Health Insurance Questions

[Deleted]

1. Those who had a baby with a High Deductible Health Plan (HDHP), did you hit your out of pocket max? How much is your OOP max? What's your monthly premium?

This is the first year my company is offering an HDHP but still offering the traditional one with increased the co-pays. I'm thinking the traditional health plan is still a better option for us next year when I have this baby.

Premium Difference (year) = $1700
HDHP --- Deductible = $3000 ---- OOP Max = $5000
Maternity ----- HDHP = 10% after deductible met ---- Trad = 100% covered
Maternity In-Patient ---- HDHP = 10% after deductible met ---- Trad = $250 copay per admission

With these info, I'm thinking the traditional plan is better. Right?

2. Can you use FSA/HSA to pay for prenatal vitamins? I'm having a hard time finding this info.

[zarapipe]

No advice about #1, but have your Dr. write you a persciption for the vitamins they you should be able to use your FSA

[arch01]

Are you adding the baby to your policy? What's the deductible/OOP max for the traditional plan?

We didn't have the HDHP option when I had DS, but we went on worst case scenarios. In my case, if DS had to be in the NICU or have anything outside of standard care related to birth, it was billed separately and therefore wasn't covered under my maternity coverage.

Do you have any other costs associated with the maternity-in patient for the traditional plan or is it strictly the $250 copay?

For #2, the dr has to write the prescription for them.

[Deleted]

Are you adding the baby to your policy? What's the deductible/OOP max for the traditional plan? Yes, baby will be added to the policy for no additional premium. $0 deductible/OOP

Do you have any other costs associated with the maternity-in patient for the traditional plan or is it strictly the $250 copay? Strictly $250. Before these new changes when I had DD, it was $0.

For #2, the dr has to write the prescription for them. So, over the counter are not covered? I'm wondering since when I stopped at Walgreens yesterday and bought some prenatal vitamins, my receipt said it's FSA eligible. Not sure if this may be plan specific.

[arch01]

See page 16: www.irs.gov/pub/irs-pdf/p502.pdf (I happened to have this up because I'm researching FSA crap right now!)

Yes, it appears the traditional is the way to go. I'm super jealous of your low costs!!

[Ashley&Scott]

Take the traditional plan, you'll hit the deductible & possibly the OOP if you do the HDHP plan.

Our total L&D costs were just under $20k, uncomplicated birth, epidural, 2 night hospital say ($16k me, $4k DS) Our portion was $4k. ($3k OOP max for me, $1k copay for DS)

[Deleted]

Oct 23, 2012 10:07:13 GMT -5 arch01 said:

See page 16: www.irs.gov/pub/irs-pdf/p502.pdf (I happened to have this up because I'm researching FSA crap right now!)

Yes, it appears the traditional is the way to go. I'm super jealous of your low costs!!

Thanks for the link. You're right, it's not covered.

Oct 23, 2012 10:34:37 GMT -5 Ashley&Scott said:

Take the traditional plan, you'll hit the deductible & possibly the OOP if you do the HDHP plan.

Our total L&D costs were just under $20k, uncomplicated birth, epidural, 2 night hospital say ($16k me, $4k DS) Our portion was $4k. ($3k OOP max for me, $1k copay for DS)

Thanks for sharing the numbers. I want to make sure I'm not missing anything before I finalize my health care plan election.

[sometimesrunner]

I actually didn't hit the OOP max. My deductible is $2400, oop max of $6400. After we hit the deductible everything is 80/20. BUT, a HDHP is our only option and we've maxed out our HSA for several years (7, I think) so we had plenty of money saved. Also, our employers kick in 75% of our deductible. I definitely wouldn't switch during a year you know you're going to have quite a few medical expenses.

[Deleted]

1. Those who had a baby with a High Deductible Health Plan (HDHP),
did you hit your out of pocket max? No
How much is your OOP max? $7k
What's your monthly premium? $110 This is all family coverage.

I should have elaborated here. Our deductible is $3,500. I paid just over $4,500. It was 80/20 after we hit the deductible. I had a vaginal uncomplicated delivery, no complications for DD. Similar hospital cost numbers as Ashley&Scott.

