Help evaluating dual HDHP coverage

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nfs
Posts: 70
Joined: Wed Jan 22, 2014 4:32 pm

Help evaluating dual HDHP coverage

Post by nfs » Sat Oct 06, 2018 6:32 pm

Can you help spot check my insurance coverage logic?
As a little back story, I have been doing IVF for the past 2 years (2 retrievals and 6 failed transfers so far). This has been the bulk of our healthcare expenses and we have hit max out of pocket each year (with a few extra things that the insurance hasnt covered too). My healthcare options at work have changed to offer a HDHP so now I'm considering dual coverage because they are providing some fertility coverage (described below).

I've been on DH's insurance so far. It's a high deductible plan and offers $40k fertility medical and $20K fertility prescription coverage.
What I have left: $14,000 Fertility med & ??? Pharmacy (maybe $3-4k? - no one can tell me)
Family Coverage
Family Deductible: $3,940
Family Max Out of Pocket: $5,830
People covered on this plan: DH, me, 3 kids (the 4th will age out next year)

This year, my work is offering a high deductible plan as well. I'm considering signing up for it too. The reason is that it will give me a $5k fertility benefit toward medical or prescription once I meet the deductible, but only at my current clinic.
Self-coverage ONLY
Individual Deductible: $1,500
Individual Max Out of Pocket: $3,000
Work would also contribute $500 to my HSA (so we'd put $500 less in from DH's paycheck)
People covered on this plan: just me

My theory is that this makes sense because:
1) If I don't need the fertility coverage at that point, it limits my out of pocket to $3k (normally I am the bulk of our healthcare expenses due to IVF)
2) If I need the fertility coverage, I'll be doing another retrieval which means I can probably use the $5k from my work toward meds and then things will primarily be covered by my husband's insurance (worst case we pay the $1,500 for my deductible to access the $5K, then, pay the $5,830 for the max out of pocket for DH's insurance).

Are there other things I should be considering?

There are no premiums for either of the plans.
Last edited by nfs on Fri Oct 12, 2018 9:10 pm, edited 1 time in total.

nfs
Posts: 70
Joined: Wed Jan 22, 2014 4:32 pm

Re: Help evaluating dual HDHP coverage

Post by nfs » Tue Oct 09, 2018 11:29 pm

Anyone? Anything obvious I should be considering as a reason not to have 2 HDHP covering me? Thanks!

seawolf21
Posts: 251
Joined: Tue Aug 05, 2014 7:33 am

Re: Help evaluating dual HDHP coverage

Post by seawolf21 » Wed Oct 10, 2018 7:08 am

nfs wrote:
Tue Oct 09, 2018 11:29 pm
Anyone? Anything obvious I should be considering as a reason not to have 2 HDHP covering me? Thanks!
Check with your insurer but I believe coordination of benefits rules come into effect where the plan thru your employer will become the primary plan. Which affects all your healthcare not just fertility treatments.

Not sure if that matters to you but wanted to point it out.

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FiveK
Posts: 5588
Joined: Sun Mar 16, 2014 2:43 pm

Re: Help evaluating dual HDHP coverage

Post by FiveK » Wed Oct 10, 2018 7:48 pm

nfs wrote:
Sat Oct 06, 2018 6:32 pm
This year, my work is offering a high deductible plan as well. I'm considering signing up for it too. The reason is that it will give me a $5k fertility benefit toward medical or prescription once I meet the deductible, but only at my current clinic.
Deductible: $1,500

Are there other things I should be considering?
If you are using the HDHP to qualify for an HSA, the new policy will disqualify you. Not because of dual coverage, but due to the
individual deductible of $1,500 for each family member. The plan doesn’t qualify
as an HDHP because the deductible for an individual family member is less than the minimum annual deductible
($2,600) for family coverage.
See Publication 969 for that quote and more info.

nfs
Posts: 70
Joined: Wed Jan 22, 2014 4:32 pm

Re: Help evaluating dual HDHP coverage

Post by nfs » Wed Oct 10, 2018 9:25 pm

FiveK wrote:
Wed Oct 10, 2018 7:48 pm
nfs wrote:
Sat Oct 06, 2018 6:32 pm
This year, my work is offering a high deductible plan as well. I'm considering signing up for it too. The reason is that it will give me a $5k fertility benefit toward medical or prescription once I meet the deductible, but only at my current clinic.
Deductible: $1,500

