Author Topic: Infant medical expenses and open enrollment  (Read 13936 times)

seattlecyclone

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Infant medical expenses and open enrollment
« on: November 03, 2015, 05:44:50 PM »
Hi everyone,

My wife and I are expecting a baby early next year. It's open enrollment time and we're trying to figure out our health plans for the following year.

I've basically narrowed it down to the following three options:

Option 1: Wife and baby on her employer's HDHP, me on my employer's HDHP
  • Total employer HSA contribution: $3,500
  • Deductibles: $4,000 for mom and baby combined, $1,300 for me
  • Coinsurance after deductible: 20% for mom and baby, 10% for me
  • Out-of-pocket max: $6,000 for mom and baby combined, $2,600 for me

Option 2: Wife on her employer's HDHP, me and baby on my employer's HDHP
  • Total employer HSA contribution: $3,500
  • Deductibles: $2,000 for mom, $2,600 for me and baby combined
  • Coinsurance after deductible: 20% for mom, 10% for me and baby
  • Out-of-pocket max: $3,000 for mom, $5,200 for me and baby combined

Option 3: Everyone on my employer's HDHP
  • Total employer HSA contribution: $2,000
  • Deductible: $2,600
  • Coinsurance after deductible: 10%
  • Out-of-pocket max: $5,200
  • Additional wrinkle: hospital is billing for all prenatal visits and the actual birth at once; pamphlets they gave us mentioned they would have to pro-rate things between the two insurances if my wife switched insurance policies mid-pregnancy. That would shift some costs back to this year's deductible/coinsurance and would likely lead to no end of administrative headaches coordinating things between the two companies.

For the current open enrollment window we're technically only signing up for me and my wife since the baby isn't born yet. After the birth we'll be able to put the baby on whichever plan we choose. Therefore the choice right now really is between "Option 1 or 2 (to be decided after the baby is born)" and "Option 3".

Premiums are roughly the same for the three options, difference of about $300/yearly (pre-tax) between most and least expensive.

I fully expect the package of prenatal visits and birth to be expensive enough that it will certainly use up the deductible of whatever plan she is on, and will likely bring us to the out-of-pocket max on her plan as well.

I tend to be very healthy, with zero out-of-pocket medical bills for the past five years. Though nothing about the future is certain, I expect the same next year.

The unknown here is how much we would be billed in the baby's name related to the birth and during the first year of life. Certain routine well-child visits and vaccinations are supposed to be covered at 100% by either plan. Any medical procedures related to the birth, and any sicknesses requiring an office visit during the first year of life are a different story.

Option 1 seems to be ideal if the baby has a lot of medical expenses and I remain healthy. We get a $3,500 total HSA contribution since we're on both employer's plans, and our total medical costs would be limited to $6,000, for a net cost of $2,500.

Option 2 seems to be ideal if the baby and I both have few medical expenses. We get the same $3,500 HSA contribution, we would pay only the single $3,000 out-of-pocket max for the childbirth, and we would be fully responsible for whatever expenses the baby and I have, up to the $2,600 deductible.

Option 3 looks like it only pays off if I have some bigger medical bills. We would only get $2,000 in HSA seed money. This would be offset by the fact that our total out-of-pocket max would be $5,200 instead of $8,600, but this offset would be counter-offset (is that a thing?) by the fact that some of the birth cost would be pushed back into this year where we still haven't quite met the deductible on my wife's plan.

What this really comes down to is the following question: what do "typical" medical expenses look like for a baby during their first year, assuming a relatively uneventful birth and a relatively average number of ear infections, other illnesses, etc.?

I would be especially interested in hearing from parents who have had kids in the past few years while on HDHP insurance. I figure if there's a premature birth requiring a NICU stay (or something else happens within the first month to cause us to expect high medical bills), we'll be able to choose Option 1 when we're enrolling our baby in insurance for the first time. If I hear from enough parents whose kids had very low medical bills during their first year, we'll probably plan to go with Option 2 if everything goes fine during the first month.

La Bibliotecaria Feroz

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Re: Infant medical expenses and open enrollment
« Reply #1 on: November 03, 2015, 05:59:35 PM »
I think each of my babies had  two or three "sick" visits in the first year for things like terrible diaper rash or an ear infection.

