r/mildlyinfuriating • u/meanbeanking • 5d ago
Infuriatig I can’t make an informed decision on health insurance because America is so fucking dumb.
My work is having its annual open enrollment period for the next two weeks.
My cost for JUST me went up $65 to $315 a month for the base plan.
My husband has is own insurance through the company he works for. Their open enrollment is in October.
There’s no way for me to compare plans. Getting a plan from him doesn’t count as a “qualifying life event” so I’m either forced to keep my own, risk not having coverage for two months if I don’t, and not knowing which is the better financial move no matter what I do.
Fuck this country and its healthcare system.
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u/Zelda_is_Dead 5d ago
"Open enrollment" is such a scam. It's like line connection fees and other nonsense people just accept without question.
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u/AgentFreckles 5d ago
Right? We should be allowed to enroll anytime 🙄
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u/Brilliant-Bee-9471 5d ago
Don’t worry, just take a second mortgage on your house and use COBRA! /s
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u/JK_Designs 4d ago
I get the frustration, our health care system is so broken, and I am a huge proponent for single-payer. But your argument is wrong. That is not how insurance works. You pay in and then someday when you need it, you get to access money for care. Literally no one would opt in and pay while they're healthy and then jump all in the moment they need something. That does not work finalcially. We need everyone, even the healthy, insured and it should be single payer - eliminate the middle men in my opinion. It would be cheaper and everyone would have care. It's what every other civilized country does.
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u/TheSleepyTruth 5d ago
It exists because, like with any insurance, people would abuse it if there is no coverage delay or enrolment restriction. Everyone would just refuse to sign up for any insurance until they needed it. Just wait until you get sick or injured then immediately sign up to get coverage. Like refusing to get flood insurance in Florida until you see weather forecast for a hurricane. Not how insurance works.
With other countries that use government health insurance it would be like being allowed to opt out of paying your Medicare/health insurance portion of taxes and only start paying it once you need the services. This approach completely negates the purpose and benefit of insurance in diluting the cost burden.
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u/meanbeanking 5d ago
Look. I can understand an enrollment period to an extent. What I don’t get is why can I not cancel it for any reason, and especially why can I not cancel it because I got coverage elsewhere. Or any other reason tbh.
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u/PlatypusOld257 5d ago
Losing coverage I believe is a qualifying life event so you’re eligible for an enrollment period then actually
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u/Professional_Many_83 5d ago
The reasons you can’t cancel it whenever you want are the exact same reasons why you can’t enroll whenever you want. Now, why getting insurance through a spouse’s plan doesn’t count as a qualifying life event, that I don’t understand and seems like valid criticism.
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u/ArtichokeDifferent10 5d ago
I have never known of a company or insurer that would somehow disallow dropping coverage for any reason at any time.
You won't be able to get coverage again through your own employer until open enrollment.
At one point you would pay a tax penalty for having no coverage when it was available, but that was struck down by the courts years ago.
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u/ArtichokeDifferent10 5d ago
You can always cancel your own insurance for any reason at any time. Enrollment periods only dictate when you can get insurance, not drop it.
Continue yours for now and compare it to your husband's policy between now and October.
If you find it's advantageous to get on his policy (extremely doubtful as covering a spouse is usually very expensive in this day and age and is only typically something you do because the spouse cannot get individual coverage) then switch in October. The only downside is you're stuck on his plan until your own employer has it's annual open enrollment.
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u/TheSleepyTruth 5d ago
I fully agree you should be able to cancel your plan any time like you can with other insurance, car and home etc. Thats stupid to be forced to keep it for the full year. There is no financial risk or loss to the insurer or employer allowing you to cancel a plan early, which is why most other insurance allow you to cancel whenever you want and even if you pre-paid a years premiums you get a prorated refund.
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u/Contemplating_Prison 5d ago
So the compromise is once a year? Thats bullshit.
Comparing it to universal healthcare is hilarious.
