Finance help - How much FSA to take out for 2011

laceysmom82 · November 2010

I'm not sure how much a vaginal/no complications delivery costs (who would I call to find out?) but, planning that that is what happens, here is the breakdown of my insurance plan:

Hospital Services

Room, Board 70%

Anesthesia, lab, x-ray 70%

Emergency Room 70%

Out Patient 70%

Deductible

Individual $ 600

Out of Pocket Limit

Individual $4,500

ETA: Co-insurance 70%/30%

So I know right off the bat I'll owe $600, but I could potentially owe $4,500? How much would you take out for FSA just for the cost of having a baby?

Doodle2011 · November 2010

I take out $1000 just for me and it's never enough. Keep in mind you can use FSA for your whole household, so anything for a family member in your house can be submitted too.

wmramsel · November 2010

What is FSA? (sheepishly hides head in shame)

Doodle2011 · November 2010

wmramsel:
What is FSA? (sheepishly hides head in shame)

pre-tax dollars withheld from your paycheck that can be used for certain medical and dependent care expenses...you submit the receipts for reimbursement out of the funds that were withheld.

wmramsel · November 2010

hollyh74:
wmramsel:
What is FSA? (sheepishly hides head in shame)
pre-tax dollars withheld from your paycheck that can be used for certain medical and dependent care expenses...you submit the receipts for reimbursement out of the funds that were withheld.

Hmmm, I should go research this, I don't know anything about it!

MichelleL1118 · November 2010

Call your hospital and ask for their billing department. Ask them how much a vaginal birth w/ no complications runs (they may ask for your insurance info to verify the insurance-negotiated rates before providing you with an estimate). Also ask for a ballpark figure of what the anesthesiologist charges for an epi, in case you end up with one.

It looks like your insurance pays 70% of all charges, after the deductible is met, up to the $4500, which means you will hit your OOP max with $14600 in medical bills. I could be wrong, but I think that's probably in the realm of reasonable charges at most hospitals, including OB fees for delivery & anesthesiologist fees.

If I were you, I'd probably max out my FSA at the OOP max for the year... if you don't use it all at delivery, you'll use it with pediatrician co-pays, prescriptions, etc over the course of the year.

Doodle2011 · November 2010

wmramsel:
hollyh74:
wmramsel:
What is FSA? (sheepishly hides head in shame)
pre-tax dollars withheld from your paycheck that can be used for certain medical and dependent care expenses...you submit the receipts for reimbursement out of the funds that were withheld.
Hmmm, I should go research this, I don't know anything about it!

it's an employee benefit that you can elect during open enrollment...your employer pays the plan fees and is also on the hook for your reimbursements, ie: on Jan 2nd you can submit the full amount you are having withheld for the year, and if you leave the company they can't come back for those amounts. They eat it. However it is also use it or lose it, so if you don't submit your claims or have more withheld than you needed, you lose the money.

Mrs.CFH2 · November 2010

MichelleL1118:
Call your hospital and ask for their billing department. Ask them how much a vaginal birth w/ no complications runs (they may ask for your insurance info to verify the insurance-negotiated rates before providing you with an estimate). Also ask for a ballpark figure of what the anesthesiologist charges for an epi, in case you end up with one.

It looks like your insurance pays 70% of all charges, after the deductible is met, up to the $4500, which means you will hit your OOP max with $14600 in medical bills. I could be wrong, but I think that's probably in the realm of reasonable charges at most hospitals, including OB fees for delivery & anesthesiologist fees.

If I were you, I'd probably max out my FSA at the OOP max for the year... if you don't use it all at delivery, you'll use it with pediatrician co-pays, prescriptions, etc over the course of the year.

This. Charges at my hospital for a delivery with no complications range from $10k-$14k and that doesn't include the baby's stay. We can take out a max of $5k, but we did $4500....we might be able to up it to $5k though and I'm considering doing that. Between my delivery and the baby's stay, we'll probably hit about $4500 alone.

laceysmom82 · November 2010

MichelleL1118:

It looks like your insurance pays 70% of all charges, after the deductible is met, up to the $4500, which means you will hit your OOP max with $14600 in medical bills. I could be wrong, but I think that's probably in the realm of reasonable charges at most hospitals, including OB fees for delivery & anesthesiologist fees.

