A benefits WWYD?

peekaboo716

Open enrollment ends Friday for both my and DH's employer. Our plans are very similar, so I am just trying to decide which is a better option. DH wants to just compare cost based on the assumption that one of us will have a major medical event to hit the out of pocket max for the per person.

DH's plan - Premium cost is $2100 for the year for our family of four. Out of pocket max is $4000/person, $8000/family. So, looking at $6100 for the potential year's cost. There is an HSA attached. His company will put in $1000 if he contributes $200.

My Plan - Premium cost is $1800 for the year. Out of pocket max is $5000/person, $10,000/family. So, looking at $6800 for the potential year's cost. There is an HSA attached. My company will put in $1000 if I contribute $500. We currently carry insurance thru my employer.

Deductibles are half of the OOP max costs on both of our plans. Preventive covered at 100% on both. Prescription drugs apply to deductible on both. Really, very similar plans. 

So, looking at this very brief summary, which seems like the better option IYO?

financialdiva

Wow. Very similar. Did you compare premiums if just you and the kids were on yours vs DH on his? Or vice versa? I know a lot of companies pay more for just the employee vs ee and family.

If there is no difference I would choose your plan. Mostly bc I am the one who uses the insurance the most and take the kids to the dr. It's just easier if my info is associated with the insurance (SSN) bc I still don't have DH's memorized. Also, your premiums are lower.

jlaOK

It sounds like your DH's plan is the better plan overall.  It is $300 more over the year, but you make that $300 back because the HSA contribution limit is less.  That makes the premiums equal and the lower out of pocket costs the deciding factor.

aglenn

How old are the kids and how often do they get sick?  What were your health expenses this past year?  Do you have any remaining money in the HSA now?  Any planned major health expenses that make you think you need to budget for hitting the out of pocket?

I would lean towards your plan.  If you add the additional money you need to contribute to the HSA the fixed costs (premium plus HSA contribution) are equal.  Unless you really think you will hit the OOP for some reason I would prefer to pay lower premium, contribute more to my HSA, and hopefully roll some of that over into the next year.  (Of course, you can choose to contribute more than $500, too). 

FYI, keep in mind that with family coverage the deductible and OOP on an HSA plan are usually "true family" limits, meaning that you have to meet the family amount before the plan kicks in.  On other types of plans each person is limited to the individual amount but that may not be the case on the HSA so check your plan summary.

peekaboo716

I did compare the costs for just me and the kids on mine and him doing employee only, and vice versa. The costs of doing that are higher for both his and my employers plans. See how hard this is?

I admit that part of me wants to keep mine just due to the convenience factor since we already use mine. But part of me likes the idea of moving to his for the potential of the lower out of pocket costs, should that happen. I do need to find out how to roll over my HSA to his plan, since I think if I keep my HSA without being on the plan I need to pay the fees to keep it open.

financialdiva

Ugh. This is a tough one!

@aglenn is our resident benefits expert around these parts. Hopefully her comments were helpful!

aglenn

Rolling over an HSA to a new provider is no big deal if you go that route.  I've done it myself a couple of times.  Just a form you need to fill out and send to your current HSA bank directing them where to send the funds; it is a bank-to-bank transaction like rolling over a 401(k).

peekaboo716

No benefit to not electing coverage for either employer.

The kids are 7 and 5, and both are involved in sports. DH and I are in good health, and as a family, we go to the doctor basically for preventive, and the occasional ear infection or strep test.

We have about $800 in our HSA currently, and for 2013, we have only incurred about $500 in out of pocket costs for medical (dental is a different story )

DH is concerned since we did have a a kid with a broken bone in 2012, and that was very costly. I think the likelihood of hitting OOP max is low (knock on wood).

aglenn

It's just a matter of risk tolerance.  If you assume the full family OOP max, there is a $2,000 difference between the two plans but yours would give you $300 more in HSA money each year for the same fixed costs, so you would have a net difference of $1,700 in the worst case scenario.  You already have $800 in the bank in an HSA, so you're really talking about insuring yourself against a possible $900 difference.  I personally would rather hold the extra money in my HSA and get to keep it if I don't use it versus paying it in premium just in case, but your answer may differ.  Really the plans are very close to equivalent.

peekaboo716

I agree. They are just so close.

Mustardseed2007

jlaOK said:

It sounds like your DH's plan is the better plan overall.  It is $300 more over the year, but you make that $300 back because the HSA contribution limit is less.  That makes the premiums equal and the lower out of pocket costs the deciding factor.

I concur.

ASmallWonder

Have you looked at the exclusions on each plan to make sure they don't differ there?  I am in open enrollment hell right now lol  I thought we had chosen until I found the exclusions on that plans.  We've affectionately begun calling it the "Sucks you got the cancer" plan.  It excludes other biggies that we are just not willing to roll the dice on.

aglenn

@elmoali - I saw your post about that plan on another thread and I am so curious about that because I've been working in group health insurance for a long time and have never seen a true group plan that excludes cancer as a category.  That is just crazy and sounds like law suit material.

ASmallWonder

@aglenn I admit to having basically zero comprehension of insurance stuff so I suppose I could be misunderstanding the sheet.  It's a page listing all four available plans and then there's a column on the left listing a bunch of diseases.  Under each plan for each disease it either says Yes or No.  That to me was saying they will Yes cover it or No not cover it.  Does it sound that way to you?

aglenn

@elmoali - It's hard to say without seeing all the materials but it would be really unusual.  It is weird to list a bunch of yes/no indicators to diseases in general so I am not sure what's going on, but it is probably worth asking your benefits person to clarify.  Most plans cover any illness.  It seems like picking and choosing could be a discrimination issue.

ASmallWonder

@aglenn that's good to know.  It's the plan DH's company is pushing this year but that list scared me right away from it.  It's a stand alone sheet without any other context so I took it for what I assumed it meant but you're right, worth asking about.