NWR: Health Insurance Plans

sarahufl

Open enrollment is going on right now at our jobs and we are kind of overwhelmed by options. Admittedly, insurance has always confused me anyway, just doubly so now.

H currently has a high deductible plan- his company actually gives them a decent chunk of money toward the plan. I have the choice of a high deductible but I have heard they are not great for pregnancy (we plan to start trying in the next month or 2). When I look at total out of pocket, I think it kind of makes sense for us to stay each on our own policies (the cost for adding a spouse is more than double a single person).

What do y'all do?

jenna8984

I would NEVER do a high deductible. My company offers us $750 in a HSA to take that plan and I was like fuck no. Each time you go to the doctor you pay the full amount due (not just a copay) so the first few times you go it could be $500 per visit. Until you reach your max which is usually pretty high, like $2,000. I'd much rather pay a little extra each week in my premium to be able to just go for a $30 visit or emergency. 

A woman at my work took that $750 and used it on stupid shit like massages (somehow got her doctor to say they were medical so she could use the HSA money) then she broke her ankle shoveling and bitched about how she had to come up with $2,000 for the deductibles. No one felt bad for her because if you chose that plan you have to have a plan for that happening. 

I don't have any medical issues, so I do the level in between the best and worst (silver, gold, platinum- if you have that many choices)

Cookie Pusher

DH's company won't let him add me to his insurance if my company offers insurance. I could add him to my policy, but it would cost much more than what he is paying currently. My insurance coverage is amazing, though - no deductible, 85% out-of-network coverage, etc. If he actually utilized his insurance ever, it would make sense to add him to mine, but since the man is allergic to doctors, we're each staying on our own plans for now.

Sugargirl1019

You mentioned pregnancy, do you work? you'll want to check if you need short term disability for maternity leave.

High deductibles are only good for a large family with super high medical bills. I would find out what's important to you: a low deductible? Medication coverage? And choose your plan that aligns with what is important to you. For me it was durable medical supplies and medication coverage.

holyguacamole79

H and I each have our own insurance through our own employers.  We've found it to be easier, and luckily H's employer will let him add me at any point if I lose my job for some reason.

Jells2dot0

DH and I have separate insurance plans, though we work for the same company and have the same coverage. It was cheaper that way.

We have a fairly low in-network deductible ($650 I think?) and max out of pocket of $2500. You can imagine that I hit my deductible and max out of pocket in one day this year. When all is said and done, I believe my medical bills will be close to $1M for the year.

beethery

I'm on a cheapo Anthem BCBS plan. High deductible. It is annoying because they offer no online payment options unless you either bought a plan from their Obamacare setup (they were the only one available in this state for some reason), or if you just do bill pay through your bank.

I already had a plan established with them pre-OC. I pay through my bank, and it's a good thing I did because they were so fucking overloaded with OC shit up until the deadline that they never sent me a bill until the deadline was up. It was so stupid.

My deductible is like... $6000. It's insane. If anything happens I can pay the deductible but I fucking haaaaaate this setup. FI's insurance is good shit from his union, it will be nice to be on that.

kms6169

It depends what 'high deductible' means with your employer.  I used to work in healthcare and just recently switched jobs and enrolled in a 'high deductible' plan.  My deductible is $1500 and my employer offers a 100% match of my HSA contributions, up to $1000.  This is not what I would consider a high deductible, especially after seeing single and married couples having a $6000-$10,000 deductible when I worked for a hospital system.  So for me, if I contribute ~$40 a month into my HSA, my employer matches and my deductible is generally taken care of (employer match is front loaded based on my dollar amount contribution during open enrollment).  

The good thing about an HSA is that they roll over year to year, so if you contribute enough to cover your deductible, you may not pay anything out of pocket with a baby, considering your time line. HOWEVER, check if you have a co-insurance responsibility.  That could change the whole planning process for you.  I have a 30% co-insurance, so I upped my contribution amount into my HSA to cover my deductible and to have additional monies to cover expenses.  With my analysis, I am actually paying less money for my premium and my HSA than I would be paying for a 'low deductible' plan and am able to carry tax-free money over for years to come to cover any medical bills.

