XP: Adding Child to Insurance - WTD?

[midwest07]

I also posted this on GotP, but thought this group might be better since you all have made these decisions and have had to live with the choice! Thanks!

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I was looking at the costs to add one child to my company's health plan. I am currently on the plan, it's a PPO, and the price is very reasonable. My husband is on an individual plan (way cheaper than his company's plan) that is a bit more than mine, it's also a PPO. Together we are paying about $330/month currently.

Here are options I am considering, and wanted to see what others are looking at.

1. All of us do the family plan at my office - PP ($1000/2000). The cost would be about 4 times (!!!) what H and I are paying in our current set-up. I am just thinking the one benefit is that office visits are covered and some other costs are covered under a PPO before you hit the deductible, and a baby in the first year is likely to have a lot of costs.

2. All of us do the family plan at my office - High Deductible Plan ($2600/$5200). The cost for a family is only slightly more than we are currently paying. The company seeds $1000 a year into the HSA as a benefit. With the lower cost of this plan, we could actually pay in the entire remaining $4200 and still be paying less in premiums and HSA pay-in than just the premiums of the PPO. Plus, hopefully we have some to keep rolling over each year. My only concern is lots of doc visits for the baby, but I guess we just pay those out of the HSA.

3. Put the baby on an individual plan like my H. I have no idea of cost or how hard this is to get.

EDIT option #4:  Put the baby on my plan at work, so employee plus child, and leave H on his plan.  With this option, would probably do the PPO.  Overall cost would be more than all of us on the family HDP, but lower than the family PPO.

Other relevant info - we both have FSAs through work. So it seems there are plenty of places to put the medical funds pre-tax to have available for the high deductible plan. H and I are healthy, no chronic conditions, except infertility (which is OOP anyway).

Is it obvious to go with the HDP??

Read more: pandce.proboards.com/thread/460193/adding-child-insurance-plans#ixzz3fDsbLe9K

[arch01]

I think that you're making a big assumption about the costs for a baby in the first year. Preventative visits should be covered. Granted, you won't know much til the kid gets here, but still.

Individual plan for the baby-we found that BCBS was the only provider that would do a plan for a minor without an adult on it.

What about adding the baby to yours or your H's? What's the cost there?

Honestly I'm a fan of the HDHP IF you either A) are all very healthy or B) know you'll hit your OOP max.

[arch01]

Also, one other benefit of the HDHP over the PPO that a lot of people forget about is that with a traditional plan you still have copays. That can add up quickly.

[midwest07]

Jul 7, 2015 11:20:03 GMT -5 arch01 said:

I think that you're making a big assumption about the costs for a baby in the first year. Preventative visits should be covered. Granted, you won't know much til the kid gets here, but still.

Individual plan for the baby-we found that BCBS was the only provider that would do a plan for a minor without an adult on it.

What about adding the baby to yours or your H's? What's the cost there?

Honestly I'm a fan of the HDHP IF you either A) are all very healthy or B) know you'll hit your OOP max.

Do you think I am assuming the costs will be higher than they will be?  When you say preventative visits are covered - does that mean the monthly visits/vaccines/etc are covered even in a HDP?  I assume we would be paying office visits for this.

If we just add the baby to mine, it adds about $100-200 to what I am currently paying for my PPO (depending on if we did the PPO or HDP).  But that still leaves H out there on his own, and it would be cheaper overall to bring him onto my plan as a family if we do the HDP.  If baby and I are on the employee plus child PPO, I guess we leave him on his own plan.

His work healthcare is outrageous, not an option to add us to his.  They basically have one cadillac PPO plan that is super pricey.

 

[midwest07]

Jul 7, 2015 11:22:52 GMT -5 @cookiemonster03 said:

2 seems like the best option here.

But is there a parent/child option at your work? That's a lot cheaper for me than the family plan.

Yes - you are right - I left that out but added to my response just above.  We could do employee plus child on the PPO, and leave H on his own plan.  That is still a higher cost than putting us all on the HDP, but a good option if a PPO is best for a younger child.

