Question for those that are insurance savvy!

kimberm0511 · January 2013

I'm going to try to make this not too long, but my dh's company has been bought out and they are switching insurance companies. First of all, our current insurance covers a little bit of infertility. They covered IUIs and monitoring appointments up to $5000. The best thing was their prescription coverage. They do/did NOT cover IVF treatments. For those that have kept up with me, you know that we did IVF and will be doing a FET cycle as soon as we get the go ahead. Therefore, we have paid oop for the past couple of months. We did have some awesome prescription coverage though, which helped with all of the drugs!

New insurance completely sucks. They do not cover infertility at all. This doesn't other me too terribly bad, because we were already prepared to pay oop for FET and luckily, there won't be as many drugs involved. His company will now be offering a regular insurance plan (I think it may be an HMO) and also a HSA. I have always been told not to do HSA if you go to the doctor a lot. The deductible is crazy high, but after that everything is covered 100%. Regular insurance plan - low deductible, REALLY high premiums. 80% covered after deductible. Neither covers infertility, of course, so that doesn't even matter.

Ugh..after everything we've gone through I hate that we have to deal with insurance. But, what should we do? It seems as though we will be spending a crap ton of money either way, but what do you use and why?

kimberm0511 · January 2013

I forgot to add that dh is actively looking for a new job...so hopefully the insurance situation is temporary.....(HOPEFULLY!!!)

tryingyetagain · January 2013

Hi, I'm new to this site, but wanted to help out if I can! I worked in Human Resources for about 15 years before staying home, and we had an HSA. Going with the high deductible/HSA plan generally is not a good option unless you hardly ever go the doctor, or you know you will be going a ton. So it might actually be a good option for you if you know you will spending some big oop cash. Fertility treatments are covered items under an HSA, so you would be able to use those funds that you are setting aside in the HSA to cover fertility costs (as well as medical, dental, vision needs, etc.). So, basically, any money you save having a cheaper premium you would want to contribute to the HSA, plus whatever else you can afford to throw in there up to the limit. Employers also can contribute to an HSA so you would want to see if YH's Employer is contributing anything. The funds roll from year to year, and you walk away with them if he leaves employment. Any money in there is his to keep and use in the future for medical (including infertility) costs. HSAs do cover IVF, Embryo storage, AI, and even OPKs if they are prescribed.

I hope this helps, but feel free to ask more questions if you need!

nawlinsgrl · January 2013

I'm not sure if we have the same understanding of HSA. I know it as a health savings account, which is basically something you put money in pre-taxes, to be used solely for qualifying medical expenses (which this should be), and I believe it is capped at a certain amount/percentage of income. Once it's gone it's gone, and it's use it or lose it each year.

I'm not sure what you are referring to in terms of a deductible and then 100% coverage. That sounds more like some sort of supplemental or alternate insurance, and I'm not familiar with it. Or, maybe you meant to put HMO there instead of HSA?

If it's a question of which insurance, HMO with lower premium and higher deductible vs alternate plan with high premium and lower deductible, I'd sit down and do the math, taking into account expected (non-IF related) medical care for the next year, and go from there. If you anticipate needing lots of medical care, then go with the higher premium. If you think you'll just need a check-up or two, maybe the HMO is a better way to go.

I think the monkey wrench in here might be maternity care costs (hopefully you'll be needing that soon, it's just a matter of when). I would definitely review maternity coverage and take that into account as you compare your anticipated needs with the costs. Hope that helps. If I'm not making sense, let me know and I'll try to rephrase it better.

kimberm0511 · January 2013

It is an HSA. So we would put money into a savings account, but they cover preventative care 100 and the deductible for other expenses is 3500. After the deductible it pays 100 for covered expenses. For expenses not covered I.e. infertility then you can use the money from the health savings account.

This is how I understand it. The other option is regular insurance cigna open access which has very high premiums, but lower deductible. This doesn't cover IF or any prescriptions that go along with it. They both suck compared to what we have. But maybe HSA is the way to go...maternity is covered after we pay the high deductible. I hate insurance. I know nothing about HSAs bc I was always told not to do it...but the other insurance option is so expensive and doesn't cover IF. sigh....

kimberm0511 · January 2013

tryingyetagain:
Hi, I'm new to this site, but wanted to help out if I can!nbsp; I worked in Human Resources for about 15 years before staying home, and we had an HSA.nbsp; Going with the high deductible/HSA plan generally is not a good option unless you hardly ever go the doctor, or you know you will be going a ton.nbsp; So it might actually be a good option for you if you know you will spending some big oop cash.nbsp;nbsp;Fertility treatments are covered items under an HSA, so you would be able to use those funds that you are setting aside in the HSAnbsp;to cover fertility costs as well as medical, dental, vision needs, etc..nbsp; So, basically, any money you save having a cheaper premium you would want to contribute to the HSA, plus whatever else you can afford to throw in there up to the limit.nbsp; Employers also can contribute to an HSA so you would want to see if YH's Employer is contributing anything.nbsp; The funds roll from year to year, and you walk away with them if he leaves employment.nbsp; Any money in there is his to keep and use in the future for medical including infertility costs.nbsp; HSAs do cover IVF, Embryo storage, AI, and even OPKs if they are prescribed.I hope this helps, but feel free to ask more questions if you need!

