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Insurance open enrollment WWYD
I need help you guys!
Soooo, this year we have to start thinking about changing up the insurance plan in case a baby makes an appearance at the end of the year.
Besides obvious benefits aside about office visits, copays being better for the PPO, it seems that the benefit of having an HSA that rolls over is what is bringing me back to the HSA option. No IF is covered at all with any of the plans, so it's a moot point anyway if that becomes an issue.
WWYD if these were your options:
ETA: I'm so dumb, I put the family deductible and OOP max down, the individual limit is half of both...why is insurance so confusing to me? I'm a smart girl!
1) PPO Standard (46.62 bi-weekly): $2000 deductible, $12000 OOP max, preventive all covered at 100%, $35 copay for all maternity office visits, 10% after deductible for hospital and related expenses
2) PPO Select (88.62 bi-weekly): $800 deductible, $4800 OOP max, preventive all covered at 100%, $35 copay for all maternity office visits, 10% after deductible for hospital and related expenses
3) Enhanced Healthfund w/ HSA (48.46 bi-weekly + HSA contributions): $3000 deductible, $6000 OOP max, preventive covered 100%, $35 copay for all maternity office visits, 10% after deductible for hospital and related expenses
Re: Insurance open enrollment WWYD
ugh. I don't know. this is hard. is it really a $12K OOP on #1??? is that per person or per family? is this coverage for both of you or just you alone?
If it's really 12K I guess I'd go with the HSA option since like you said you can roll those funds over.
also remember that if you do have a baby that is usually a qualifying event so you could change plans when you add the baby if you wanted/needed to.
I find it interesting they charge a $35 copay for maternity services - is that for every visit? I never pay a copay for all maternity care, I paid like one copay of $20 at the first one and that is it. I do have to pay a $500 inpatient fee for delivery regardless of if it is vaginal or CS.
Yeah, I for sure would not do #1. The $2k deductible gets me, too. Without insurance I wouldn't spend that much in a normal year. I also find the $35/visit to be a lot. I have a $15 copay for the first visit and none after that, plus all well baby care for the first year is 100% covered with no copay.
I don't know much about HSAs, so I can't really choose between the other two. I was inclined to think #2, but more so because I don't really know the benefits of the HSA. FWIW, I pay about $150/month to cover both of us on an HMO plus vision and dental, so the costs you are citing don't seem like a lot to me if it's for both of you.
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I'd calculate the true difference between #1 and #2 (take the biweekly payment and multiply by 26 to get your yearly payment, then add in the deductible and OOP max) and then pick that way.
Also, giving birth is a qualifying event that will allow you 30 days to make new elections. Given that maternity care sounds about equal, I wouldn't worry too much about what you choose at this point (aside from the OOP max since that's what you're looking to hit if you are pregnant and give birth before the end of 2012)
ETA: at quick glance, I'd pick #2
My quick review of the plans makes me say that #2 is your best bet. Plus baby is qualifying event, as Kara said, and you can make changes to your plan or add things within 30 days of the birth.
My HSA/FSA does not get to roll over from year to year. I am kind of surprised if they have one that does. Basically any money put in must be used that plan year.
Also, I would be surprised if you actually have to pay $35 for each maternity visit. I only paid my co-pay for my first visit and all other visits are then considered part of the same treatment so additional co-pay isn't required.
Also, DH's company puts $1000 into your HSA for you as well with that HSA plan. The difference in cost for the year for the lower deductible is $1100. I guess I'm just torn. I'd rather have the ability to access those funds we put into insurance past the plan year if that's how much we're spending on insurance/deductibles/etc., KWIM?
Is there any difference in covered providers/hospitals/etc?
Based on this info, #2 is best. You'd have to incur (if I did my very quick math right) well over $15k to hit the deductible in #3. And even if my math isn't right, #2 is $1100/yr more than #3. If you had complications - even a 15 day stay in the NICU (let's say you delivered at 35w and had an IUGR baby who's doctor's bills alone were over $17k without even having breathing assistance -just theoretically) - you'd blow through the additional $2500 in costs on #3. If you weren't thinking of TTC, I'd probably do #3 though.
ETA: I know a baby is a qualifying event, but given my example above, if you then moved to #2, what would happen to your HSA? I just think its risky.
Thanks for the info, I didn't realize that there was the difference in HSA/FSA. The two terms have always been used interchangably here.
I agree with Emily, if you are on for TTC to this year I would stick with Option 2. If you are thinking about pushing it off for another year, you could totally go with Option 3. I guess I have always been afraid of something big happening and I would rather have the lower deductible in case of that, even if it meant paying more each year to cover it.
Option #2 looks best to me. It seems to be the cheapest overall when you consider in the OOP max.
I don't know what HSA is but I am thinking it's like FSA (for us) where there's a percentage of your pay check you elect to go into a fund (before taxes) and that amount can be used for medical costs, daycare, prescriptions, etc.
CRAFTY ME
my read shelf:
You guys really haven't been exposed to HSA plans at all? That surprises me!
FSA's are just spending "use it or lose it" type accounts that you can put $$ into.
HSA's are tax exempt savings accounts, usually managed by an bank or investment fund like Fidelity or something and are tied to your insurance plan. You have to have a high deductible plan to be eligible for an HSA, but the big benefit is that you can put payroll deductions into your HSA and they roll over and accrue interest from year to year. HSA's are most useful when you're younger and don't have a lot of healthcare expenses. They are not good when you get sick a lot and have to pay office visits at full price (usually copays aren't associated with HSA plans) and you have to pay full price for non-preventive visits.
A+S | Met 8/24/06 | Married 9/27/08
Started TTC 12/2008 | dx PCOS 5/2009
6 failed clomid/femara/TI cycles, 1 failed clomid/ovidrel/IUI cycle
Successful Cycle: 5/12/11 - 1000mg Metformin + 100mg Clomid(late response) + TI = BFP
? 2/13/12 - We proudly welcomed our daughter, Hadley Teresa! ?
? Lots of Luck to all of 3T/IF ?