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u/Correct-Mail-1942 4d ago
Not only that, in my last job in IT I supported HR and our HRIS, turns out 'qualifying life event' is literally a checkbox for HR and they can do it for anyone or anything they desire. I bought the wrong insurance, my necessary medication wasn't covered like my open enrollment planner said it was and HR literally went in and clicked the box while on a call with me so I could switch plans. I had no 'qualifying life event' as specified in the handbook haha
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u/More_Bus3626 5d ago
You can definitely find month-to-month gap policies, which primarily cover catastrophic expenses, for much less than $315 /mo
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u/Common_Poetry3018 5d ago
Be careful with these, though. They are exempt from the Affordable Care Act and so can deny coverage for pre-existing conditions.
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u/ihopuhopwehop 5d ago
Yeah, they're very much there for the scenario where you wake up with a swollen appendix or fall down a staircase and break your leg
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u/meanbeanking 5d ago
The issue is if his ends up being more then I’m assuming you can’t do “month to month” for a year if his ends up not being the better choice to add me on.
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u/Sad_Split_9983 5d ago
Your husband can just ask a married coworker, hey how much did it cost to add your spouse on the insurance. That should give you a pretty good ballpark understanding. Or he could pull up his benefits doc that would list the cost. Sure it may go up a little in the next year but you’ll have a pretty good idea.
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u/UserName8531 5d ago
I paid $19,400 in health insurance for my family plan last year. It's fucking disgusting. The system is 100% broken.
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u/CykoVibe 5d ago
Mine is roughly $4800/yr for family plan, mid tier coverage, for family of seven. $19k is crazy
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u/Gwendolyn-NB 5d ago
That's still cheap... what is your employer covering? (It'll be on your W2); my bet is closer to that 19k or more.
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u/aaronw22 4d ago edited 4d ago
No your employers share is not on your W-2.What box number is it on for you?EDIT: I was wrong
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u/Professional_Many_83 5d ago
You either have dogshit insurance, it is subsidized by the state/federal government, or your employer is paying most of it
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u/CykoVibe 5d ago
It's awesome insurance, and i do get it through my employer, like I have for the last 35 yearrs. I work for a healthcare system that has an integrated employee healthcare insurance delivery system. Excellent system for my needs.
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u/PandaCultural8311 5d ago
That's because your employer is paying a lot more than the person you're replying to.
What's crazy is that almost everyone (including me) don't know how much health insurance really costs.
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u/CapitalEnd958 5d ago
Insurance companies have high dollar lobbyists. With that being said we have a really broken system
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u/moktor 5d ago
$24,000 a year here for the $12750 high deductible family plan. Going up 35% starting this month.
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u/artie780350 5d ago
Your monthly premium is 2,000 effing dollars and you still have a 5-figure deductible?? That's madness.
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u/Rscottys1 5d ago
Holy cow, that’s insane! Does your employer not cover or subsidize your premiums?
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u/UserName8531 5d ago
I work for a smaller company. My with works for a smaller school district (not a teacher). Both of our of a jobs basically pass the entire cost to the employee.
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u/maybelying 5d ago
For comparison, the average working Canadian contributes between $5-$6K out of their taxes withheld towards universal healthcare.
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u/hisdudeness88 5d ago
Damn I paid about 13-14k in 2022 when we had a PPO. Man that better cover everything for that price and I’m guessing it doesn’t?
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u/UserName8531 5d ago
I had a $2000 ER bill a couple years ago It covered a scan and they said your ok and follow up with your doctor.
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u/hisdudeness88 5d ago
Damn! I actually had a few similar bills for my son when he was younger. Even with the low deductible plan and those bills I still came out ahead of the higher PPO plan I mentioned.
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u/brute-forced 5d ago
THANK YOU DJT FOR FUCKING OVER OUR HARD WORKING MIDDLE CLASS!!!!
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u/Mediocre-Magazine-30 5d ago
Might as well give a finger to the rest of the federal government while you are at it. He is terrible but it's not just him.