Are there other things I should be considering?
If you are using the HDHP to qualify for an HSA, the new policy will disqualify you. Not because of dual coverage, but due to the
individual deductible of $1,500 for each family member. The plan doesn’t qualify
as an HDHP because the deductible for an individual family member is less than the minimum annual deductible
($2,600) for family coverage.
See Publication 969 for that quote and more info.
I'll have to look into this more. We definitely max our contributions to our HSA through DH's work and use that money throughout the year (since we've had so many expenses). I would hate to not be able to use it or cause tax issues. Thank you for this!

Spooky
Posts: 101
Joined: Mon Apr 04, 2011 11:00 am

Re: Help evaluating dual HDHP coverage

Post by Spooky » Thu Oct 11, 2018 1:45 pm

I don't see where the OP posted what the family deductible would be for her HDHP plan.

Quote from publication 969: " Family plans that don’t meet the high deductible
rules. There are some family plans that have deductibles
for both the family as a whole and for individual family
members. Under these plans, if you meet the individual
deductible for one family member, you don’t have to meet
the higher annual deductible amount for the family. If either
the deductible for the family as a whole or the deductible
for an individual family member is less than the minimum
annual deductible for family coverage, the plan
doesn’t qualify as an HDHP." -- I don't see where the OP has indicated this is part of her or her husband's plan.

One potential benefit to having separate plans is that (I think--please check this for yourself)--husband (with kids on his insurance) could contribute the full family amount to the HSA, and you could contribute to an FSA. But if the husband's HDHP will cover more fertility--which it looks like from what is posted, it is probably more advantageous to be double covered.

megabad
Posts: 585
Joined: Fri Jun 01, 2018 4:00 pm

Re: Help evaluating dual HDHP coverage

Post by megabad » Thu Oct 11, 2018 1:55 pm

nfs wrote:
Sat Oct 06, 2018 6:32 pm
Can you help spot check my insurance coverage logic?
As a little back story, I have been doing IVF for the past 2 years (2 retrievals and 6 failed transfers so far). This has been the bulk of our healthcare expenses and we have hit max out of pocket each year (with a few extra things that the insurance hasnt covered too). My healthcare options at work have changed to offer a HDHP so now I'm considering dual coverage because they are providing some fertility coverage (described below).

I've been on DH's insurance so far. It's a high deductible plan and offers $40k fertility medical and $20K fertility prescription coverage.
What I have left: $14,000 Fertility med & ??? Pharmacy (maybe $3-4k? - no one can tell me)
Deductible: $3,940
Max Out of Pocket: $5,830
People covered on this plan: DH, me, 3 kids (the 4th will age out next year)

This year, my work is offering a high deductible plan as well. I'm considering signing up for it too. The reason is that it will give me a $5k fertility benefit toward medical or prescription once I meet the deductible, but only at my current clinic.
Deductible: $1,500
Max Out of Pocket: $3,000
Work would also contribute $500 to my HSA (so we'd put $500 less in from DH's paycheck)
People covered on this plan: just me

My theory is that this makes sense because:
1) If I don't need the fertility coverage at that point, it limits my out of pocket to $3k (normally I am the bulk of our healthcare expenses due to IVF)
2) If I need the fertility coverage, I'll be doing another retrieval which means I can probably use the $5k from my work toward meds and then things will primarily be covered by my husband's insurance (worst case we pay the $1,500 for my deductible to access the $5K, then, pay the $5,830 for the max out of pocket for DH's insurance).

Are there other things I should be considering?

There are no premiums for either of the plans.
Well firstly, I wish you only the best with the treatment as I know that this can be a very tough process. Also, I feel very happy for you that you have IVF coverage as most plans in most states do not, so that is a blessing. Other posters have brought up HSA eligibility questions so I just have a few others, but you may have already considered these.
-You don't mention any coinsurance or copays for either drugs or treatment so that may be a consideration. This can affect your total health cost (not just for IVF).
-Also, most plans that offer fertility coverage are highly restrictive in most states so I would double check that you meet all the rules for cycle limits and other eligibility rules. There can be differences between your two plan requirements.
-Another consideration is the primary/secondary insurance company battle that might ensue.