I've had an HSA before at a previous employer and did not have to pay the full amount, just my co-pay for preventative visits and the remaining balance after my employer paid their share.  That could happen, I'm sure, but I haven't experienced it.

I would just do your research and see what plan is best in terms of coverage and what is most important to you.  It definitely can save you money if you both stay on your own plans for now.  An HSA plan is essentially just another form of budgeting and it definitely helps when your employer offers additional money towards it.  I don't go to the doctor very often except for preventative care and can bank that HSA money for the next few years for babies or other unforeseen circumstances.

Good luck!

theartistformerlyknownas

Do you have a cost of care calculator through the insurance company website? Use that to see how much you might actually need to pay out of pocket to have a baby, whether that is more or less than your deductible, etc.

FWIW, I would not do high deductible if you're TTC - that's a LOT of prenatal visits to pay out of pocket. I have no copay for any prenatal care beyond the first $25 visit to determine pregnancy, then it's a 550 copay plus an additional like 1300 in labs and whatnot. High deductible plans are more beneficial for people who are willing to risk not needing a doctor at all.

theartistformerlyknownas

FYI, not every HSA plan allows rollover. Mine is use it or lose it.

kms6169

@lolo883, really?  From what I understand with tax law, HSA balances are allowed to rollover up to a certain maximum for singles/famileis where Flexible Spending Accounts (FSA) are use it or lose it accounts.  My company offers an HSA and an FSA, and I have never been inclined to choose an FSA because of the limitations.  HSA's, from my understanding, are put in place to aid high deductible plans and help the insured with the high deductibles and cost of care.  I live in Ohio and thought these were federal laws, not state laws.  I could be wrong, though.  It might differ state to state, employer to employer, etc.

ETA: I'm not a tax law expert or a health insurance expert, by ANY means, just pulling from what I learned at my last job working with insurance contracts, etc and personal experience. 

jenna8984

lolo883 said:

FYI, not every HSA plan allows rollover. Mine is use it or lose it.

HSA rolls over. FSA does not. 

sarahufl

Sugargirl1019- I currently work, but I plan to leave my job when we have our first child. TBD if that arrangement will remain permanent, but that is the plan for the time being.

lolo883- We do have a cost calculator, and the total out of pocket is actually a lot lower for the high deductible, which is contrary to what I would have expected.

Our deductible is only $2600, which isn't that high. The premiums are so much lower than they are with the silver, bronze, gold option- about $42/month vs close to $300.

theartistformerlyknownas

Nope, I asked HR about it specifically. We don't have an FSA option, and the HSA does not roll over for our particular plan. It's fucked up. So now we're basically betting on whether or not I think I'll be knocked up by March in order to benefit from the HSA before the calendar year ends. :-/

kms6169

lolo883 said:

Nope, I asked HR about it specifically. We don't have an FSA option, and the HSA does not roll over for our particular plan. It's fucked up. So now we're basically betting on whether or not I think I'll be knocked up by March in order to benefit from the HSA before the calendar year ends. :-/

Well that is extremely shitty, especially since HSA's were enacted to HELP us...I know that the contribution limits for HSA/FSA changed for contributions for the 2015 tax year, but don't know that if rules were changed for HSA.  You might want to look into this more because I don't think an insurance plan can claim to offer an HSA without the option of rolling over (which would make it an FSA).  Just something to look into and again, I am not a tax lawyer or tax expert.  It just pisses me off how confusing the government and insurance companies make it for people to get proper health insurance.  Ugh.

huskypuppy14

I have amazing insurance through my company. When my husband and I got married, I added him to my insurance immediately. For 2 people in a family it's more than double a single, but my husband's premiums at his job were more than mine, so it evened out.  My company pays 90% of the premium (they used to pay 100% the first few years I worked for them), so that's a bonus too.

I have a chronic condition, that I need medication for, so insurance is really important to me. My husband rarely utilized his insurance at his job because he never was sick.

When my husband had appendicitis in September, I was so glad he was on my insurance, because we only had to pay 50 dollars for the emergency room copay, and 250 dollars for the hospital admission (haven't gotten that bill yet, but that's what we will have to pay). (Not including any prescriptions). 