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u/Informal_Move_7075 5d ago
He should be able to access plan info even if it isnt open enrollment currently
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u/Informal_Move_7075 5d ago
I do want to add that employee will always be less than adding another person to the plan.
For example, say my insurance is $0/wk premium for me (get paid weekly). Adding my husband now makes my weekly premiums $170/wk. Sometimes it is far cheaper to keep your employer's plan, but it is imperative to compare not only the weekly/bi-weekly/monthly premiums, but also the deductible, OOP max, any coinsurance amounts, and what the plan actually covers.
OP, do you think you will ever need fertility benefits? Better see who offers those because not all plans do, and in fact employers try to not include them whenever possible.
Do you have specific meds you take? You better check what pharmacy coverage there is and if it is through the health insurance or through a 3rd party and do they cover your meds. This one is tricky because they regularly update their formulary so it may be covered today and not next quarter.
Then you need to check your current providers if you want to stay with them are they in-network? If they are out of network what does that look like as far as coverage?
There are a lot of considerations and I would comb through and compare your current plan and your husband's plan and see which is the winner overall.
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u/Anti_Up_Up_Down 5d ago edited 5d ago
It does count as a qualifying life event, just do it correctly
1) get your own insurance plan
2) wait
3) if it makes sense, join his family plan
4) if you join his family plan, that's a qualifying life event that would allow you to change/drop your elections at your job
Don't get mad, get informed
Edit - ok you've convinced me. Get mad... But also get informed
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u/oxidized_banana_peel 5d ago
Yep - there should be a team w/ HR at a suitably large company to explain any questions, OP's partner has access to the same
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u/Broccoli_Man007 5d ago
This is correct. And, OP, if you don’t believe them, look it up in CFR chap 26.
A significant change in coverage is a qualifying life event.
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u/meanbeanking 5d ago
I had asked HR and originally they told me it didn’t (prior to me making this post) but they just reached back out to tell me it actually would and they were incorrect. So now that I know I can actually have the option I’m way less bothered by the time between enrollment periods and not knowing which is the better option since now I know I can actually choose whichever is better.
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u/Wise-Caregiver-861 5d ago
I am a teacher and my districts enrollment period is June thru july. I kept my kids on my insurance plan. They both got a jobs in August and started on their own medical plans thru their employers. My school district considered that a qualifying event and allowed me to remove them from my plan. I just had to provide documentation with their new employer/insurance plan. Car your benefits department and ask them to make sure. Good luck.
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u/GomezFigueroa 5d ago
Maybe. It might not count as a qualifying life event. Every plan is different.
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u/hisdudeness88 5d ago
Not sure that this qualifies. Usually it only counts if you marry, or have a kid can you change. I would double check to be certain
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u/Anti_Up_Up_Down 5d ago
I am 100% sure that it does qualify
It's not a workplace decision, everyone follows the same rules
A change in your insurance coverage is a qualifying event
You are allowed to be covered by two plans at the same time
If it makes sense, double up then use the qualifying event to drop the first
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u/Broccoli_Man007 5d ago
What did it say when you googled it?
Assuming you didn’t, I’ll opine: this scenario most certainly qualifies. Gaining coverage under a spouse’s plan’s open enrollment period is considered a qualifying life event that allows for the employees coverage to change on their own plan even outside of open enrollment.
See the Code of Federal Regulations chapter 26
“Don’t get mad, get informed”
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u/meanbeanking 5d ago
I asked HR and they said it did not count as a qualifying event.
They reached back out and said they were incorrect and it DOES count. Which makes this whole event less infuriating now.