Can you explain how you got this number?! I about fell out of my chair. I think the max I can take out for FSA is $5,000, is that what I should do?

If a normal uncomplicated delivery is $10,000 - I will owe no more than $4,500? or is that not right?

Mrs.CFH2 · November 2010

laceysmom82:
MichelleL1118:

It looks like your insurance pays 70% of all charges, after the deductible is met, up to the $4500, which means you will hit your OOP max with $14600 in medical bills. I could be wrong, but I think that's probably in the realm of reasonable charges at most hospitals, including OB fees for delivery & anesthesiologist fees.

Can you explain how you got this number?! I about fell out of my chair. I think the max I can take out for FSA is $5,000, is that what I should do?

If a normal uncomplicated delivery is $10,000 - I will owe no more than $4,500? or is that not right?

Is $4500 the max co-insurance? Or the total max? Usually they tell you the max co-ins. For example, I think mine (for individual) is a deductible of $500 and then a max co-ins of $2k. So for me alone, I will pay a max of $2500 a year. This has nothing to do with LO though.

I might end up on my H's insurance though, and I think for family, it is something like a $500 deductible and then a max co-ins up to $4k for family (at 90%). So, total, max for the year we'd be out $4500 for the whole family- obviously plus our premium which is pre-tax as well.

Mrs.CFH2 · November 2010

Oh and just for more information. Our baby's stay (uncomplicated) will range anywhere from $2k-$4k.

For you though, let's say your L&D costs come in at $15k- which is a fairly reasonable amount, you will pay $600 up front (as your deductible).

So 15,000-$600 = $14,400.

Then you pay 30% up to $4500 for your co-ins (at least that's what it appears).

So $14,400 x 30% = $4320

$600 (deductible) + $4320 (co-ins)- you will pay about $4920.

Keep in mind, this is purely an example. And if it's what I think, you would be out a total max (for individual) of $5100 which is your deductible and your co-ins added together.

MichelleL1118 · November 2010

Mrs.CFH2:

Oh and just for more information. Our baby's stay (uncomplicated) will range anywhere from $2k-$4k.

For you though, let's say your L&D costs come in at $15k- which is a fairly reasonable amount, you will pay $600 up front (as your deductible).

So 15,000-$600 = $14,400.

Then you pay 30% up to $4500 for your co-ins (at least that's what it appears).

So $14,400 x 30% = $4320

$600 (deductible) + $4320 (co-ins)- you will pay about $4920.

Keep in mind, this is purely an example. And if it's what I think, you would be out a total max (for individual) of $5100 which is your deductible and your co-ins added together.

Yep, that's how I did the math. Smile

MichelleL1118 · November 2010

Mrs.CFH2:

Oh and just for more information. Our baby's stay (uncomplicated) will range anywhere from $2k-$4k.

For you though, let's say your L&D costs come in at $15k- which is a fairly reasonable amount, you will pay $600 up front (as your deductible).

So 15,000-$600 = $14,400.

Then you pay 30% up to $4500 for your co-ins (at least that's what it appears).

So $14,400 x 30% = $4320

$600 (deductible) + $4320 (co-ins)- you will pay about $4920.

Keep in mind, this is purely an example. And if it's what I think, you would be out a total max (for individual) of $5100 which is your deductible and your co-ins added together.

Yep, that's how I did the math. Smile

laceysmom82 · November 2010

MichelleL1118:
Mrs.CFH2:

Oh and just for more information. Our baby's stay (uncomplicated) will range anywhere from $2k-$4k.

For you though, let's say your L&D costs come in at $15k- which is a fairly reasonable amount, you will pay $600 up front (as your deductible).

So 15,000-$600 = $14,400.

Then you pay 30% up to $4500 for your co-ins (at least that's what it appears).

So $14,400 x 30% = $4320

$600 (deductible) + $4320 (co-ins)- you will pay about $4920.

Keep in mind, this is purely an example. And if it's what I think, you would be out a total max (for individual) of $5100 which is your deductible and your co-ins added together.

Yep, that's how I did the math.

A+ for both you girls - you're so smart!!

There was a line about co-insurance, but I left that out (thought it only applied if you had another insurance policy Embarrassed ), can't remember what it was now, will see if I have that info at home.

laceysmom82 · November 2010

I looked it up, for co-insurance it says 70%/30%

and the Out of Pocket maximum is $4,500.

