 · May 2016

Okay, so we ran the numbers last night. We do have the option to put her on my H's plan at work, now. It will save us $50/month pre-tax, so likely an additional $10/month (being very conservative) once you factor in the tax advantage on that.

So a total savings of $60/month.

Individual:

His deductible is $3k, Max OOP 6,350

My deductible is $1k, Max OOP $3k.

Family:

His deductible $5k, Max OOP $13k

My deductible $3k, Max OOP 5k.

So, we ran some break even analysis, because we're both nerds like that. :-)
On his plan, it would take 3 years without a claim for us to break even with the deductible. With the max OOP, it would take 5 years. That's on individual.

With a 1 year old, I'm not sure that's a risk we should take on.

Then when you factor the family max OOP, it will take us 11 years of no claims in order to break even on that one.

I know I'm thinking worst case scenario with all of this, but I don't want to have 1 large health event that spans across 2 years/max OOP's, to clean out our savings. Just to save $60/month. Is it worth it?

@curiouskiddosmama How are you liking it so far? We're really considering doing this for DD, but I have no clue if we can get coverage for just her through them. My biggest fear with going through a ministry, is that there's a max they pay out. That scares me. I know you can "share" your needs beyond that and the results for that are pretty high that the needs are met.

brij2006 · May 2016

smerka said:

brij2006 said:

AprilZ81 said:

brij2006 said:

@vlagrl35 It is insane! The worst part is that now we're out of open enrollment for her to be able to get onto her own plan. So we're stuck until January, unless we put her on H's plan. Which scares me, because his deductible and max OOP is so high. It's $16k for family max OOP. 1 year of them both being sick, and it would break us.
His individual deductible is $3k and individual max OOP is $9k. That scares the crap out of me.

I get that it sucks, but she would only have to be on his plan until January. Then you can reevaluate to see if it would be cheaper to put her on her own plan.

Also, while I understand no one wants to be looking at a $6,000 deductible for $9,000 OOP max also try to keep in mind that you guys are DEBT FREE. If one or both of them get sick or hurt you aren't going to lose the house, cars or your investments. This is what an emergency fund is for.

Any preventative visits (which a child's regular well child visits should be coded as) should also be covered 100% by the plan.

Yeah but see, the problem with this is that we only make so much money. 2 years of meeting the max OOP and there goes a ton of our savings. Or if H were to get sick and not be able to work, then we wouldn't have that income to cash flow any of it. In order for us to remain debt free, we have to continue putting money aside so that we don't have to take out debt again whenever we replace vehicles or upgrade something. So our budget is usually still pretty tight.

I know this is a worst case scenario type of thing and the likelihood of us meeting the family max OOP is low, but it still makes me very nervous. Right now with her on my plan, our family max OOP is $5k, and $3k for individual. That's doable. $16k would kill us. Heck, even $9k for the individual OOP would be hard if there was a sickness and we lost 1 of our incomes.

Want a little cheese with that whine? I get that your company is not treating you right and you have a right to be pissed. But MOST people would be in dire straits if they were hit with two OOP maximums and lost one income. Anyone would be in crisis mode at that point. And frankly you are in a way better position to handle that kind of situation than probably 99.9% of your peers. For a little perspective, we hit our $5,200 OOP max on March 9th this year. And that will continue to happen every year for the foreseeable future. We've planned for that now that we have an autism diagnosis and it sucks, but we have other stuff to worry about.

I know, I know I'm whining. Pass the cheese, please. ;-)

It's just all frustrating. We want to make sure we're protecting ourselves and not choosing something that could potentially put us in a financial bind or lose our savings because we wanted to save a few bucks monthly.

I also know that hitting 2 max OOP's in a row is actually a lot more likely than one may think. The labor and delivery of DD was without complications nor medications, and DD came out perfectly healthy and spent no time in the nursery. However, I met my max OOP for that year just with her birth. We also met the family deductible for the 2 of us. Then since my pregnancy ran over 2 calendar years, I met my individual deductible and almost my max OOP for the year my pregnancy was in. It adds up quickly, then I was on maternity leave and we didn't have my income. Thankfully pregnancy gives you 9 months to save for the birth, because we did exactly that, but a sickness or broken limb that needs surgery, doesn't give you a warning.

Those are the things that get me tense and nervous. Granted, the likelihood of us hitting the family max is pretty slim as both H and DD are relatively healthy. But hitting an individual max, can happen pretty quickly.

jtmh2012 · May 2016

brij2006 said:

smerka said:

brij2006 said:

AprilZ81 said:

brij2006 said:

@vlagrl35 It is insane! The worst part is that now we're out of open enrollment for her to be able to get onto her own plan. So we're stuck until January, unless we put her on H's plan. Which scares me, because his deductible and max OOP is so high. It's $16k for family max OOP. 1 year of them both being sick, and it would break us.
His individual deductible is $3k and individual max OOP is $9k. That scares the crap out of me.