I had the kind of health insurance at the time where you just pay a $50 sick visit copay, but my sister has had an HDHP for years and she tells me that a typical sick visit for her kids (for something like an ear infection, to which her oldest is prone) costs about $200.

seattlecyclone

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Re: Infant medical expenses and open enrollment
« Reply #2 on: November 03, 2015, 06:05:10 PM »
I think each of my babies had  two or three "sick" visits in the first year for things like terrible diaper rash or an ear infection.

I had the kind of health insurance at the time where you just pay a $50 sick visit copay, but my sister has had an HDHP for years and she tells me that a typical sick visit for her kids (for something like an ear infection, to which her oldest is prone) costs about $200.

Thanks. Did you get any bills in the baby's name for procedures related to the birth itself, or was that all billed under the mom's name?

La Bibliotecaria Feroz

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Re: Infant medical expenses and open enrollment
« Reply #3 on: November 03, 2015, 06:31:21 PM »
In my case, baby care in the hospital was all under me. Baby #1 had some minor issues--he was what they call a mec baby and had to be suctioned out in the OR and later was seen by a neonatologist (not in the NICU, just in my room) and we did not receive a bill for either. (We were super-broke then, so I would have remembered!)

His first checkup, the doctor's office sent it in a sick visit at first and I got a bill. But I fussed at them until they re-submitted it as a well visit (which it was!).

Forgot to say. congrats on upcoming baby! I remember being super-stressed about our insurance options the first time, too :-).

TechMike

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Re: Infant medical expenses and open enrollment
« Reply #4 on: November 03, 2015, 06:49:32 PM »
My daughter was born while we had a HDHP. The plan had a family deductible of $6,000, then 100% coverage after that.

We ended up maxing out that deductible. Both the procedures for my wife and my daughter ended up billing around $12,000 total. We had an inversion (daughter was breech), a normal birth (i.e., no C-section), two nights in the hospital for both and a night under the UV lights for our daughter. The inversion and birth were billed to my wife, the UV lights to my daughter, and both had two nights billed to their accounts.

Since then, our daughter (who is now 1 yr old) has been perfectly healthy and has not had any medical costs beyond normal visits and vaccines.

You can try and do things to reduce potential costs, such as finding a facility with a low c-section rate, but in the end, it's difficult to predict the procedures that would be needed.

ETA: Because we paid the full $6,000 deductible for the family, my wife was able to get an IUD without paying. This was before some of the ACA stuff for birth control kicked in, so I bet it's different. Otherwise, the IUD would have been like $800.
« Last Edit: November 03, 2015, 06:53:12 PM by TechMike »

Frs1661

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Re: Infant medical expenses and open enrollment
« Reply #5 on: November 04, 2015, 04:34:41 AM »
When does the 'family' deductible kick in? Will the birth only count against mom's single deductible in both options 1 and 2, or just option 2? Plan on a hospital birth maxing any of those deductibles.

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seattlecyclone

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Re: Infant medical expenses and open enrollment
« Reply #6 on: November 04, 2015, 12:49:57 PM »
There is no "individual deductible" within a family HDHP. The plan doesn't pay anything until the full deductible is paid. Yes, I plan on the birth exceeding the deductible, which is why Option 2 with the lower deductible seems like a good option if we can assume that the baby probably won't be billed for much on his own.

norabird

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Re: Infant medical expenses and open enrollment
« Reply #7 on: November 04, 2015, 01:01:09 PM »
If #2 is for the option where you incur minimal health costs for the baby, I would go with #1--that's what insurance is for, right, to cover the worst case of health expenses? Better to spend more on coverage than you use than vice versa in this instance, since the downside can be so very high.

Also congrats!

TechMike

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Re: Infant medical expenses and open enrollment
« Reply #8 on: November 04, 2015, 02:36:45 PM »
There is no "individual deductible" within a family HDHP. The plan doesn't pay anything until the full deductible is paid. Yes, I plan on the birth exceeding the deductible, which is why Option 2 with the lower deductible seems like a good option if we can assume that the baby probably won't be billed for much on his own.
Two nights, room & board at the local hospital for just my daughter was $2,0008. If you're having a hospital birth, expect to pay out the nose for what amounts to an expensive hotel visit. My daughter was also heavily jaundiced and spent a night under UV lights, that was $800.