Help?

sweettea_and_peonies · November 2010

One other thing to keep in mind (although OP asked about just HAVING the baby) but this is fresh on my mind b/c DH and I were discussing last night: Insurance companies differ on what applies to your OOP max. Typically your deductible does not apply, and I believe it's typical for prescriptions to not apply to that either. It's possible lab work or things like that may also not apply. Which is to say that your "OOP max" might be $4500, but you could end up paying $6000 by the time the year is up based on all of the other factors. Just something to check with your insurance for planning purposes.

laceysmom82 · November 2010

brittanytx26:
One other thing to keep in mind (although OP asked about just HAVING the baby) but this is fresh on my mind b/c DH and I were discussing last night: Insurance companies differ on what applies to your OOP max. Typically your deductible does not apply, and I believe it's typical for prescriptions to not apply to that either. It's possible lab work or things like that may also not apply. Which is to say that your "OOP max" might be $4500, but you could end up paying $6000 by the time the year is up based on all of the other factors. Just something to check with your insurance for planning purposes.

Thanks for the tip!!

KatInTheHat28 · November 2010

brittanytx26:
One other thing to keep in mind (although OP asked about just HAVING the baby) but this is fresh on my mind b/c DH and I were discussing last night: Insurance companies differ on what applies to your OOP max. Typically your deductible does not apply, and I believe it's typical for prescriptions to not apply to that either. It's possible lab work or things like that may also not apply. Which is to say that your "OOP max" might be $4500, but you could end up paying $6000 by the time the year is up based on all of the other factors. Just something to check with your insurance for planning purposes.

This for sure. My insurance doesn't count the deductible OR co-pays towards the OOP max. So I will basically never hit my OOP max because most of my insurance payments are co-pays. Annoying!

Mrs.CFH2 · November 2010

laceysmom82:
I looked it up, for co-insurance it says 70%/30%

and the Out of Pocket maximum is $4,500.

Help?

Then what I said is exactly right. Your insurance will pay 70% of your charges. Then you pay the remaining 30% but UP TO an annual amount of $4500, plus your $600 deductible. So even if your L&D costs were $20k, the most you would pay is $5100. Make sense? So you could probably safely take out the max of $5000, because you will get close to that with just the delivery costs and depending on how your baby's insurance goes, that would probably put you over the $5k. Then keep in mind, you still have the remainder of the year to spend whatever didn't get spent on co-pays, prescriptions, etc. Let me know if you have any other questions. I was seriously confused on all this stuff until I realized I really needed to figure it out for budgeting purposes!

laceysmom82 · November 2010

Mrs.CFH2:
laceysmom82:

I looked it up, for co-insurance it says 70%/30%

and the Out of Pocket maximum is $4,500.

Help?

Then what I said is exactly right. Your insurance will pay 70% of your charges. Then you pay the remaining 30% but UP TO an annual amount of $4500, plus your $600 deductible. So even if your L&D costs were $20k, the most you would pay is $5100. Make sense? So you could probably safely take out the max of $5000, because you will get close to that with just the delivery costs and depending on how your baby's insurance goes, that would probably put you over the $5k. Then keep in mind, you still have the remainder of the year to spend whatever didn't get spent on co-pays, prescriptions, etc. Let me know if you have any other questions. I was seriously confused on all this stuff until I realized I really needed to figure it out for budgeting purposes!

You are awesome, thanks for your help!! Now, how do I figure out the baby's insurance? Would that be whatever the out of pocket max is for "Family" insurance instead of "Individual"?

For my insurance, this is what it changes to when I change to "Family" which wouldn't be until baby is born.

Deductible - $900

Out of pocket maximum - $9.000

Co-insurance - 70%/30%

mishu917 · November 2010

I didn't take out an FSA but now that you guys are talking about it, I should have. My insurance right now has a co-pay which is small, but my doctor will bill me a lump sum once the baby is born next year. I should have taken out an FSA to cover those charges. I changed my insurance to no deductible/ 100% coverage from January because this seemed like the best plan for a woman of child bearing age. No worries about next year. I guess going to the doctor for about 16-20 times this year shouldn't be too much??

