Open enrollment/health insurance question

[rubybeth]

It's coming up on open enrollment and exchange enrollment, and I'm wondering if there's a cheat sheet or calculator that someone can recommend for comparison shopping.

DH and I have, up to now, been on separate plans because it saves us significant money, but this year may be the first time that it makes sense to elect to both be on his employer's plan.

Factors I'm considering: premium cost, deductible cost, max out of pocket, likelihood of meeting deductibles, worst case scenario if both deductibles are met, HSA funding level (we always save the maximum), and taxes.

Right now, I am on a plan from our state exchange, but the premium is going up about 55% from $223/mo to $347 and the deductible is going from $2,750 to $3,000. DH will be on his employer's plan that will likely cost around $165/mo. with a $3,000 deductible, but the employer gives him $1,000 into his HSA. The third option is to both be on DH's employer's plan at around $415/mo. with a $6,000 combined deductible. My husband can generally reach his $3,000 deductible on his own quite easily (chronic illness that involves expensive specialist visits and monthly Rx). I typically visit the doctor a couple times a year, but haven't met my deductible for many years. We already have a bunch saved in our HSAs and could easily afford the $6,000 in deductibles, if needed. But, if we are on separate plans and somehow both meet our deductibles, the total cost for premiums + deductibles = over $12,000. On the combined plan, total cost for premium + deductible = a bit under $11,000.

I am thinking I just need to compare what our taxes would look like if we were on the employer plan vs. me being on the after-tax exchange plan, but just wondering if there's other things to consider/factor in.

[Bill76]

I would double check that you're eligible to be on his plan. A few years back, I worked for a company whose insurance plan wouldn't cover a spouse if the spouse was eligible for coverage under their employer's plan.

I'm not sure if that's still legal under the ACA, but assuming it is, read all of your fine print before dropping your other coverage.

[rubybeth]

I would double check that you're eligible to be on his plan. A few years back, I worked for a company whose insurance plan wouldn't cover a spouse if the spouse was eligible for coverage under their employer's plan.

I'm not sure if that's still legal under the ACA, but assuming it is, read all of your fine print before dropping your other coverage.

Oh, very good point. I will check on that. Many years ago, we were on his plan together, but that could have changed.

[WootWoot]

In my state, if one spouse is on the Exchange, the other must be too. So I would check into that as well.

[rubybeth]

In my state, if one spouse is on the Exchange, the other must be too. So I would check into that as well.

Really? What state is that? I have never been asked questions about my spouse's coverage when applying via our state exchange (Minnesota) so I would guess that's not a requirement here. Right now, both DH and I are on separate plans from the exchange (I got mine first, then he started grad school and got onto an exchange plan when he left his job last year). Neither of our applications asked about that.

[Monkey stache]

You can have private insurance even if you or your spouse's employer offers it. The catch is that you can't get a tax credit (assuming your income is low enough). I'm in Minnesota btw.

[rubybeth]

You can have private insurance even if you or your spouse's employer offers it. The catch is that you can't get a tax credit (assuming your income is low enough). I'm in Minnesota btw.

Right, I don't get a tax credit for being on the exchange instead of taking my employer's coverage. But I can use my benefit funds from my employer on other stuff so that money doesn't go to waste--I'm not forfeiting money, that's for sure. My employer's plan is around $500/mo. for single coverage, and my exchange plan is around $350/mo. I think the tax benefit of being on my DH's plan with him might win out, but we don't yet have solid premium numbers from either employer, so I'm waiting on that.

[merula]

Contributing to the anecdata, my employer has a rule where if an employee covers a spouse who is eligible for their own employer-provided insurance, there's a surcharge. It's sliding-scale based on the combined income, but it's meant to offset the subsidy that the company provides to its own employees and spouses who aren't otherwise eligible.

I'm also in MN, working for a company whose HQ is in another state but HR is based here. If that matters.

[rubybeth]

Contributing to the anecdata, my employer has a rule where if an employee covers a spouse who is eligible for their own employer-provided insurance, there's a surcharge. It's sliding-scale based on the combined income, but it's meant to offset the subsidy that the company provides to its own employees and spouses who aren't otherwise eligible.

I'm also in MN, working for a company whose HQ is in another state but HR is based here. If that matters.

Hmm, interesting. I know my employer doesn't ask that. Will find out if his employer does. Thanks for this!

[merula]

Hmm, interesting. I know my employer doesn't ask that. Will find out if his employer does. Thanks for this!

They started it either last year or the year before. No one ever asked before, but now I have to "certify" that my husband meets one of the following:

•SP/DP is not a Working Spouse or No Access Employer Med. - You are covering your spouse or domestic partner under medical and at least one of the following statements is true:
◦ Your spouse or domestic partner does not meet the definition of a Working Spouse
◦ Your spouse or domestic partner does not have access to employer medical coverage
◦ Your spouse's or domestic partner's employer is not required to provide medical coverage under health care reform

•SP/DP w/ Access Comb. Salary > 60K - You are covering your spouse or domestic partner who has access to medical coverage through an employer that is required to provide coverage under health care reform, and your combined salaries are more than $60,000.

•SP/DP w/ Access Comb. Salary < 60K - You are covering your spouse or domestic partner who has access to medical coverage through an employer that is required to provide coverage under health care reform, and your combined salaries are $60,000 or less.

[rubybeth]

Yikes, merula, I hope that's not the case, but will find out soon. Benefit meetings are coming up for his employer in a week or so.