If I were to get pregnant, I'd only have to pay the initial 15 dollar copay for the first doctor visit, and then all other visits are covered 100%. Then for the hospital stay, it's just 250 dollars. That's it. 

My parent's have a high deductible because my Dad's insurance is terrible at his job. My mom said they have a 10K dollar deductible. It's like what's the point of insurance.

[Deleted User]

My company has moved to only a HDHP.  The deductible for an individual though is only $1,500 ($3k for a family), and all routine checkups including OBGYN and maternity checkups are covered at 100%.  They paid 80% after deductible for all my labor and delivery related costs.  But they matched my HSA dollars 100% up to $900, so that covered my deductible plus some!  Plus all well baby visits, etc are covered.

It's really going to vary based off the coverages and limits your employers chooses for their particular plans.

JaxInBlue

DH and I are on our own, separate, employer-provided options.  It won't make sense for us to combine plans for a while - maybe when there's a little person, maybe not; it will depend on how our contributions change.  I was able to choose a plan without an annual deductible which is great because I can see my primary care doctor or GYN very easily if I need to - less worry about cost.

My plan also offers tremendous support while pregnant/trying to get pregnant.  We're trying right now, but if things don't go well, I've got great coverage for infertility testing/fertility treatments should we decide to go that route.  It's part of the reason I chose the plan I did - the maternal health coverage is more than other plans.

cupcait927

kms6169 said:

lolo883 said:

Nope, I asked HR about it specifically. We don't have an FSA option, and the HSA does not roll over for our particular plan. It's fucked up. So now we're basically betting on whether or not I think I'll be knocked up by March in order to benefit from the HSA before the calendar year ends. :-/

Well that is extremely shitty, especially since HSA's were enacted to HELP us...I know that the contribution limits for HSA/FSA changed for contributions for the 2015 tax year, but don't know that if rules were changed for HSA.  You might want to look into this more because I don't think an insurance plan can claim to offer an HSA without the option of rolling over (which would make it an FSA).  Just something to look into and again, I am not a tax lawyer or tax expert.  It just pisses me off how confusing the government and insurance companies make it for people to get proper health insurance.  Ugh.

I would highly recommend looking into this as well. It's definitely an HSA, not an HRA, correct? An HSA should've been set up as a personal bank account for you, so that you can take it with you should you leave your job and keep any money after the end of the plan year. I've just never heard of an HSA that doesn't rollover and I work for an insurance broker. HRAs and FSAs don't but an HSA def should. I hope that your employer isn't trying to penalize its employees!

SmileDamnit

sarahufl said:

Open enrollment is going on right now at our jobs and we are kind of overwhelmed by options. Admittedly, insurance has always confused me anyway, just doubly so now.

H currently has a high deductible plan- his company actually gives them a decent chunk of money toward the plan. I have the choice of a high deductible but I have heard they are not great for pregnancy (we plan to start trying in the next month or 2). When I look at total out of pocket, I think it kind of makes sense for us to stay each on our own policies (the cost for adding a spouse is more than double a single person).

What do y'all do?

I haven't read the whole thread yet but I had to jump right in b/c I'm dealing with this now. We have a 2k deductible and it BLOWS BALLS right now since I'm prego. NOTHING is covered 100% since I haven't yet met deductible, and then once I do, it's still only going to be 70%/30%. So, the only saving grace (ha!) is that I'll hit the 5k out of pocket before it's all said and done and then won't have to pay anything more . 

ETA - I'm being a little rash. OB office visits are covered 100%, but that's it. Ultrasounds, blood work, anything from the lab (urinalysis, genetic testing, etc.) goes to deductible and then the 70/30 split.

flyingfoxes

I tried to talk to FI about this the other night, because I'll be put on TriCare as soon as we're married in April so I'll have dual insurance.  We have the high deductible option here, but if I go to doctors on base, it's 100% free on TriCare.  I guess I'll stick with my regular plan and not switch to the high deductible one and just see how this next year goes before I decide. 

theartistformerlyknownas

cupcait927 said:

kms6169 said:

lolo883 said:

Nope, I asked HR about it specifically. We don't have an FSA option, and the HSA does not roll over for our particular plan. It's fucked up. So now we're basically betting on whether or not I think I'll be knocked up by March in order to benefit from the HSA before the calendar year ends. :-/

Well that is extremely shitty, especially since HSA's were enacted to HELP us...I know that the contribution limits for HSA/FSA changed for contributions for the 2015 tax year, but don't know that if rules were changed for HSA.  You might want to look into this more because I don't think an insurance plan can claim to offer an HSA without the option of rolling over (which would make it an FSA).  Just something to look into and again, I am not a tax lawyer or tax expert.  It just pisses me off how confusing the government and insurance companies make it for people to get proper health insurance.  Ugh.

I would highly recommend looking into this as well. It's definitely an HSA, not an HRA, correct? An HSA should've been set up as a personal bank account for you, so that you can take it with you should you leave your job and keep any money after the end of the plan year. I've just never heard of an HSA that doesn't rollover and I work for an insurance broker. HRAs and FSAs don't but an HSA def should. I hope that your employer isn't trying to penalize its employees!

Urgh they're being stupid with their wording, that's why. They call it a "health spending account" which isn't actually a thing. So it works like an FSA and somebody's trying to be sketchy making people think it's a health savings account.

theartistformerlyknownas

Actually @cupcait927 or anyone who knows more about this than I do... is it possible to withdraw from an FSA (we'll just call it that) for unapproved expenses and just pay the tax penalty? So if we put some money in there and I don't end up procreating before the end of the year, we don't lose it since there's no way we can spend that much on contact solution and acupuncture?

cupcait927

lolo883 said:

Actually @cupcait927 or anyone who knows more about this than I do... is it possible to withdraw from an FSA (we'll just call it that) for unapproved expenses and just pay the tax penalty? So if we put some money in there and I don't end up procreating before the end of the year, we don't lose it since there's no way we can spend that much on contact solution and acupuncture?

It depends on how it's set up. Do you have a benefits card (like a debit card) for the account? If you do, and there's a pin where you can withdraw the cash, you certainly can take the money out and use it for whatever and just pay the penalty on it. You'd have to pay back the amount that you spent plus a 20% penalty (I believe that's the current penalty percentage). 

jenna8984

lolo883 said:

Actually @cupcait927 or anyone who knows more about this than I do... is it possible to withdraw from an FSA (we'll just call it that) for unapproved expenses and just pay the tax penalty? So if we put some money in there and I don't end up procreating before the end of the year, we don't lose it since there's no way we can spend that much on contact solution and acupuncture?

I really don't think so. My dog bite happened in 2012 and I had a stack of medical bills. When I got a new job in 2013, I thought perfect I can do an FSA for $1,000 and pay off some of my bills with it untaxed. The FSA company denied every claim because it wasn't in the coverage period. I was beyond livid and was like but it's medical?! They were like no, the medical didn't happen in our coverage period. So I tried every way in hell to get that $1,000 back and spend it on other things and they wouldn't let me/ denied everything. I had a few co-pays here and there but ended up losing about $800 and I was so pissed.

theartistformerlyknownas

cupcait927 said:

lolo883 said:

Actually @cupcait927 or anyone who knows more about this than I do... is it possible to withdraw from an FSA (we'll just call it that) for unapproved expenses and just pay the tax penalty? So if we put some money in there and I don't end up procreating before the end of the year, we don't lose it since there's no way we can spend that much on contact solution and acupuncture?

It depends on how it's set up. Do you have a benefits card (like a debit card) for the account? If you do, and there's a pin where you can withdraw the cash, you certainly can take the money out and use it for whatever and just pay the penalty on it. You'd have to pay back the amount that you spent plus a 20% penalty (I believe that's the current penalty percentage). 

So the penalty is less than the amount I would have been taxed on it?! 

I have no idea whether this one is a debit card or a "mail in your receipts and we'll send you a check" kind. I haven't used it before because my BCP and annual checkups are $0 copay, so last year I didn't have to pay anything out of pocket (and I've only worked here for a year).

cupcait927

jenna8984 said:

lolo883 said:

Actually @cupcait927 or anyone who knows more about this than I do... is it possible to withdraw from an FSA (we'll just call it that) for unapproved expenses and just pay the tax penalty? So if we put some money in there and I don't end up procreating before the end of the year, we don't lose it since there's no way we can spend that much on contact solution and acupuncture?