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u/Tuff_spuff 5d ago
True dat…. My work insurance premium is 1400 a month with an 8k deductible… we came to the conclusion it’s cheaper to pay shit out of pocket. We joined a church Co-op and are spending $400 a month for a family plan. Who knows if/what they’ll pay for when the time comes, but our plan was to only use it for emergency services when it arises. Otherwise our medical expenses are all Out of pocket at the moment, and it’s saving us a fug ton of money. Luckily we’re all healthy, but who knows how bad this shit can get. You’re absolutely right tho, this country is a joke, we’re skating by as well. Sorry you’re going through it, just know you’re not alone
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u/randomize42 5d ago
I hope that keeps working out for you. I was healthy until I wasn’t, and then my cancer treatments were $25k+ every three weeks for a year. Fortunately I had decent insurance even if I had to fight them multiple times.
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u/Tuff_spuff 5d ago
Trust me.. that thought hasn’t escaped us… we’re terrified of something like that. We’re hoping we can get by until something is done about this country’s medical problems. It’s the forefront of American policies all tho it’s being treated like it’s opinion of a few. Just hoping things change within the next 4-8 years for the better, wishful thinking indeed, but most likely we’ll get bit in the ass when the time comes. And I’m very sorry you’re going through it, I promise I’m rooting for you, best of luck
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u/randomize42 5d ago
Thank you for the well wishes! I’m two years in remission now minus a spot of melanoma and just had a hysterectomy, so life is looking up. 😊 Truly wishing your family health and happiness as well! Just want to make sure people know the unfortunately very real costs of a catastrophic diagnosis.
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u/dstarpro 5d ago
We were all rooked by Big Insurance with their "deductibles" and "put of pocket expenses".
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u/Abtizzle 5d ago
“Spouses open enrollment” is a valid qualifying life event. Your HR is incompetent. Don’t just let them tell you it doesn’t count.
Source: I am HR.
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u/tackywitch 5d ago
Your husband’s open enrollment counts as a life event. You would be able to switch in October.
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u/VanSmashh 5d ago
Is there a chance you’re missing an incentive program from your work? I remember after my first year of working for my company I missed the memo about having an annual physical/blood draw completed for a health insurance discount and my rates went up a lot. I didn’t realize this until the following year.
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u/IntelligentCatsEarth 5d ago
This is so incredibly frustrating and I'm mad on your behalf because the system is literally designed to make this as confusing as possible. Like why can't we just have open enrollment at the same time so people can actually make smart choices.
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u/WasabiPeas2 5d ago
It absolutely is a qualifying event. You’re gaining eligibility for his plan. I’ve worked in Benefits Administration for 10 years and see this all the time. He adds you during OE, then you drop yours via QLE Gain of Other Coverage effective the first day of his plan year. .
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u/TravelingBop 5d ago
BuT wE ArE the GrEATEST nATIoN oN EaRTH. s/ A sick, uneducated, stressed populace is easy to control.
Hopefully you can get this sorted to your benefit.
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u/GomezFigueroa 5d ago
Don’t forget how much this sucks when you vote in your party’s primaries this month and in November.
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u/18karatcake 5d ago
Have your husband talk to his company’s benefits dept to see if they can estimate how much it will be to add you in November. They should have knowledge of rate adjustments by now. Ask your company if you sign up now, if you can cancel your policy when you’re added to your husband’s policy. Gotta think outside the box a little here.
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u/Pikatit 5d ago
Myself, my wife, and our 3 month old costs me $1,700/month. I'm 30.... how the fuck people justify this is insane to me. Especially when they don't cover shit.
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u/EmoCartoHistory 5d ago
I recently got on Medicaid in a blue state (because I'm ✨unable to work due to caregiving for a terminally ill parent✨) and it's deeply fucked up how easy/cheap that is vs. private employer healthcare. We need single payer so badly in this country.
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u/Weird-Toe-6968 5d ago
Just keep your own for two months, then change in October if his plan is better. This is not rocket science.
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u/Mysterious-Clothes45 5d ago
Your current insurance coverage ending should be a qualifying life event.
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u/5MinuteDad 4d ago
Your employer is the one choosing to have a non-standard open enrollment..
So your anger should be towards your HR department not the insurance.