The premium difference for us was $5,500. So it wouldn't have made sense, it would have cost way more OOP. It looks like your traditional plan is better.


2. Can you use FSA/HSA to pay for prenatal vitamins? I'm having a hard time finding this info.

No idea, I just bought Target generics.

[readyin07]

I am too tired to follow the #s so here was my general experience which may or may not give you things to think about.

FWIW our OOP Max is $3,000. When I had DS#1, we had the OOP Max and then everything was covered at 100%, including RX. When I had DS#2, the insurance was crappier so after we hit our OOP max it went to 80%/20%, NOT including RX which have their own OOP max. Under both plans, kids get wellness visits covered at 100% (which includes vaccines) regardless of hitting our OOP Max.

With DS #1, the HDP was awesome. He was a January baby AND we had no issues whatsoever so basically we met our deductible when we went through L&D and were 100% covered the rest of the year. We did dermatologist visits we had been postponing and I got an echocardiogram I need every few years, but never get because it is so $$.

There are lab fees and ultrasounds that you will have to pay at or around the time of service. If your pregnancy spans two calendar years this can kind of suck if you need to have a lot of ultrasounds or any additional obgyn care for any reason. We did not so it worked out ok. With our second son, who was born in September and under "worse" coverage, the HDP was enh. I ended up needing to have an amnio which put us at our OOP Max, but it was in the same calendar year as L&D so it was fine. If they had spanned two calendar years, that would have sucked.

The way it works is that the OB's don't bill your insurance for your full OB services until after you give birth. However (at least in my doctor's office), you have to pay your portion of the deductible UP FRONT. They will stay on top of checking your deductible, but if you have to pay say $2000 by your halfway point to your obgyn, they don't report that to your insurance. So if you go to your dermatologist the week after you pay your full balance to your obgyn, your dermatologist is still charging you their full amount b/c they have no way of knowing that you will have already met your deductible though your obgyn until the obgyn bills them after your L&D. We found out the hard way this sucks. I ended up getting refunds in the two thousand dollar range from my ob's office so you are possibly putting out more money if that makes sense. Basically I had to pay about 75% of my OB payment before I had the amnio so when they billed me for the amnio it was in the full amount. We were using our HSA which didn't have enough to carry more than just the $3k for our OOP max so we just paid it. We had the money to do this so it was fine but I can see it being a problem if you are tight on income.

[Deleted]

Oct 23, 2012 12:34:21 GMT -5 readyin07 said:

FWIW our OOP Max is $3,000. When I had DS#1, we had the OOP Max and then everything was covered at 100%, including RX. When I had DS#2, the insurance was crappier so after we hit our OOP max it went to 80%/20%, NOT including RX which have their own OOP max. Under both plans, kids get wellness visits covered at 100% (which includes vaccines) regardless of hitting our OOP Max.

Wow! I thought the beauty of HDHP is that you pay $0 after you hit the OOP max. That sucks.

[cjeanette]

I buy OTC meds with my HSA card? Claritin every month. No script for it.

[arch01]

Oct 23, 2012 13:42:57 GMT -5 cjeanette said:

I buy OTC meds with my HSA card? Claritin every month. No script for it.

you aren't supposed to be able to...

2. How are the rules changing for distributions from health savings accounts (HSAs) and Archer Medical Savings Accounts (Archer MSAs) that are used to reimburse the cost of over-the-counter medicines and drugs?
A. In accordance with Section 9003 of the Affordable Care Act, only prescribed medicines or drugs (including over-the-counter medicines and drugs that are prescribed) and insulin (even if purchased without a prescription) will be considered qualifying medical expenses and subject to preferred tax treatment.
3. When will the changes become effective?
A. The changes are effective for purchases of over-the-counter medicines and drugs without a prescription after Dec. 31, 2010. The changes do not affect purchases of over-the-counter medicines and drugs in 2010, even if they are reimbursed after Dec. 31, 2010.

www.irs.gov/uac/Affordable-Care-Act:-Questions-and-Answers-on-Over-the-Counter-Medicines-and-Drugs