Messed up with health insurance this year—individual vs. family deductible

[x02947]

So this year we maintained our insurance carrier, but switched to a high-deductible plan.  They do a premium pass-through where they contribute money to our HSA, and even though my SO will have recurring medical bills this year (therapy, still some follow ups from surgeries last year, etc), I ran the math and figured we would come out ahead, particularly since we will max out the HSA.

Fast forward to today when I’m checking on how we’re doing and see that nothing is being credited to her deductible.  Call up insurance to find out that for this HDHP there is only the family deductible.   In our previous non-HDHP plan, each individual in the family had their own, smaller deductible that also contributed to the bigger family deductible, and that’s what I subconsciously (and wrongly) assumed would be the case for the HDHP. 

So now we will have an extra $1500 in medical expenses this year before we meet the deductible.  Our marginal tax rate is pretty darn low, so amount saved by maxing out the HSA does not offset the extra $1500.

Frustrated because I would love to do an HSA, but looking at my growing family and the future, I forsee a good number of medical bills each year.   

Has anyone else run into a situation like this?

[Sibley]

It's just how some plans work. Now you know. In future, ask the question and factor it into the analysis. Depending on the plan, premiums, etc it might still work in your favor.

[Altons Bobs]

Some plans go by individual deductibles (embedded), some plans go by the family deductible (non-embedded or aggregate), you just have to read it closely before you sign up next time.

[maisymouser]

This was a big surprise for our family too, though we had the opposite problem- I knew one individual in our family would max out the deductible / OOP and was hoping the rest of the family could get medical care without expenses afterward. I guess I, too, need to read the fine print on our health plans. It's really unfortunate that the health care & insurance system is so confusing to navigate.

[kimura]

The personal and family deductibles are confusing for sure.

[DaMa]

I believe that is true of all HDHP plans, but not necessarily true of any others.

Before the ACA passed, my employer (a major health insurance company) started offering employees a HDHP + HSA.  It had something like a $2500 deductible, 20% coinsurance, $5000 out-of-pocket maximum.  The trick was that the deductible did not apply to the OOP max, only the coinsurance did.  So the real OOP max was $7500, but they never said that.  (The ACA ended this practice.) 

Plans will do anything they can get away with to sneak the details past you.

[kanga1622]

We have brand new insurance policies starting in July at my employer. The HDHP policies show an embedded deductible and start paying for the first family member once they hit the single person OOP max. But I can’t find any language that talks about that for the lower deductible policies. So hard to compare policies when they aren’t spelled out well and trying to contact someone for answers is much harder than it needs to be.

Trying to decide whether a HDHP that starts paying once I hit the single person amount while hoping everyone else is healthy will make more sense or just doing a lower deductible one figuring I will cover the family OOP max and then everyone else will be free for the year. So far every question I’ve asked to HR has been “we’re not sure about that detail yet but should know more by the end of April.” Glad to know I might get answers before I have to pick a policy.

[DaMa]

For an HDHP to be a qualified HDHP for HSA contributions, a family plan has to have a minimum deductible of $2800 (2021).  If the individual deductible in a family plan is embedded, it still has to be a minimum of $2800. 

The maximum aggregate family deductible is $7200