Does FSA for next year cover this year's expenses though? Because I can start it up next year once the baby is born.... Anyone?

laceysmom82 · November 2010

I'm enrolling now for my 2011 expenses. It's all a guess as to how much my expenses will be in 2011, that's why I was asking for help about the estimated cost of having a baby. For instance, for 2010 I took out $600 for the FSA and I've still got $200 left to use before December 31, 2010 - if I don't use it that money is gone!

mishu917 · November 2010

laceysmom82:
I'm enrolling now for my 2011 expenses. It's all a guess as to how much my expenses will be in 2011, that's why I was asking for help about the estimated cost of having a baby. For instance, for 2010 I took out $600 for the FSA and I've still got $200 left to use before December 31, 2010 - if I don't use it that money is gone!

Oh bummer. Does your doctor bill you like mine does? Maybe you can pay for some of the prenatal visits? IDK...

miliamp · November 2010

I"ll verify this tomorrow, during our open enrollment session, but I understand that you can change your FSA amount in the event of a life changing event. So you can put in what you want now, but you'll be able to change it once you find out details from the hospital. I guess this would help if the hospital does their billing pretty quickly (within 30 days of delivery). Just a thought.

laceysmom82 · November 2010

miliamp:
I"ll verify this tomorrow, during our open enrollment session, but I understand that you can change your FSA amount in the event of a life changing event. So you can put in what you want now, but you'll be able to change it once you find out details from the hospital. I guess this would help if the hospital does their billing pretty quickly (within 30 days of delivery). Just a thought.

Be sure and let us know what you find out. I'll have to ask HR tomorrow about this as well.

To the OP - I have not had to pay a.single.dime for any of my ob visits...kinda scary!!

Mrs.CFH2 · November 2010

laceysmom82:
Mrs.CFH2:
laceysmom82:

I looked it up, for co-insurance it says 70%/30%

and the Out of Pocket maximum is $4,500.

Help?

Then what I said is exactly right. Your insurance will pay 70% of your charges. Then you pay the remaining 30% but UP TO an annual amount of $4500, plus your $600 deductible. So even if your L&D costs were $20k, the most you would pay is $5100. Make sense? So you could probably safely take out the max of $5000, because you will get close to that with just the delivery costs and depending on how your baby's insurance goes, that would probably put you over the $5k. Then keep in mind, you still have the remainder of the year to spend whatever didn't get spent on co-pays, prescriptions, etc. Let me know if you have any other questions. I was seriously confused on all this stuff until I realized I really needed to figure it out for budgeting purposes!

You are awesome, thanks for your help!! Now, how do I figure out the baby's insurance? Would that be whatever the out of pocket max is for "Family" insurance instead of "Individual"?

For my insurance, this is what it changes to when I change to "Family" which wouldn't be until baby is born.

Deductible - $900

Out of pocket maximum - $9.000

Co-insurance - 70%/30%

Quick answer: just take out the max. You will definitely reach $5000 between you and the baby.

Longer answer: You should call the hospital to find out what the average cost for a baby's stay is. Like I said, mine is $2k-$4k, but that could definitely vary for you. BUT, let's say it was $3k for you, we'll stick with my $15k example for you before.

Total cost $15k (mom) + $3k (baby) = $18k.

$18k-$900 (deductible) = $17,100

$17,100 x 30% = $5130

Total cost for you $900 (deductible) + $5130 (co-ins) = $6030.

So...you would definitely max out your FSA allowance of $5k. Now, the only thing I want to point out, is if you had your baby in December, the FSA wouldn't apply since you are enrolling now for 2011. Does that make sense too? I think what pp said is correct, that with a life changing event (i.e. having a baby) you should be able to change your amount w/i 30 days of that event. Now, I need to figure that out for my sake as well to be certain, but I think that is the case. So you could always take out a small amount now and take the rest out when you have the baby- just to be sure that you actually have the baby in January.

Now, for your extra FSA money this year, keep in mind with our wonderful healthcare changes ( Confused ) a lot of things won't be covered next year. If you have extra money this year, stock up on any OTC products such as Tylenol, contact solution, bandages, etc. Many of the things currently covered, will no longer be covered in 2011.

laceysmom82 · November 2010

You have been a HUGE help! Thanks! Big Smile

miliamp · December 2010

THanks for all the information on this thread..

I did check with our plan, and babies are life changing, so of course you can change almost all your benefit enrollment options

Finance help - How much FSA to take out for 2011

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