[carifly]

Do you have savings to cover the full deductible amount if you had health expenses before you had funded the HSA? I think HDHP with HSAs are great options unless you would possibly be in a situation where you have medical expenses before you've been able to find the HSA to cover the deductible. If that isn't an issue for you, the HDHP can be an excellent option. With a traditional PPO, you are out the premiums regardless of whether you get sick, and although you can put money into an FSA to help with copays, there is still a lot of guessing involved.

A HDHP with an HSA lets you reduce your premiums and then use the HSA as a savings/investment for future health expenses if you don't need it that year (unlike an FSA). And with both plans well-child visits should be covered at no cost, so you might not actually end up having significant baby-related health expenses unless there are unexpected issues.

[thebreakfastclub]

A 4th option is to purchase cover for your child through your state's health insurance program for children. Premiums are income based.

My son had one non well child visit in his first year (and one in his second year too). All well checks are covered 100% as preventative care.

[arch01]

Jul 7, 2015 11:27:46 GMT -5 midwest07 said:

Jul 7, 2015 11:20:03 GMT -5 arch01 said:

I think that you're making a big assumption about the costs for a baby in the first year. Preventative visits should be covered. Granted, you won't know much til the kid gets here, but still.

Individual plan for the baby-we found that BCBS was the only provider that would do a plan for a minor without an adult on it.

What about adding the baby to yours or your H's? What's the cost there?

Honestly I'm a fan of the HDHP IF you either A) are all very healthy or B) know you'll hit your OOP max.

Do you think I am assuming the costs will be higher than they will be?  When you say preventative visits are covered - does that mean the monthly visits/vaccines/etc are covered even in a HDP?  I assume we would be paying office visits for this. Yes-monthly visits should all be covered. Check the terms of the HDHP, DS is on a HDHP on his own and his were covered at no cost. We had 2 (I think) non-well visits in the first year. Once they hit 18 months they can go go Minute Clinic, which is awesome because it's cheaper than what you'll pay at the pedi. Each person has their own opinion on that though.

If we just add the baby to mine, it adds about $100-200 to what I am currently paying for my PPO (depending on if we did the PPO or HDP).  But that still leaves H out there on his own, and it would be cheaper overall to bring him onto my plan as a family if we do the HDP.  If baby and I are on the employee plus child PPO, I guess we leave him on his own plan. I'd still go the HDHP then. Honestly, every year we go through the following exercise:

DH, DS and myself all on separate plans: add premiums+OOP max+deductibles+projected copays

Same math as above with DH/DS on one plan, me on a separate plan.

Same math as above with Me/DS on one plan, DH on a separate plan.

I don't have a HDHP option at work but we may soon. It ends up cheaper for all of us to be on separate plans each time. The one thing I have to watch out for though is because DS is on a HDHP on his own, he isn't allowed to have a HSA. I have a FSA to cover some guaranteed expenses and a little extra each year.



His work healthcare is outrageous, not an option to add us to his.  They basically have one cadillac PPO plan that is super pricey.

 

[midwest07]

Jul 7, 2015 11:32:03 GMT -5 carifly said:

Do you have savings to cover the full deductible amount if you had health expenses before you had funded the HSA? I think HDHP with HSAs are great options unless you would possibly be in a situation where you have medical expenses before you've been able to find the HSA to cover the deductible. If that isn't an issue for you, the HDHP can be an excellent option. With a traditional PPO, you are out the premiums regardless of whether you get sick, and although you can put money into an FSA to help with copays, there is still a lot of guessing involved.

A HDHP with an HSA lets you reduce your premiums and then use the HSA as a savings/investment for future health expenses if you don't need it that year (unlike an FSA). And with both plans well-child visits should be covered at no cost, so you might not actually end up having significant baby-related health expenses unless there are unexpected issues.

Yes - we could cover with savings until we have the HSA built up.  I really like the idea of rolling over the funds in the HSA rather than having to guess with the FSA.  It hasn't been an issue the last 2 years with the FSA because fertility treatments ate it all up quickly, but could be going forward.

[Ashley&Scott]

We did option 4 & I'm happy we did. M had tear duct surgery twice in the first year & tons of sick visits. We hit our OOP max that year. 