I get that it sucks, but she would only have to be on his plan until January. Then you can reevaluate to see if it would be cheaper to put her on her own plan.

Also, while I understand no one wants to be looking at a $6,000 deductible for $9,000 OOP max also try to keep in mind that you guys are DEBT FREE. If one or both of them get sick or hurt you aren't going to lose the house, cars or your investments. This is what an emergency fund is for.

Any preventative visits (which a child's regular well child visits should be coded as) should also be covered 100% by the plan.

Yeah but see, the problem with this is that we only make so much money. 2 years of meeting the max OOP and there goes a ton of our savings. Or if H were to get sick and not be able to work, then we wouldn't have that income to cash flow any of it. In order for us to remain debt free, we have to continue putting money aside so that we don't have to take out debt again whenever we replace vehicles or upgrade something. So our budget is usually still pretty tight.

I know this is a worst case scenario type of thing and the likelihood of us meeting the family max OOP is low, but it still makes me very nervous. Right now with her on my plan, our family max OOP is $5k, and $3k for individual. That's doable. $16k would kill us. Heck, even $9k for the individual OOP would be hard if there was a sickness and we lost 1 of our incomes.

Want a little cheese with that whine? I get that your company is not treating you right and you have a right to be pissed. But MOST people would be in dire straits if they were hit with two OOP maximums and lost one income. Anyone would be in crisis mode at that point. And frankly you are in a way better position to handle that kind of situation than probably 99.9% of your peers. For a little perspective, we hit our $5,200 OOP max on March 9th this year. And that will continue to happen every year for the foreseeable future. We've planned for that now that we have an autism diagnosis and it sucks, but we have other stuff to worry about.

I know, I know I'm whining. Pass the cheese, please. ;-)

It's just all frustrating. We want to make sure we're protecting ourselves and not choosing something that could potentially put us in a financial bind or lose our savings because we wanted to save a few bucks monthly.

I also know that hitting 2 max OOP's in a row is actually a lot more likely than one may think. The labor and delivery of DD was without complications nor medications, and DD came out perfectly healthy and spent no time in the nursery. However, I met my max OOP for that year just with her birth. We also met the family deductible for the 2 of us. Then since my pregnancy ran over 2 calendar years, I met my individual deductible and almost my max OOP for the year my pregnancy was in. It adds up quickly, then I was on maternity leave and we didn't have my income. Thankfully pregnancy gives you 9 months to save for the birth, because we did exactly that, but a sickness or broken limb that needs surgery, doesn't give you a warning.
Those are the things that get me tense and nervous. Granted, the likelihood of us hitting the family max is pretty slim as both H and DD are relatively healthy. But hitting an individual max, can happen pretty quickly.

Personally, I think the solution for that is either putting money away in the HRA/HSA attached to your high-deductible account or keep a separate savings account. I'm currently building up to cover 1yr of OOP max. I'm not currently worried about hitting it two years in a row and I have other emergency savings should it come to it.

hoffse · May 2016

Honestly, I would spend the extra $60/month and then just not worry about it. It's frustrating, yes, but your plan is otherwise a fairly decent one with a MUCH lower OOP max than you often see for that price.

I can say that our insurance is going to be frustratingly expensive when we start a family, but that's just part of it, and ultimately it would cost more to get a plan through the exchange due to our tax bracket and the fact that we can deduct the premiums through our employer's insurance (I have number crunched this). So we are trying to count our blessings with the fact that we are both employed and can afford that coverage and ultimately will save a little bit by using our employer's insurance.

$5K/year as a family OOP max should be do-able for you guys. Just make sure to have that much in an e-fund that's always earmarked for health emergencies, and then you don't have to worry about it.

brij2006 · May 2016

jtmh2012 said:

brij2006 said:

smerka said:

brij2006 said:

AprilZ81 said:

brij2006 said:

@vlagrl35 It is insane! The worst part is that now we're out of open enrollment for her to be able to get onto her own plan. So we're stuck until January, unless we put her on H's plan. Which scares me, because his deductible and max OOP is so high. It's $16k for family max OOP. 1 year of them both being sick, and it would break us.
His individual deductible is $3k and individual max OOP is $9k. That scares the crap out of me.

I get that it sucks, but she would only have to be on his plan until January. Then you can reevaluate to see if it would be cheaper to put her on her own plan.

Also, while I understand no one wants to be looking at a $6,000 deductible for $9,000 OOP max also try to keep in mind that you guys are DEBT FREE. If one or both of them get sick or hurt you aren't going to lose the house, cars or your investments. This is what an emergency fund is for.

Any preventative visits (which a child's regular well child visits should be coded as) should also be covered 100% by the plan.

Yeah but see, the problem with this is that we only make so much money. 2 years of meeting the max OOP and there goes a ton of our savings. Or if H were to get sick and not be able to work, then we wouldn't have that income to cash flow any of it. In order for us to remain debt free, we have to continue putting money aside so that we don't have to take out debt again whenever we replace vehicles or upgrade something. So our budget is usually still pretty tight.