It is difficult to predict what medical procedures will be needed after the child is born and how many nights you'll end up staying in the hospital. My understanding is two nights is actually short... we would've had only one night though if it weren't for the jaundice.

TechMike

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Re: Infant medical expenses and open enrollment
« Reply #9 on: November 04, 2015, 02:37:34 PM »
Also congrats!
Yes, this. Congratulations! Raising a child is far more rewarding than any other experience in my life.

lakemom

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Re: Infant medical expenses and open enrollment
« Reply #10 on: November 05, 2015, 06:07:03 AM »
I would think either option 2 or 3 because you don't know what will happen at the birth (easy or complicated, completely healthy baby or baby born with anything from very minor issues to very major issues) and your deductibles and copays are less.  Also, IF the baby has even minor issues (think reflux or allergies) you may be at the doctor fairly often in the first year of life and the difference between a 10% and 20% copay can add up especially if there is any kind of testing involved.  Also, don't forget that YOUR contributions to the HSA can grow tax free until withdrawn (or maybe that's tax deferred) so you can bank the amount of your estimated copays then let it grow until retirement or you actually need it.

Frs1661

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Re: Infant medical expenses and open enrollment
« Reply #11 on: November 08, 2015, 06:36:11 AM »
There is no "individual deductible" within a family HDHP. The plan doesn't pay anything until the full deductible is paid. Yes, I plan on the birth exceeding the deductible, which is why Option 2 with the lower deductible seems like a good option if we can assume that the baby probably won't be billed for much on his own.

Yes, but it stays an 'individual' plan until the baby is added, correct? It's not clear to me if the birth would apply to the individual deductible (since it happens before moving to a family plan) or if it applies to the 'family' deductible anyway.

Forgive me if this is a stupid question :)

chaskavitch

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Re: Infant medical expenses and open enrollment
« Reply #12 on: November 10, 2015, 07:33:41 AM »
I'm glad you posted, I've been wondering about this same thing.  I have a choice between a PPO plan and an HDHP.  The deductibles are obviously less expensive for the PPO, but after the employer HSA contribution, the OOP max is cheaper for the HDHP.  I just have no idea if I'll reach the $6000 OOP max, like, EVER.  I've never had a baby before, though, so heck if I know the answer yet.

There is no "individual deductible" within a family HDHP. The plan doesn't pay anything until the full deductible is paid. Yes, I plan on the birth exceeding the deductible, which is why Option 2 with the lower deductible seems like a good option if we can assume that the baby probably won't be billed for much on his own.

Yes, but it stays an 'individual' plan until the baby is added, correct? It's not clear to me if the birth would apply to the individual deductible (since it happens before moving to a family plan) or if it applies to the 'family' deductible anyway.

Forgive me if this is a stupid question :)

From what I've been able to find out about my plans, the family deductible and OOP max don't kick in until the baby is born.  I'll probably reach my OOP max well before my due date and get some things taken care of, but after there's a baby, I'll have to pay another $3000 (with the HDHP) before we're home free again.  My employer contributes more to my HSA for a family plan, but they also prorate their HSA contributions throughout the calendar year, so they'll switch from ~$43/pay period to ~$80/pp once there is a baby.  Technically the family contribution is $2000 (vs $1000 for an individual), but I'll end up receiving ~$1500, since I'll only get family contributions from the end of May onward.

MustardTiger

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Re: Infant medical expenses and open enrollment
« Reply #13 on: November 19, 2015, 02:03:16 PM »
Related question:

My wife is has an ACA plan.  When do we add the baby?  For example once the baby is delivered do I have to sign up for a plan for the baby at that moment or is there a grace period?

Gin1984

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Re: Infant medical expenses and open enrollment
« Reply #14 on: November 19, 2015, 02:06:35 PM »
My daughter had croup during her first year of life and we ended up in the ER for it because she could not breathe.  All other random sick visits pale before that.

La Bibliotecaria Feroz

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Re: Infant medical expenses and open enrollment
« Reply #15 on: November 19, 2015, 02:26:17 PM »
Related question:

My wife is has an ACA plan.  When do we add the baby?  For example once the baby is delivered do I have to sign up for a plan for the baby at that moment or is there a grace period?