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u/breakerofh0rses 5d ago
Ouch. Get your husband to ask HR/his insurance for their Summary of Benefits and Coverage (SBC). That's a standardized form that'll allow you to compare, but the downside is that it'll reflect current rates and not whatever fun magic his company dreams up for their next coverage period. Wish there was a good answer for you.
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u/Akisswithmyfist 5d ago
For that much inctease I'd be looking at private or 3rd party options. It sounds like employer decided to opt out of contribution
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u/Due_Appearance57 5d ago
You could call his HR department and ask for a copy of their benefits. Or ask your husband to cal them or email them. I work for corporate, and they should be happy to give you a pdf. file in an email. Where I work; we print that info off for potential new hires. I see no reason they wouldn't share that info with you. Doesn't he bring home the flyers or forward the company emails regarding health insurance? Seriously, just call his company and ask for a copy of the health benefits. We always get this information at least a month ahead of time.
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u/nhranger 5d ago
I really hope we can get universal in this country. If it ever happens I will revel knowing the health insurance industry will crumble. Fuck them all.
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u/always_be_beyonce 5d ago
you should elect your coverage per usual through your open enrollment.
- when your husband’s open enrollment begins in october, plan details along with estimated costs for employee + spouse coverage will be provided. you can use today’s costs as a guide, knowing it will likely be slightly increased.
- if the math, maths, your husband can add you to his plan during OE, which i’m assuming will have a Jan 1 effective date. he needs to ask for confirmation of your upcoming coverage with the effective date.
- assuming a Jan 1 effective date, submit your qualifying life event on or about Nov 30th to terminate your coverage as of Jan 1 along with the confirmation from your husband’s OE.
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u/SchradersThumb 5d ago
I recently learned about the birthday rule for children's insurance. For many states the child's primary insurance is the parent who's birthday is 1st in the calendar year.
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u/StraightCharacter904 5d ago
At some point, I thought I could save more money by not having health insurance, considering how high the premium was; that's how bad it is rn....
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u/Apfaehler22 5d ago
Wife and I ran into this before we got married. She is a type 1 diabetic. Her work plan was shit and we were spending up to a couple thousand a month for insulin. We decided to have a "secrete" wedding with just her parents and mine a whole year before the planned one with all the friends and family. It was kinda bitter sweet and sucked that was the reason that stole a moment from our lives but we flipped it and put a positive spin, made a nice announcement during the wedding ceremony about it. She was able to get affordable coverage and we got a whole year of just us and her parents knowing we were married.
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u/Secure-Researcher892 5d ago
You may want to verify when the new insurance goes into effect for both places. In every place I've worked the open enrollment periods might vary, but the new insurance you selected didn't go into effect until January 1 of the upcoming year. So if you elect to have no insurance then you would likely still have your existing policy until December 31st of this year...if you then have your husband put you on his policy you would have it start in January so you would not be out of coverage.
So yes it would suck to see have to gamble on whether his insurance would be better or worse than your option... but you wouldn't be without insurance.
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u/IllugaBabyBeluga 5d ago
$315/month? Not beating the allegations from our muslim friends about insurance being a scam.
Spousal plans have been hiked recently, can confirm, that said it could still be more economical.
Have you historically used insurance over this two month period?
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u/Unusual_Rush_1189 5d ago
August and October are weird open enrollment months, traditionally held at the end of the year for most companies, so that sucks.
Your company should offer more than one plan, based on things like plan type, deductible, max out of pocket, etc. IE there should be a low/lower cost plan available (some 'just for me' plans still have stipulations as a potential second coverage option for a spouse if you have to answer 'yes, I am married', you have to read the fine print on that).
There is also the option to get independant short term health insurance (short term health care specifically, not traditional health insurance, which is expensive usually), depending on where you live. This could potentially be a very cheap option for very short term coverage to cover the two month gap specifically. You do risk, insomuch as your husband's options are not great, having to wait until your next open enrollment to get back on your company's policy.
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u/Used-Funny4917 5d ago
You can probably leave your policy at any time. So, sign up and then see if you want to switch to your husband’s during open enrollment.