I really don't think so. My dog bite happened in 2012 and I had a stack of medical bills. When I got a new job in 2013, I thought perfect I can do an FSA for $1,000 and pay off some of my bills with it untaxed. The FSA company denied every claim because it wasn't in the coverage period. I was beyond livid and was like but it's medical?! They were like no, the medical didn't happen in our coverage period. So I tried every way in hell to get that $1,000 back and spend it on other things and they wouldn't let me/ denied everything. I had a few co-pays here and there but ended up losing about $800 and I was so pissed.

That's the shitty thing about FSAs. You can only use the funds on expenses that occured within the plan year that you elect the FSA. So if you have an FSA in 2013, you can only use it for service dates within 2013. So even if you don't get the bill until the next plan year, you can't use the FSA to pay it since you didn't incur the service within that plan year. I HATE FSA accounts, unless you have planned monthly expenses like prescriptions or you know you need glasses or your kid needs braces.

jenna8984

cupcait927 said:

jenna8984 said:

lolo883 said:

Actually @cupcait927 or anyone who knows more about this than I do... is it possible to withdraw from an FSA (we'll just call it that) for unapproved expenses and just pay the tax penalty? So if we put some money in there and I don't end up procreating before the end of the year, we don't lose it since there's no way we can spend that much on contact solution and acupuncture?

I really don't think so. My dog bite happened in 2012 and I had a stack of medical bills. When I got a new job in 2013, I thought perfect I can do an FSA for $1,000 and pay off some of my bills with it untaxed. The FSA company denied every claim because it wasn't in the coverage period. I was beyond livid and was like but it's medical?! They were like no, the medical didn't happen in our coverage period. So I tried every way in hell to get that $1,000 back and spend it on other things and they wouldn't let me/ denied everything. I had a few co-pays here and there but ended up losing about $800 and I was so pissed.

That's the shitty thing about FSAs. You can only use the funds on expenses that occured within the plan year that you elect the FSA. So if you have an FSA in 2013, you can only use it for service dates within 2013. So even if you don't get the bill until the next plan year, you can't use the FSA to pay it since you didn't incur the service within that plan year. I HATE FSA accounts, unless you have planned monthly expenses like prescriptions or you know you need glasses or your kid needs braces.

Also not just the year but when you were enrolled in the plan. I still had lingering bills from physical therapy that were from March 2013 but I started this job in Aug 2013 so even though those were 2013 bills- they STILL weren't in the coverage period. Such fucking bullshit, I'll never get an FSA again.

cupcait927

lolo883 said:

cupcait927 said:

lolo883 said:

Actually @cupcait927 or anyone who knows more about this than I do... is it possible to withdraw from an FSA (we'll just call it that) for unapproved expenses and just pay the tax penalty? So if we put some money in there and I don't end up procreating before the end of the year, we don't lose it since there's no way we can spend that much on contact solution and acupuncture?

It depends on how it's set up. Do you have a benefits card (like a debit card) for the account? If you do, and there's a pin where you can withdraw the cash, you certainly can take the money out and use it for whatever and just pay the penalty on it. You'd have to pay back the amount that you spent plus a 20% penalty (I believe that's the current penalty percentage). 

So the penalty is less than the amount I would have been taxed on it?! 

I have no idea whether this one is a debit card or a "mail in your receipts and we'll send you a check" kind. I haven't used it before because my BCP and annual checkups are $0 copay, so last year I didn't have to pay anything out of pocket (and I've only worked here for a year).

I'm a little rusty on the penalties so I would double check with your HR office or you can google it, but I do believe there is a 20% penalty that you have to pay on any expenses that aren't deemed eligible (someone correct me if I'm wrong!).