There is normally a 30 day grace period. But you might as well do it from the hospital while you're thinking about it.

lampstache

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Re: Infant medical expenses and open enrollment
« Reply #16 on: November 24, 2015, 12:08:47 PM »
We had our 2nd child about two months ago and were faced with the same dilemma. In the end I ended up choosing what my colleague called "the poor man's plan". We had multiple options and in the end chose the plan that offered the highest employer HSA contribution (while also maxing the HSA contribution on my end since it's tax free money) and highest deductible, but had the lowest monthly premium cost. We figured the money saved on a lower monthly premium and higher employer HSA contribution made up for the difference in deductibles (1500 vs 4k).

If you really dive into the details and break it down penny by penny comparing plans, they all end up being relatively close to the same. Much of it depends on how risk adverse you are.

Total bill for mom and baby was around $12,000 and we ended up paying about $5,000 (4k deductible and approximately 1k in additional expenses after coverage kicked in). Sounds hefty, but was easily covered with our HSA account (tax free!). My monthly premium for a family of 4 was $158 per month vs the higher coverage plan for around $400.

We're a health family and the lowest monthly premium plan was the best option for us, but the key is making sure to max your HSA every year.

Gin1984

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Re: Infant medical expenses and open enrollment
« Reply #17 on: November 24, 2015, 12:50:57 PM »
We had our 2nd child about two months ago and were faced with the same dilemma. In the end I ended up choosing what my colleague called "the poor man's plan". We had multiple options and in the end chose the plan that offered the highest employer HSA contribution (while also maxing the HSA contribution on my end since it's tax free money) and highest deductible, but had the lowest monthly premium cost. We figured the money saved on a lower monthly premium and higher employer HSA contribution made up for the difference in deductibles (1500 vs 4k).

If you really dive into the details and break it down penny by penny comparing plans, they all end up being relatively close to the same. Much of it depends on how risk adverse you are.


Total bill for mom and baby was around $12,000 and we ended up paying about $5,000 (4k deductible and approximately 1k in additional expenses after coverage kicked in). Sounds hefty, but was easily covered with our HSA account (tax free!). My monthly premium for a family of 4 was $158 per month vs the higher coverage plan for around $400.

We're a health family and the lowest monthly premium plan was the best option for us, but the key is making sure to max your HSA every year.
That was not true for my plans, nor for my parent's plan which is a completely different state/employer.

Schnurr

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Re: Infant medical expenses and open enrollment
« Reply #18 on: November 27, 2015, 01:39:36 PM »
There is no "individual deductible" within a family HDHP. The plan doesn't pay anything until the full deductible is paid. Yes, I plan on the birth exceeding the deductible, which is why Option 2 with the lower deductible seems like a good option if we can assume that the baby probably won't be billed for much on his own.

I think whether and how much the baby will be billed will depend on the hospital, your insurance, and the care needed. Just so you have one more data point: total billing amount was $8500 for my wife and just under $2000 for the baby. This was for an uncomplicated hospital birth earlier this year.

RelaxedGal

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Re: Infant medical expenses and open enrollment
« Reply #19 on: December 03, 2015, 01:39:00 PM »
Total bill for mom and baby was around $12,000 and we ended up paying about $5,000 (4k deductible and approximately 1k in additional expenses after coverage kicked in). Sounds hefty, but was easily covered with our HSA account (tax free!). My monthly premium for a family of 4 was $158 per month vs the higher coverage plan for around $400.

Assuming OP's expenses are the same, a $12,000 figure makes me say Option 2 or 3.  If 2, you're guaranteed to hit her $3,000 out of pocket max, might not hit yours.

For what it's worth we have a HDHP and live in Massachusetts.  We pay our Dr's office about $285 each sick visit.  Our daughter went into daycare quickly, which meant she started bringing home colds quickly.  I was never so sick as that first year.  I think I went in for strep/pink eye/etc. 3 or 4 times, she had 4 or 5 appointments, my husband was luckier and only had to go in 2 or 3 times (one of which might have been because his blood pressure was higher/had to have medications adjusted thanks to New Baby stress).
« Last Edit: December 03, 2015, 01:42:56 PM by RelaxedGal »

lsalinas

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Re: Infant medical expenses and open enrollment
« Reply #20 on: December 04, 2015, 01:25:58 PM »
Another thing to consider is when or if your baby will go to daycare.  My babies stayed at home for 8 months and had only one or two doctors visits.  After they started daycare part time they came home sick every two weeks.  It was never a simple cold, it was always something gross and terrible like pneumonia or hand foot and mouth disease.  After about 6 months they stopped getting sick all the time and now just get a runny nose every once in a while.  Your baby might not get as sick as mine did, but daycare usually does increase the frequency of illness. 