I'm assuming your baby isn't born yet. What are the maternity coverages of the two plans?

Also if you switch plans after the birth from your current PPO to the HDP you would want to make sure the amounts you paid toward your previous plan's OOP max & deductibles transfer. I would hate for you to pay the deductible/OOP max for L&D then have that not count towards your OOP max on the new plan.

[huskymom]

Definitely #2. I hit my deductible with the birth ($3750) but my additional $2k out of pocket max, with 10% co-insurance? Didn't hit it last year. However, we have $0 in premiums. Other than that, I've had $0 in costs for the baby, since she's had no sick visits and wellness appts are covered 100%.

I don't think you can have a FSA (for medical purposes) AND the HSA. There are limited FSAs for vision/dental maybe that can be used in conjunction? Definitely check, and clear out your FSA before you switch!

[midwest07]

Jul 7, 2015 11:53:32 GMT -5 Ashley&Scott said:

We did option 4 & I'm happy we did. M had tear duct surgery twice in the first year & tons of sick visits. We hit our OOP max that year. 

I'm assuming your baby isn't born yet. What are the maternity coverages of the two plans?

Also if you switch plans after the birth from your current PPO to the HDP you would want to make sure the amounts you paid toward your previous plan's OOP max & deductibles transfer. I would hate for you to pay the deductible/OOP max for L&D then have that not count towards your OOP max on the new plan.

Baby is due in October, so I would switch after that (both because it's a qualifying event and October happens to be my office open enrollment period).  So unless there are any lingering complications of delivery, the maternity coverage would be on the PPO plan.

I will have to look into any deductible payments transferring, but I am guessing they wouldn't since it's also a new plan year, if that makes sense.

[midwest07]

Jul 7, 2015 12:20:14 GMT -5 huskymom said:

Definitely #2. I hit my deductible with the birth ($3750) but my additional $2k out of pocket max, with 10% co-insurance? Didn't hit it last year. However, we have $0 in premiums. Other than that, I've had $0 in costs for the baby, since she's had no sick visits and wellness appts are covered 100%.

I don't think you can have a FSA (for medical purposes) AND the HSA. There are limited FSAs for vision/dental maybe that can be used in conjunction? Definitely check, and clear out your FSA before you switch!

Good point, I think you are right.  We do have limited FSAs and I wasn't sure what that was for.  I think we are about out of the FSA $$ for this plan year, so it will be used up before we switch.

[midwest07]

Jul 7, 2015 11:58:31 GMT -5 @cookiemonster03 said:

For option 4- how does your OOP max compare (the potential cost of premiums and deductibles and general OOP) between the family HD plan and the split PPO?

Unless you're expecting medical issues (knock on wood and all) I wouldn't expect infants to be wildly expensive in the first year. Well visits are covered. My kids started daycare at 5 mo and were each at the pedi 1-2x a month for 4ish months, but even OOP that's only like $1-2k each tops, so without other issues, you may very well not hit the HD deductible.

I would need to do some more math to figure that out, but good point.

[Ashley&Scott]

Jul 7, 2015 13:03:07 GMT -5 midwest07 said:

Jul 7, 2015 11:53:32 GMT -5 Ashley&Scott said:

We did option 4 & I'm happy we did. M had tear duct surgery twice in the first year & tons of sick visits. We hit our OOP max that year. 

I'm assuming your baby isn't born yet. What are the maternity coverages of the two plans?

Also if you switch plans after the birth from your current PPO to the HDP you would want to make sure the amounts you paid toward your previous plan's OOP max & deductibles transfer. I would hate for you to pay the deductible/OOP max for L&D then have that not count towards your OOP max on the new plan.

Baby is due in October, so I would switch after that (both because it's a qualifying event and October happens to be my office open enrollment period).  So unless there are any lingering complications of delivery, the maternity coverage would be on the PPO plan.

I will have to look into any deductible payments transferring, but I am guessing they wouldn't since it's also a new plan year, if that makes sense.

Still worth checking into. Our plan year restarts on Sept. 1 but for us the deductible & OOP max is calendar year.