Open enrollment soon...

[TheHaitian]

Trying to decide if I should say with my current plan or go with the High Deductible plan?

Next year might be the most expensive year medical cost wise for us since we have been paying for our own insurance. Going from 1 doctor visit a year to:

- a few semen analysis
- Possible testicular semen extraction
- IVF
- OB/GYM visits
- *possible/hopeful childbirth

I am also kicking my wife off my insurance so IVF/OBGYN will be under her insurance.

So if we each have our own insurance next year, under who's insurance does the kid(s) go?

[justme]

Hard to answer that without knowing the options.

[Deleted]

Oct 20, 2014 9:03:33 GMT -5 TheHaitian said:

So if we each have our own insurance next year, under who's insurance does the kid(s) go?

One of you will have to switch to family insurance after the birth.  Whichever one is the better deal, there are no rules about whose insurance the kids go on.

[gooddecisions]

Oct 20, 2014 9:03:33 GMT -5 TheHaitian said:

So if we each have our own insurance next year, under who's insurance does the kid(s) go?

You don't need to worry about that right now. When you have a baby, you have 30 days to make a decision on whose insurance. Any bills that happen for the baby (hospital stay, pediatrician, tests) during that 30 day period will be re-billed accordingly once he/she is enrolled.

I will say that keeping my comprehensive plan for child birth turned out to be a big mistake. I still had to pay about $4000 out of pocket (for a routine pregnancy and childbirth) plus $400/month premiums. I would have come out ahead keeping the high deductible. But, your plan might be better than mine was.

[milee]

Cawiau,

Definitely get out the plan details and review them before making a decision.  Make a list of what you normally do over the year plus that extra stuff you are planning on.  Run the numbers under both scenarios to see which costs more - premium plus OOP costs.

**** Very important - also go over the doctor, lab and hospital network covered under each plan.  You may find that one or more of the plans do not cover the doctors, specialists or hospitals you might want to go to.

[TheHaitian]

Oct 20, 2014 9:04:30 GMT -5 justme said:

Hard to answer that without knowing the options.

I currently pay $60/week for a family plan and pay co-pays, limited out of pocket expenses.

If I want to maintain that plan I think it drops to $45/week for single. The High deductible plan is something like $20/week but of course it is $5,000 deductible or something like that.

But plus side get to contribute to the HSA accounts. In the past 6 years marriage we only have routine visits once a year and would have benefit from an HSA accounts.

But with the whole fertility/pregnancy thing I think next year will possibly be our most expensive year so far. So even if I go with the HDHP plan I will probably incur more than $5.000 out of pocket.

My wife is meeting with the person in charge of insurance at her job to figure out which one would be best for her once I kick her off mine come January.

[milee]

Again, run the actual numbers. If it only costs $15 more a week to keep your wife on your plan you may even find it's less expensive to keep her on your plan than to use the "free" insurance at her work. 

The devil is in the details. You really, really need to run some actual numbers and scenarios as well as making sure the docs you want are covered or you could make a big mistake.

[TheHaitian]

Oct 20, 2014 9:14:10 GMT -5 milee said:

Again, run the actual numbers. If it only costs $15 more a week to keep your wife on your plan you may even find it's less expensive to keep her on your plan than to use the "free" insurance at her work. 

The devil is in the details. You really, really need to run some actual numbers and scenarios as well as making sure the docs you want are covered or you could make a big mistake.

My company doesn't offer IVF coverage only IUI. The way it is looking we will most likely go IVF.

She works for the State of MA and they offer IVF coverage.

If I don't kick her off now, she will have to wait till July for Open Enrollment.

[TheHaitian]

Oct 20, 2014 9:09:24 GMT -5 gooddecisions said:

Oct 20, 2014 9:03:33 GMT -5 TheHaitian said:

So if we each have our own insurance next year, under who's insurance does the kid(s) go?

You don't need to worry about that right now. When you have a baby, you have 30 days to make a decision on whose insurance. Any bills that happen for the baby (hospital stay, pediatrician, tests) during that 30 day period will be re-billed accordingly once he/she is enrolled.

I will say that keeping my comprehensive plan for child birth turned out to be a big mistake. I still had to pay about $4000 out of pocket (for a routine pregnancy and childbirth) plus $400/month premiums. I would have come out ahead keeping the high deductible. But, your plan might be better than mine was.

Ouch! Ok definitely need to look closely at the details!

[justme]

Oct 20, 2014 9:11:31 GMT -5 TheHaitian said:

Oct 20, 2014 9:04:30 GMT -5 justme said:

Hard to answer that without knowing the options.

I currently pay $60/week for a family plan and pay co-pays, limited out of pocket expenses.

If I want to maintain that plan I think it drops to $45/week for single. The High deductible plan is something like $20/week but of course it is $5,000 deductible or something like that.

But plus side get to contribute to the HSA accounts. In the past 6 years marriage we only have routine visits once a year and would have benefit from an HSA accounts.

But with the whole fertility/pregnancy thing I think next year will possibly be our most expensive year so far. So even if I go with the HDHP plan I will probably incur more than $5.000 out of pocket.

My wife is meeting with the person in charge of insurance at her job to figure out which one would be best for her once I kick her off mine come January.

You also have to take into consideration that, depending on when you do IVF, your wife might not be giving birth until the next plan year. 

Also, you have to take into account your max OOP with either plan. I would think kiddos greatly increase your likelihood of using emergency healthcare. 

[The Walk of the Penguin Mich]

You just need to run the numbers both ways, Carl.  Not only that, since you are seeing a batch of specialists, you need to consider which specialists are in network or out of network and factor THAT into the equation too.  

For instance, if the reproductive specialist is in-network on your plan, even if your insurance does not cover IVF, if s/he is OON on your wife's plan, it might make sense to continue with your plan even if you have to pay OOP.  And since the procedure is very specialist driven, then you may find that you want to go with the specialist that has the best success rate, not necessarily who happens to be in network.  This is because I think that many IVF coverage only has so many rounds that will be covered.

Also consider which hospitals AND labs either of you have access to.  It might make more sense for you to go on your wife's insurance instead.

[shanendoah]

Here's another question to complicate matters.

Have you two decided that you must start IVF before next July? I know you both really want a baby, but you are also young.
And I ask this because for my friends who went the IVF route, it was actually cheaper to pay the premiums for wife to have her own insurance AND for spouse to cover her on his, and have the wife double covered than for her to only have coverage through one of them and pay co-insurance.

$15/week is $60/month. Given how many specialists you think you're going to see and what co-insurance on those might be, and given the possible complications that go with IVF and the costs that go with those, having her double covered might just be the smartest move. And, you can also talk to your HR department, but in some places, your spousal premium is less if you can show they are also covered under another policy (and therefore this policy will be secondary coverage).


Generally, double coverage works with her insurance being the primary and paying what it pays. Any patient responsibility can then be billed to your insurance (showing that the primary insurance already paid) and they will then pay (or reimburse you) for another chunk. In these cases, you want to make sure you follow the rules of the PRIMARY insurance.

Anyway, it's just a thought.

[taz157]

Oct 20, 2014 9:06:24 GMT -5 minnesotapaintlady said:

Oct 20, 2014 9:03:33 GMT -5 TheHaitian said:

So if we each have our own insurance next year, under who's insurance does the kid(s) go?

One of you will have to switch to family insurance after the birth.  Whichever one is the better deal, there are no rules about whose insurance the kids go on.

Yeah that.

FWIW, DD is on my DH's insurance and I have mine own through my employer.