RedBaron3

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Re: Infant medical expenses and open enrollment
« Reply #21 on: December 17, 2015, 10:51:33 AM »

There is normally a 30 day grace period. But you might as well do it from the hospital while you're thinking about it.

I would agree to do it immediately if possible.  For our first child, my wife had already met her full deductible from our healthfund plan so she should pay no costs for the rest of the year.  The healthfund was also pretty much exhausted.  I added the baby 3 or 4 days after birth which changed us from a Me+Spouse plan to a Me+Family.  Additional funds were deposited into the healthfund by my company due to this plan change.  Some of the childbirth claims then came in under the child's name on dates before the child was added.  My responsible part of these claims were lower than what I now had in the healthfund but higher than what was in the healthfund before I changed it to add the baby. The insurer still honored and processed the claims but said the money deposited due to the plan change wasn't available for use for these claims since the claim dates were before the money was added, even though I  had enough in the account now to cover them.  After endless frustrating phone calls, I ended up paying the ~$500 out of pocket.  When baby #2 came around, I added her to the plan from the hospital room and had no issues. 

seattlecyclone

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Re: Infant medical expenses and open enrollment
« Reply #22 on: April 08, 2016, 06:35:35 PM »
Our kid was born, and the billing has finally been sorted out. I just want to report back on how the financial aspects worked out.

We were expecting a January birth, but our son decided to be born in December instead, pushing things back into the 2015 plan year. My wife was still on her employer's plan. We decided to add her to my insurance as secondary coverage (retroactive to the birth date), along with putting our son on my insurance as primary coverage.

I later found out that my employer doesn't actually charge for health insurance premiums during parental leave, so adding my wife actually didn't cost us any extra in terms of premiums, and it saved us quite a bit on our medical bills as I'll explain later. Even if we did have to pay a premium we would have come out well ahead with the double coverage.

Mrs. Cyclone's expenses
DescriptionSticker priceInsurance negotiated ratePrimary insurance paidSecondary insurance paidWe owed
OB physician services$5,059.00$4,399.42$3,135.92$1,263.50$0.00
Hospital stay$6,584.05$6,584.05$6,368.03$216.02$0.00

Approximately $1,500 of Mrs. Cyclone's $2,000 deductible on her primary insurance was used up on lab tests, ultrasounds, and other stuff prior to the birth. The OB doctor bill (having gone through insurance first), used up the rest of the deductible and the 20% coinsurance got most of rest of the way to the $3,000 out-of-pocket maximum. The rest of the out-of-pocket maximum was reached with the hospital bill.

I'm still not entirely sure how secondary insurance calculates payment amounts. I would have naively expected to still need to actually pay any amount not paid by primary insurance. That amount would then count toward the secondary insurance's deductible, at which point the secondary insurance would start paying for stuff. What actually happened was that the secondary insurance just paid the rest of the bill that the primary insurance didn't pay. Perhaps they consider amounts paid by the other insurance as counting toward the deductible? It's still not exactly clear to me. I haven't been too quick to inquire, since we ended up owing nothing out of the whole deal.

Mini Cyclone's expenses
DescriptionSticker priceInsurance negotiated rateInsurance paidWe owed
Pediatrician visit (day 1 in hospital)$145.00$116.80$0$116.80
Pediatrician visit (day 2 in hospital)$165.00$137.83$0$137.83
Newborn hearing test$326.00$297.12$267.41$29.71
Hospital stay$3,108.55$3,037.00$2,733.42$303.68

An interesting thing about Mrs. Cyclone's secondary insurance is that when her expenses went through, the deductible became satisfied. This means that order of submitting expenses to insurance mattered. Mini Cyclone's pediatrician visits went through the billing before Mrs. Cyclones' bills did, so we paid the full amount of these visits and it counted toward the deductible. The other expenses went through later, so we only paid the 10% coinsurance on these.