I think this helps a lot. Thanks so much!

nawlinsgrl · January 2013

I'm glad someone in HR was able to chime in, and I second her recommendations. It just goes to show that insurance varies around the country, because I have Cigna through my job and do have IF coverage ($25K medical, $10K meds, lifetime maxes).

I know mine is something specific, through the state I believe. I work for a state university health sciences center, and know two others who have this insurance (one is a state hospital employee, the other a state employee in general). My guess is that individual states/companies choose whether or not to add IF coverage, which sucks. I wish some coverage, not matter how little was mandatory for every policy.

tryingyetagain · January 2013

nawlinsgrl:
I'm not sure if we have the same understanding of HSA. I know it as a health savings account, which is basically something you put money in pre-taxes, to be used solely for qualifying medical expenses (which this should be), and I believe it is capped at a certain amount/percentage of income. Once it's gone it's gone, and it's use it or lose it each year.

HSAs are Health Savings Accounts, but I think you are thinking of FSAs (Flexible Spending Arrangements). FSAs are actually the ones that are use it or lose it. HSAs are slightly different, and are used in conjunction with high deductible health plans. HSAs definitely roll over year-to-year, and the money is yours if you leave employment. I lived and breathed this stuff when I was working in HR, and just wanted to clarify the difference. Don't want to step on toes, just wanted to throw it out there in case it affects OP's decision!

nawlinsgrl · January 2013

No offense taken. I appreciate the info, it's good to know the difference, since it's all a mess, and what's more important is that kimber gets the correct info.

I have an HRA, which I imagine is a hybrid. I get a set amount each year that pays any deductibles (the portion of the bill that insurance allows and I would be responsible for, not a set % or $ amount). For our family plan, I get $2000 in my HRA account, which can be rolled over (not sure if there's a cap or not). If I exceed that, I pay a set amount deductible ($1000 I think), and then after that 10% up to $2000 more, after which time we are covered at 100%.

kimberm0511 · January 2013

I just wanted to let you guys know what we decided (if anyone reading cares). My dh talked to the Cigna rep and I think we understand each plan. In our case (with fertility issues, etc) it is a really close decision. If we know that we will have to pay a lot of money this year, then our costs will be VERY similar. Either we will meet the deductible for the HSA (which by the way, she says we have to meet the family deductible of $7500...not just the individual deductible before it covers 100%) or we will be paying a higher premium, but way lower deductible (which I just have to meet the individual deductible). The lifetime max for the open access plan is way lower than the HSA plan, so that is good...although, if we do the math it is still very similar in costs assuming we will need to spend a lot of $. Sooo...we have decided to do the regular open access plan and pay the higher premiums for now. Hopefully dh won't work at this company for the next year, but if he did then the scenario changes. We would have to worry about maternity coverage and we have to assume that most likely we will be having an early 2014 baby if we have to wait another month or two to do our FET..which means paying the deductible twice...and we decided it would probably work out best to have the lower deductible. Whew! Insurance is so confusing to me....

Nawlins - I am completely jealous that your insurance covers infertility. It is crazy how much it varies over states. I had one person recently tell me that their daughter was doing IVF (somewhere in the northeast) and in her state, the insurance companies were required to cover it. Boo for living in Texas right now!!

tryingyetagain · January 2013

Glad you got it figured out. And, yes insurance stuff is so complex!

nawlinsgrl · January 2013

kimberm0511:
I just wanted to let you guys know what we decided (if anyone reading cares). My dh talked to the Cigna rep and I think we understand each plan. In our case (with fertility issues, etc) it is a really close decision. If we know that we will have to pay a lot of money this year, then our costs will be VERY similar. Either we will meet the deductible for the HSA (which by the way, she says we have to meet the family deductible of $7500...not just the individual deductible before it covers 100%) or we will be paying a higher premium, but way lower deductible (which I just have to meet the individual deductible). The lifetime max for the open access plan is way lower than the HSA plan, so that is good...although, if we do the math it is still very similar in costs assuming we will need to spend a lot of $. Sooo...we have decided to do the regular open access plan and pay the higher premiums for now. Hopefully dh won't work at this company for the next year, but if he did then the scenario changes. We would have to worry about maternity coverage and we have to assume that most likely we will be having an early 2014 baby if we have to wait another month or two to do our FET..which means paying the deductible twice...and we decided it would probably work out best to have the lower deductible. Whew! Insurance is so confusing to me....
Nawlins - I am completely jealous that your insurance covers infertility. It is crazy how much it varies over states. I had one person recently tell me that their daughter was doing IVF (somewhere in the northeast) and in her state, the insurance companies were required to cover it. Boo for living in Texas right now!!

That kind of gives me a headache just reading it, but glad you figured it out and have an answer that works for you right now. I had to decide whether to go to a slightly lower premium with higher deductible right before we did our recent IVF cycle, and I gambled that we'd be pregnant and would want the lower deductible. Luckily I was right.

I am really, really lucky to have coverage, and it definitely influenced our choice to go straight to IVF. As far as I can tell, mine may be the only plan in the area with any real IF coverage. Louisiana's not far from Texas. Move down here! Seriously though, I am pretty sure MA is the state with mandatory coverage in the NE. I have heard a lot about them having it.

Question for those that are insurance savvy!

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