[Axecleaver]

In my state, if one spouse is on the Exchange, the other must be too. So I would check into that as well.

I can say with certainty that this is not a federally mandated requirement, and I am not aware of any states with this requirement (but I don't know every state's requirements perfectly). You might be saying that to qualify for a subsidy, you must be on the Exchange, which is true. But that has nothing to do with what your spouse does.

WRT the OP's question, the best thing to do is to create a spreadsheet for the plans you're comparing, and make some assumptions about your healthcare experience for the coming year. Estimate how many primary care visits, specialist visits, prescriptions, etc. Also be aware that it's often cheaper to buy coverage as two individuals, rather than a married couple or family plan. Healthcare through your employer may be available pre-tax, which can make a big difference. So run all the numbers for your situation until you determine the best mix of cost/benefits.

[rubybeth]

WRT the OP's question, the best thing to do is to create a spreadsheet for the plans you're comparing, and make some assumptions about your healthcare experience for the coming year. Estimate how many primary care visits, specialist visits, prescriptions, etc. Also be aware that it's often cheaper to buy coverage as two individuals, rather than a married couple or family plan. Healthcare through your employer may be available pre-tax, which can make a big difference. So run all the numbers for your situation until you determine the best mix of cost/benefits.

Yes, I've been doing that every year for a while. My spreadsheet compares total premium cost, total cost with met deductible, maximum out of pocket, a couple weird things since my employer gives me benefit dollars and his gives him HSA dollars, and a few different "most likely" scenarios. Typically, my husband can meet his lower single deductible on his own quite easily (chronic illness with an expensive monthly Rx), and we've done the separate plans thing for many years, but this is the first year where total premiums for separate plans is more expensive, even if he meets his deductible and I don't meet mine--and if I meet my deductible as well (like with an ER visit), then we definitely spend more being on separate plans. It's a little bizarre, which is why I was like, "What am I missing here?" And I did compare my taxed insurance exchange plan with both being on his employer's untaxed plan, and I think it would save us a few hundred, likely more.

Just waiting on firm numbers from his employer, and the chance to ask the questions that others have suggested (can I be on his plan even though my employer offers a plan? and is there a surcharge?).

I may post real numbers here once we get pricing from his employer. The other thing I confirmed yesterday is that with my benefit funding at my employer, I can fully fund my HSA to $5,750 if we are on a plan together (his employer gives him $1,000 in the HSA) whereas right now, I can only fund mine to the single limit ($3,350) so that basically covers the combined $6,000 deductible we'd be moving to (vs. separate $3,000 deductibles). We also have a good chunk in our HSAs already, so it would not hurt us financially to meet that $6,000 deductible. We are very lucky.

[WootWoot]

I'm in Pennsylvania.

[WootWoot]

I stand corrected. I have insurance at work, but if my nonworking spouse wants to be on the exchange, we would not get a subsidy. We do get a subsidy because of the percentage bracket into which we fall.

[rubybeth]

Okay, we got the numbers from DH's employer. I still can't decide and need to discuss with him what he thinks he medical needs will actually be in 2017. Hard to predict, but if we could look at how many specialist visits, primary care physician visits, and how his Rx subsidy works, that might help us.

Plan options for us:
Employer HSA plan single - $157.46/mo. ($78.73 from each paycheck), deductible/MOP - $3,000 (employer gives $1,000 in HSA, so we could put another $2,300 for the $3,400 max)
with me on my current plan - $347.32/mo (TAXED, no subsidy), deductible/MOP - $3,000 (I can put $3,350 into my HSA at work to avoid taxes and this is extra money on top of my paycheck just for benefits)
= premiums total $504.78/mo. and deductibles combined equal $6,000
(worst case scenario here is that we pay a total of $12,057.36 for our separate premiums and two separate $3,000 deductibles)

or both on:

Employer HSA plan employee+1 - $397.46 ($198.73 from each paycheck), deductible/MOP - $6,000 (employer would still give $1,000, but we could max out my HSA at my employer to $5,750 for the family max of $6,750)
(worst case scenario here is that we pay a total of $10,769.52 in premiums and the $6,000 deductible)

I ran the paycheck calculator on our checks for each scenario and our other benefit elections (disability ins., union dues, 401k/457b), and I think, even with paying a combined $6,000 deductible as worst case scenario (using all untaxed HSA funds), we come out ahead in terms of take-home pay due to lower monthly premium cost and not paying income tax on the premium cost. So our healthcare stuff would all be untaxed with the employer payroll tax break and the HSA tax break. And, we may not meet the $6,000 deductible.

[moosestache]

What are the differences in coverage after you meet the deductibles?  Or does the deductible equal the max out of pocket on each plan?

[rubybeth]

What are the differences in coverage after you meet the deductibles?  Or does the deductible equal the max out of pocket on each plan?

Deductibles and max out of pocket is the same for all plans, from what I can tell. I can see if I can find more info. on that to confirm, though.

Okay, just looked this up. DH's plan options list that maximum out of pocket is the same as the deductible (so $3,000 for him alone, or $6,000 for us combined). But for the scenario when we're on separate plans, and I stay on my MNsure plan, the maximum out of pocket for me alone with $6,550. Coinsurance is 20% my responsibility. So that's not as good, either. It's unlikely I'd meet that, but in a catastrophic situation (like a car accident that we're both in), then we'd be on the hook for $9,550 plus the separate premiums which are higher than the combined untaxed premium.

Here's that plan document: https://mn.checkbookhealth.org/hie/MN/2017/assets/pdfs/34102MN0010005-01.pdf