All told, we owed $588.02 toward Mini Cyclone's medical bills. If we hadn't added Mrs. Cyclone on to my insurance plan to have those expenses double-dip on the deductibles, we would have instead owed $2,600 toward the deductible plus 10% of the remaining expenses ($98.88), for a total of $2,698.88. Thus adding Mrs. Cyclone to my insurance ended up saving us $2,110.86. That turned out to be a great move!

What worked less well was the limited purpose FSAs we signed up for.

During open enrollment we signed up for a $1,000 2016 contribution to Mrs. Cyclone's LPFSA. This would cover the entirety of her post-deductible medical expenses up to the out-of-pocket maximum. However since the birth actually happened right at the end of 2015, she has not had any medical expenses yet in 2016 and we may need to blow that money on some fancy prescription glasses or something.

I took advantage of the special enrollment period to put $500 in my LPFSA for 2015. The problem with this is that any expenses needed to be submitted by mid-February to meet the deadline for that account. For whatever reason, the final medical bill didn't go through until last week, and the deductible wasn't met until well after the deadline. So I lost those funds under the "use it or lose it" rule. However I haven't yet had that money come out of my paycheck, so I'm assuming that the "don't bill for insurance premiums during paternity leave" policy also applies to LPFSA contributions. Either that, or the fact that I increased my 2015 LPFSA contribution after the last 2015 paycheck went through means I don't actually get billed for this. Either way, I'm calling it a wash.

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Re: Infant medical expenses and open enrollment
« Reply #23 on: April 08, 2016, 07:02:52 PM »
Congrats on the Mini Cyclone! ForuMMM Jr showed up around the same time. Fortunately we signed Mrs ForuMMM up for the fancy expensive health plan and our OOP costs were about $150 total (although they tried to bill us $850 for a private room, even though the hospital only had private rooms and the policy covers private rooms when that's all that's available--a phone call took care of that).

Does your LPFSA have a grace period or carryover? Our FSA has a $500 carryover if we don't spend it.

Due to a few surprises, we're going to have lower expenses this year than I anticipated as well. I scoured the list of eligible reimbursement items with an HCFSA to stock up on things at the end of the year if we're running short. Turns out saline solution, sunscreen, lactaid, OTC fluoride (w/Rxn from dentist), dental visits, and a bunch of other random stuff we'd buy anyway are reimbursable. See what you might be able to get with the money if you wouldn't otherwise be buying expensive glasses.

seattlecyclone

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Re: Infant medical expenses and open enrollment
« Reply #24 on: April 08, 2016, 08:31:23 PM »
Congrats on the Mini Cyclone!

Thanks! Congrats to you as well!

Quote
Does your LPFSA have a grace period or carryover? Our FSA has a $500 carryover if we don't spend it.

Mine has the same deal. I already had put $500 in my 2015 LPFSA with the expectation that it would roll over if I didn't need it. I had only used some $17 on a prescription prior to the birth. I added another $500 to the 2015 plan after the birth, thinking that of course we would owe at least $500 after deductibles (true) and of course they could figure out how to send us a bill by the middle of February for a birth that happened in December (false). So we ended up losing that extra $500 on my plan, and rolled over $500 to this year. As I said, my employer hasn't actually withheld the $500 that I added to the LPFSA at the end of the year, and at this point I don't expect them to. If I could have used this free money to pay for $500 of those expenses it would have been icing on the cake. Oh well.

Quote
Due to a few surprises, we're going to have lower expenses this year than I anticipated as well. I scoured the list of eligible reimbursement items with an HCFSA to stock up on things at the end of the year if we're running short. Turns out saline solution, sunscreen, lactaid, OTC fluoride (w/Rxn from dentist), dental visits, and a bunch of other random stuff we'd buy anyway are reimbursable. See what you might be able to get with the money if you wouldn't otherwise be buying expensive glasses.

Yeah, when I left my last job I emptied my FSA (about $250) on a bunch of Band-Aids, sunscreen, prenatal vitamins, etc. We might do some of that again, but there are only so many Band-Aids that a person needs. I might end up needing some dental work this year which would help with the balance. Otherwise prescription glasses can use up the money.