I know this is a worst case scenario type of thing and the likelihood of us meeting the family max OOP is low, but it still makes me very nervous. Right now with her on my plan, our family max OOP is $5k, and $3k for individual. That's doable. $16k would kill us. Heck, even $9k for the individual OOP would be hard if there was a sickness and we lost 1 of our incomes.

Want a little cheese with that whine? I get that your company is not treating you right and you have a right to be pissed. But MOST people would be in dire straits if they were hit with two OOP maximums and lost one income. Anyone would be in crisis mode at that point. And frankly you are in a way better position to handle that kind of situation than probably 99.9% of your peers. For a little perspective, we hit our $5,200 OOP max on March 9th this year. And that will continue to happen every year for the foreseeable future. We've planned for that now that we have an autism diagnosis and it sucks, but we have other stuff to worry about.

I know, I know I'm whining. Pass the cheese, please. ;-)

It's just all frustrating. We want to make sure we're protecting ourselves and not choosing something that could potentially put us in a financial bind or lose our savings because we wanted to save a few bucks monthly.

I also know that hitting 2 max OOP's in a row is actually a lot more likely than one may think. The labor and delivery of DD was without complications nor medications, and DD came out perfectly healthy and spent no time in the nursery. However, I met my max OOP for that year just with her birth. We also met the family deductible for the 2 of us. Then since my pregnancy ran over 2 calendar years, I met my individual deductible and almost my max OOP for the year my pregnancy was in. It adds up quickly, then I was on maternity leave and we didn't have my income. Thankfully pregnancy gives you 9 months to save for the birth, because we did exactly that, but a sickness or broken limb that needs surgery, doesn't give you a warning.
Those are the things that get me tense and nervous. Granted, the likelihood of us hitting the family max is pretty slim as both H and DD are relatively healthy. But hitting an individual max, can happen pretty quickly.

Personally, I think the solution for that is either putting money away in the HRA/HSA attached to your high-deductible account or keep a separate savings account. I'm currently building up to cover 1yr of OOP max. I'm not currently worried about hitting it two years in a row and I have other emergency savings should it come to it.

Can you save into an HRA/HSA separately even though H's plan isn't considered a "high deductible plan?"

I threw that out to him. That we could budget even just $100/month to put into one and then just let it build for if/when something larger happens. Giving us an extra cushion to dip into just in case.

hoffse · May 2016

Can you save into an HRA/HSA separately even though H's plan isn't considered a "high deductible plan?"

I threw that out to him. That we could budget even just $100/month to put into one and then just let it build for if/when something larger happens. Giving us an extra cushion to dip into just in case.

No, it has to be a high deductible plan.

But you can always just save separately for it.

vlagrl35 · May 2016

For me I always look at the family max OOP - the individuals deductibles are important to look at too but I like to look at the big picture. Honestly I think I would keep her on yours until you can shop around the individual market come open enrollment time.

CuriousKiddosMama · May 2016

brij2006 said:

Okay, so we ran the numbers last night. We do have the option to put her on my H's plan at work, now. It will save us $50/month pre-tax, so likely an additional $10/month (being very conservative) once you factor in the tax advantage on that.
So a total savings of $60/month.

Individual:
His deductible is $3k, Max OOP 6,350
My deductible is $1k, Max OOP $3k.

Family:
His deductible $5k, Max OOP $13k
My deductible $3k, Max OOP 5k.

So, we ran some break even analysis, because we're both nerds like that. :-)
On his plan, it would take 3 years without a claim for us to break even with the deductible. With the max OOP, it would take 5 years. That's on individual.
With a 1 year old, I'm not sure that's a risk we should take on.

Then when you factor the family max OOP, it will take us 11 years of no claims in order to break even on that one.

I know I'm thinking worst case scenario with all of this, but I don't want to have 1 large health event that spans across 2 years/max OOP's, to clean out our savings. Just to save $60/month. Is it worth it?

@curiouskiddosmama How are you liking it so far? We're really considering doing this for DD, but I have no clue if we can get coverage for just her through them. My biggest fear with going through a ministry, is that there's a max they pay out. That scares me. I know you can "share" your needs beyond that and the results for that are pretty high that the needs are met.

This group pays up to $250k, after that it's like $300 a year for basically unlimited. And you only send the $300 if it's needed. So I like that. Until we use it ourselves the first time, and I make sure I know how to do their paperwork Right I'm going to be nervous I will screw it up to be honest. But this weekend I had to make a call between taking my youngest to urgent care before our insurance was up for a possible ear infection and paying the urgent care copay plus our 20%, or waiting until Monday and paying our pediatrician $40 for the check. Pediatrician was much cheaper, and my baby has just developed a healthy pissed off cry when he's waiting

no ear infection. So that visit was cheaper without insurance And under $300 so we paid for it. I feel better knowing he's ok

Health Insurance: Vent

Re: Health Insurance: Vent

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