Insurance open enrollment- plan switch before TTC?

[lindalee1456]

I know you guys are planners like me, so I figured some of you would have done this research already. It's open enrollment at my company, and I'm wondering (panicking?) about potentially switching from a "regular plan" (with copays), to a high deductible plan. Hubs and I are planning on getting knocked up at the end of this calendar year or early 2018, with a likely due date after NEXT year's open enrollment. It looks like I would end up paying less for the birth with the HDHP, BUT I have no idea what kind of medical care a baby needs... would I end up paying more under the HDHP once the baby comes?

Current Plan:

Deductible (indiv/family)	1000/2000
OOP Max (indiv/family)	3500/7000
Co-insurance	20%
PCP/Specialist Co-pay	$30

Annual premium total (me only/me+baby)
640/5835

Standard plan birth example costs

HDHP:

Deductible (indiv/family)	2850/5700
OOP Max (indiv/family)	2850/5700
Co-insurance	0% after deductible
PCP/Specialist Co-pay	0% after deductible

Annual premium total (me only/me+baby)
310/5,165

High deductible birth example costs

a) Given that most practices do global billing (bill insurance for prenatal care and delivery all at once), I will probably meet my deductible, even if my pregnancy falls across calendar years... right?

b) Again with the global billing question... does it even matter if I change my insurance now? I'll be able to change my plan again next year. I think in a normal year of medical events, I would end up paying more under the HDHP ($100+ every doctor visit, $300 urgent care, etc.). I never come close to hitting my deductible, and I maybe have 2 doctors visits a year.

c) Giving birth is a life event, but I found out you can't SWITCH your plan at that time, only add the baby. So whichever plan I have at open enrollment (whether it's this one or the next one) is the one that we're stuck with.

I HAVE NO IDEA WHAT I'M DOING! Hubs is not as much of a planner as me so he's like "Idk babe, we'll figure it out when we get there." I wanted to ask/vent to you guys because I trust y'all... I don't want to post on r/babybumps, and r/personalfinance scares me lol. Hopefully this turns into a productive convo for other people too. I need to turn in my paperwork today, and I have no idea what to do. Thanks for reading!

 

[elisha_buffet]

@lindalee1456 The example cost images you linked aren't showing up for me

One factor you may also want to consider is that the HDHP should make you eligible for an HSA, which is a great tool for saving pre-tax money for health expenses. Other than that I'd have to see the example costs to give you any advice...

 

[lindalee1456]

@elisha_buffet Whoops, ok, try now.

Excellent point about the HSA, which I neglected to mention in my comparison.

 

[roa]

@lindalee1456 I'd suggest asking for a copy of the "SBC" (summary of benefits and coverage" for each plan. They typically include two cost estimates: managing diabetes and having a baby. This will help compare "apples to apples" what your put-of-pocket costs will be.

Other things to keep in mind: will the higher premium on the non-HDHP end up costing just as much in the long run as lower premium (but higher out of pocket) on the HDHP? Is there a health savings account available to you with the HDHP? Will your employer contribute to it? During open enrollment at my job I always suggest to people who are nervous about switching to a HDHP to take the amount they save in premiums by switching (its quite a lot at my employer) and deposit it to an HSA. Then you never "miss" the money but you have the option to use it later for expenses. Also remember that you can usually pay expenses back over time from a HSA (i.e. You get a bill for $4,000 but only have $2,000 in the HSA; set up a payment plan, increase your pre-tax contributions to the HSA, then pay back from the HSA as your balance grows).

If you used either plan to its fullest (meeting your out of pocket maximum for the year) the HDHP will save you almost $2,000 (premiums included). Also if you meet that early in the year on the HDHP, all of your care will likely be provided at no cost thereafter.

Also check that both plans cover the same services and use the same network. Picking one plan over another may mean your doctor is suddenly out of network.

 

[lindalee1456]

@roa Thanks for the detailed reply! Lots of good points to consider!

I'd suggest asking for a copy of the "SBC"

That's exactly what I did lol, that's what those linked images are Having a baby ends up being slightly cheaper under the HDHP due to the lower OOP max.

will the higher premium on the non-HDHP end up costing just as much in the long run as lower premium (but higher out of pocket) on the HDHP?

My HDHP actually has a lower OOP max than my non-HD plan. Is that normal? And no, the difference in premiums does not make up the difference in deductible.

the amount they save in premiums by switching (its quite a lot at my employer) and deposit it to an HSA.

The difference in premiums is only $12/paycheck, $24 with a kiddo.

I think that's what's making it hard, is that they seem so close in price. And it's hard to see the HSA as putting money in my pocket later rather than money taken out of my pay check right now lol. It's easier to just stick with what I know.

 

[jessd77]

@lindalee1456 Think about the HSA this way: it's a way to save for the birth! I set up my HSA at the beginning of this year, and now I have over $1000 to go towards the birth of my future baby without having to do anything. An HSA is an awesome benefit! The money rolls over in it from year to year, and it even doubles as a retirement account if you still have money in it once you hit age 60.