Prioritize health insurance premiums or paying for care?

[liulu]

Lurker here - I would love some input.

My husband is paid as a partner, so our health insurance premiums are not pre-tax (as I understand it). His premiums are paid by the firm and are included in his taxable income. The rest of us have had an individual health plan since he began as a partner. 

Right now I and the kids have an HDHP with really low premiums per month (about $200) but a high deductible (family $11,900 with coinsurance 100% after that in network). My son sees a couple of specialists and my daughter sees one (once a year). I'm pregnant and our current plan doesn't cover maternity but I'm using a midwife anyway. We've fully funded our HSA for 2014.

I'm trying to decide if we should join my husband's plans so that I have maternity coverage just in case. My hangup is that we'd pay at LEAST $550 a month in premiums and the coinsurance max for that plan is $10,000. It doesn't make sense to me to pay more in premiums if I could instead put that away in our HSA tax-free. Am I thinking about this wrong?

Thanks!


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[mich1]

I would, especially now. Even though it seems like with this high deductible, it is obscenely easy to reach it in the hospital and depending upon when your insurance year falls, you could be looking at 2 deductibles, not just one. I'd also factor in what your max out of network OOP would be too.

When I got sick, my problem took me a year to resolve. However, my insurance year ended about halfway through this. So for 2 years, I met my $1500 in network deductible and because I chose the best surgeon I could find, my $4500 out of network deductible. So in one year, I was out $12K in deductibles and probably another $2000 in costs that were not covered at all.

Total bills for 4 surgeries, a combined month in the hospital and another month in rehab = $750K.

[liulu]

mich1, you're saying you'd choose a lower deductible/OOP plan even if the premiums were higher?

The max OOP if we go out of network is a huge difference, so I can see that.

[mich1]

Yep. You can always change after the birth, if there are no issues. However, if I was getting ready to give birth, I would want the best coverage I could find just so that I could deal with anything that could possibly happen.

Like I said, if you need a specialist, you will want the best specialist that you can find. Having this flexibility takes a HUGE burden off of you. It is not uncommon for a premature birth bills to reach $1M, with many different specialists involved in care.

My issue was that I had hip problems and knew I would need to have surgery. I had no idea how bad it would get, but as the potential was there, I covered myself to the hilt to make sure that I could cover any contingency that could hit. I was fortunate in that I was so well covered such that my costs were relatively low and I could cover them. If you have a $10K deductible in network, you are looking at the potential for $20K plus (again, depending on when you are giving birth and what date your insurance year turns over) what any OON charges are in a worst case scenario.

[liulu]

Thanks, mich1. I needed that little push!

[Deleted]

There are so many things that could happen in a birth/pregnancy that could cost into the many thousands. I could be wrong but even a c-section would likely cost more than your deductible, I think, and those are so common. Hopefully everything will go well and you'll have a simple birth, but I'd want to be covered in case of worst case scenario.

This is also why I pay $230 a month for just me with a $4500 deductible. Hopefully I won't need to use it, but I'll be glad I have it if the worst happens and I need many thousands of dollars of medical care.

[Deleted]

If you don't have maternity coverage, your plan doesn't comply with ACA guidelines, so I'm not sure how you have it anyway.

That said, spending a little bit more for a short time until your child is born is well worth it to me. After the birth, that is a qualifying event to change to another plan.

[liulu]

I appreciate the other replies! This wasn't a planned pregnancy, or I'd have switched before (oops).

mrsspunky, we've had this plan for two years now so I assume it's grandfathered.

You all are right, I should have maternity just in case. We actually had the unthinkable happen during our first pregnancy, so maybe I'm in denial something could go wrong again. We'll be switching for sure.

[af1212]

Dec 18, 2014 21:48:04 GMT -5 @mrsspunky said:

After the birth, that is a qualifying event to change to another plan.

This is not true of the two different health plans I have been on after having a child. It was a qualifying life event to add a dependent to the insurance plan but no other changes could be made. I would definitely check into it.

[Deleted]

Dec 19, 2014 9:50:35 GMT -5 af1212 said:

Dec 18, 2014 21:48:04 GMT -5 @mrsspunky said:

After the birth, that is a qualifying event to change to another plan.

This is not true of the two different health plans I have been on after having a child. It was a qualifying life event to add a dependent to the insurance plan but no other changes could be made. I would definitely check into it.

I sell health insurance so I deal with this all the time. Perhaps it is your company's limitations, but it is not a carrier or USDoL rule

[af1212]

Dec 19, 2014 10:03:05 GMT -5 @mrsspunky said:

Dec 19, 2014 9:50:35 GMT -5 af1212 said:

This is not true of the two different health plans I have been on after having a child. It was a qualifying life event to add a dependent to the insurance plan but no other changes could be made. I would definitely check into it.

I sell health insurance so I deal with this all the time. Perhaps it is your company's limitations, but it is not a carrier or USDoL rule

I'm sure it is the company's rule then - everything else about their health insurance sucks so I'm sure they want to be consistent

[Deleted]

I would calculate the annual premium + max oop for both insurances and go with the lower one, even if you go with a midwife. You never know. I had an easy delivery but due to some bad luck, our family's medical expenses this year are in the 6 figures (if we didn't have insurance).