If it's set up to mail in your receipts, you won't get anything through that isn't an approved item. Also, if you have a card attached to your account, unless you can swipe it as debit and withdraw cash, you'll most likely be required to send in receipts to substantiate the purchase. If it's deemed not eligible, you just have to pay that amount back and there's no penalty. It's only if you get audited that you would incur that penalty.

cupcait927

jenna8984 said:

cupcait927 said:

jenna8984 said:

lolo883 said:

Actually @cupcait927 or anyone who knows more about this than I do... is it possible to withdraw from an FSA (we'll just call it that) for unapproved expenses and just pay the tax penalty? So if we put some money in there and I don't end up procreating before the end of the year, we don't lose it since there's no way we can spend that much on contact solution and acupuncture?

I really don't think so. My dog bite happened in 2012 and I had a stack of medical bills. When I got a new job in 2013, I thought perfect I can do an FSA for $1,000 and pay off some of my bills with it untaxed. The FSA company denied every claim because it wasn't in the coverage period. I was beyond livid and was like but it's medical?! They were like no, the medical didn't happen in our coverage period. So I tried every way in hell to get that $1,000 back and spend it on other things and they wouldn't let me/ denied everything. I had a few co-pays here and there but ended up losing about $800 and I was so pissed.

That's the shitty thing about FSAs. You can only use the funds on expenses that occured within the plan year that you elect the FSA. So if you have an FSA in 2013, you can only use it for service dates within 2013. So even if you don't get the bill until the next plan year, you can't use the FSA to pay it since you didn't incur the service within that plan year. I HATE FSA accounts, unless you have planned monthly expenses like prescriptions or you know you need glasses or your kid needs braces.

Also not just the year but when you were enrolled in the plan. I still had lingering bills from physical therapy that were from March 2013 but I started this job in Aug 2013 so even though those were 2013 bills- they STILL weren't in the coverage period. Such fucking bullshit, I'll never get an FSA again.

Yeah that's the other shitty caveat. I'm sorry that you went through all of that hassle I used to work with FSA accounts a lot more and it was so confusing for people. I used to have one, before I got an HSA, and I would only put in enough to cover a refill on my contacts and a new pair of glasses so I was sure to not lose any money. I would see people all the time that would max out their FSA, since the contributions are pre-tax, and then lose thousands of dollars because they didn't spend anywhere near what they thought they would.

theartistformerlyknownas

cupcait927 said:

lolo883 said:

cupcait927 said:

lolo883 said:

Actually @cupcait927 or anyone who knows more about this than I do... is it possible to withdraw from an FSA (we'll just call it that) for unapproved expenses and just pay the tax penalty? So if we put some money in there and I don't end up procreating before the end of the year, we don't lose it since there's no way we can spend that much on contact solution and acupuncture?

It depends on how it's set up. Do you have a benefits card (like a debit card) for the account? If you do, and there's a pin where you can withdraw the cash, you certainly can take the money out and use it for whatever and just pay the penalty on it. You'd have to pay back the amount that you spent plus a 20% penalty (I believe that's the current penalty percentage). 

So the penalty is less than the amount I would have been taxed on it?! 

I have no idea whether this one is a debit card or a "mail in your receipts and we'll send you a check" kind. I haven't used it before because my BCP and annual checkups are $0 copay, so last year I didn't have to pay anything out of pocket (and I've only worked here for a year).

I'm a little rusty on the penalties so I would double check with your HR office or you can google it, but I do believe there is a 20% penalty that you have to pay on any expenses that aren't deemed eligible (someone correct me if I'm wrong!).

If it's set up to mail in your receipts, you won't get anything through that isn't an approved item. Also, if you have a card attached to your account, unless you can swipe it as debit and withdraw cash, you'll most likely be required to send in receipts to substantiate the purchase. If it's deemed not eligible, you just have to pay that amount back and there's no penalty. It's only if you get audited that you would incur that penalty.

Yeah that was the way I understood it. When I had one before (before they limited the crap out of what you could buy) I used it at CVS which verified everything on the spot and only charged for the approved things. But then I read somewhere about a penalty for spending on unapproved things, and thought if there was a loophole where I'd just pay the taxes on it rather than just lose all my money, I wouldn't end up any worse off than if I hadn't contributed at all. But it's not worth risking 2 grand to potentially save $560 in taxes.

Grr.