New dad, need help!

[dork87]

Hi, my wife and I had our first child last week, and I’m trying to decide the best way to get the kid covered. My wife and I are currently on separate single plans offered by our respective employers. I’ve broken down our options in the following table, but I’m having trouble interpreting what I’m seeing - hoping one of you fine folks can help make sense of this for me.

In the table below, CP = Copayment, CI = Coinsurance, DD N/A = Deductible does not apply. The “Dad” plans are Employee + Child, while the Mom option is a Family plan. I left out the Dad family plan options because my wife’s single plan is a $0 premium, and I think that means it wouldn’t make sense for me to move to a family plan given the Employee + Child option (maybe I’m wrong?). I’m assuming if we went with my wife’s family plan, I would drop my coverage and be covered under her plan (does that make sense?)

Dad 1
Dad 2
Dad 3 (HDHP)
Mom

Premium
$2,425.92
$1,755.72
$1,380.60
$3,264.60

Deductible
$4,000
$7,500
$7,000
$1,700

Out of Pocket Max
$8,000
$12,500
$7,000
$3,400

Office Visit

 

[munyaku]

@dork87 The SEP is for the child, if you're not already enrolled in each other's plans, you may not be able to do so now.

 

[dork87]

@munyaku I think I’m following, I reviewed the language from our current plans and they both imply we are able to make changes to our enrollment when a qualifying life event occurs, and birth of a child is listed as a qualifying event. I believe we both have 30 days from baby’s birthday to add dependents, but I’ll definitely verify that with HR, thanks for bringing that up.

 

[munyaku]

@dork87 With an SEP, you can only generally add or remove people to your existing selections. You wouldn't generally be able to change what plan you're on or add people for whom the SEP does not apply. But sometimes I see it happen so it is something to confirm.

 

[dork87]

@munyaku I see, thanks for explaining that, I’ll check with HR and have my wife do the same. Assuming we are able to add each other, do you have any initial impressions of the plans outlined in the table? I don’t really have a sense of what a “good” plan is, I know there are various trade offs involved and it ultimately comes down to each family’s situation, but I’d love to get some feedback from someone who has a better sense of these plans.

 

[munyaku]

@dork87 Dual coverage is pretty useless these days unless one is free or offers a benefit the other does not. It's definitely pointless if either plan is Kaiser, and generally pointless if the primary would be a PPO and the secondary an HMO. The premiums you'd pay to be double covered aren't usually worth it.

So I'd pick whatever combination of plan covers each of you individually and then the least cost for the infant. They'll rack up their own claims once born so take into account the new plan deductible/OOP.

Pick whatever has the lowest total sum cost, including tax savings from HSA contributions you may make.

 

[dork87]

@munyaku This is really helpful and I appreciate the insight. Thanks!

 

[smart2773]

@dork87 Hey! Have you had a chance to look at medically underwritten insurance products? If you are in your mid-20's and healthy that's what I would recommended . You could definitely get a really competitive rate!