User avatar
FiveK
Posts: 5588
Joined: Sun Mar 16, 2014 2:43 pm

Re: Help evaluating dual HDHP coverage

Post by FiveK » Thu Oct 11, 2018 2:14 pm

Spooky wrote:
Thu Oct 11, 2018 1:45 pm
I don't see where the OP posted what the family deductible would be for her HDHP plan.

Quote from publication 969: "...If either
the deductible for the family as a whole or the deductible
for an individual family member is less than the minimum
annual deductible for family coverage, the plan
doesn’t qualify as an HDHP."
Doesn't matter whether "Deductible: $1,500" is individual or family, because either way the plan doesn’t qualify as an HDHP.

nfs
Posts: 70
Joined: Wed Jan 22, 2014 4:32 pm

Re: Help evaluating dual HDHP coverage

Post by nfs » Fri Oct 12, 2018 8:53 pm

Spooky wrote:
Thu Oct 11, 2018 1:45 pm
I don't see where the OP posted what the family deductible would be for her HDHP plan.

Quote from publication 969: " Family plans that don’t meet the high deductible
rules. There are some family plans that have deductibles
for both the family as a whole and for individual family
members. Under these plans, if you meet the individual
deductible for one family member, you don’t have to meet
the higher annual deductible amount for the family. If either
the deductible for the family as a whole or the deductible
for an individual family member is less than the minimum
annual deductible for family coverage, the plan
doesn’t qualify as an HDHP." -- I don't see where the OP has indicated this is part of her or her husband's plan.

One potential benefit to having separate plans is that (I think--please check this for yourself)--husband (with kids on his insurance) could contribute the full family amount to the HSA, and you could contribute to an FSA. But if the husband's HDHP will cover more fertility--which it looks like from what is posted, it is probably more advantageous to be double covered.
For my work's HDHP I will elect self-only coverage. My understanding is that this does meet the HDHP guideline of having a $1,300 or higher deductible. Then through my husband I will be under family coverage which meets the $2,600 or higher deductible. On the family plan through my husband there is not individual deductible per family member, it is a family deductible. The more I read, the more I think this guideline is NOT an issue in my case, but I will meet with my benefits folks and call the insurance companies to confirm.

nfs
Posts: 70
Joined: Wed Jan 22, 2014 4:32 pm

Re: Help evaluating dual HDHP coverage

Post by nfs » Fri Oct 12, 2018 9:09 pm

megabad wrote:
Thu Oct 11, 2018 1:55 pm
Well firstly, I wish you only the best with the treatment as I know that this can be a very tough process. Also, I feel very happy for you that you have IVF coverage as most plans in most states do not, so that is a blessing. Other posters have brought up HSA eligibility questions so I just have a few others, but you may have already considered these.
-You don't mention any coinsurance or copays for either drugs or treatment so that may be a consideration. This can affect your total health cost (not just for IVF).
-Also, most plans that offer fertility coverage are highly restrictive in most states so I would double check that you meet all the rules for cycle limits and other eligibility rules. There can be differences between your two plan requirements.
-Another consideration is the primary/secondary insurance company battle that might ensue.
Thank you! It is a challenging process. I am hopeful that I will not need the additional fertility coverage by the time January rolls around, but having been at this for almost 2 years, I've learned to prepare for anything.

Good questions - coinsurance/copays don't come into play until I hit my deductible. At that point, if I still need fertility coverage, I'll wind up blowing through my Out of Pocket Max pretty quicly, so co-insurance doesn't matter much. (My plan is 80% coverage in-network, husband's is 90%). Honestly, with the fertility stuff being handled by insurance at least for now, I pretty much expect to hit my max out of pocket every year. On the plus side, on my work's individual HDHP, my OOP max is lower, so even if I don't need fertility treatments, I think I'll come out ok cost wise.

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