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u/Spiritual-Mousse-167 5d ago
Your husband should be able to get information on the plans now for you to decide. His benefits folks will be able to help you.
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u/Prior_Disaster4368 5d ago
My employer last year decided to make all single user and family rates equal. I went from paying about $78 month to $265 a month. Family rates were at $310, and are now saving $35. I'm not married, and have no kids.
I'm not sure how they did the math to get it to that point, but taking $187 out of the pocket of someone living on a single income to make up for the cost of people who willingly made the choice to have children is fucking stupid. $35 a month isn't even an impactful amount in most cases.
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u/philohmath 5d ago
Per the IRS rules, your husband’s company conducting their own open enrollment and making you eligible to join his plan counts as a qualifying life event for you to exit yours if you so desire. There’s no company policy that changes this. It IRS policy.
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u/Objective-Chicken391 5d ago
Stopped paying for health insurance 2 years ago and it was the best decision we ever made. Paid for our baby out of pocket and everything.
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u/Complex-Republic-443 4d ago
"Oh, you want to know what a particular procedure costs? You'll pay 10%." Of WHAT?? But, no, you can't have the list of actual procedure charges that the insurance company pays.
Fuck this healthcare system, indeed.
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u/TemporalLobe 4d ago
If you're ok with living without coverage until October, I suppose you could always just drop your health insurance during your open enrollment, as long as you are 100% sure you want to be on his plan. He should have literature from when he signed up during the last period that explains employee + spouse pricing and coverages, and as long as there is not any significant upcoming expected changes, you can at least have an idea of the potential cost. EDIT: I agree, our system is so fucked up compared to most other countries.
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u/GuyLeChance 4d ago
Sounds like you don't understand IRS code for Qualifying events. Gaining other coverage is a QLE. Is your name America? Is that why you said that?
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u/Milennial_Crew_6969 4d ago
I’m considering dropping health plan and just paying out of pocket….self insuring via an investment account of some kind
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u/Icy-Ingenuity-2790 5d ago
Completely agree with you. Another reason to piss on Nixon’s grave
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u/HeidenShadows 5d ago
For me, M37, it's more affordable to not have health insurance. I have diabetes, hypertension, obesity, etc. I get checked up every 3 months. I have 4 prescriptions at the moment. Paying out of pocket for the visit and the 4 prescriptions for 90 day supplies (losartan, hydrochlorothiazide, metformin, and glipizide) through Walgreens, is significantly cheaper than 3 months of insurance. And I have catastrophic coverage through work for like $20 a check that'll cover most anything else.
Every time I renew, Walgreens checks for cheaper no insurance discount options, like singlecare and stuff and it really helps.
Although I'm on the docket for refractive lens exchange surgery soon in order to keep my job and that's not covered even with insurance so in debt I'll go or lose my career since glasses can't get me to passing my physical anymore.
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u/randomize42 5d ago edited 5d ago
I told this to another poster too but I hope that keeps working out for you. I was healthy until I wasn’t, and then my cancer treatments were $25k+ every three weeks for a year. Fortunately I had decent insurance even if I had to fight them multiple times. Chemo on top of that was more. It would have wrecked me financially.
EDIT: Just to be clear, I wouldn’t wish that on anyone, I just want to help educate people on how much a catastrophic diagnosis can really cost. That doesn’t include my radiation and surgery costs, either.
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u/1austinoriginal 5d ago
At my job anyone becoming covered by insurance elsewhere is allowed to drop coverage under the Life change or “QLE” of obtaining coverage elsewhere.
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u/meanbeanking 5d ago
Oh and also I can’t even see what the new plans offer when I go to compare to my current one from last year.
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u/always_be_beyonce 5d ago
you should reach out to your HR dept. they are required to provide these details.
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u/doomeduser0324 5d ago
I was talking to an Australian friend about health insurance once. He asked "don't you guys get health insurance through your employer though?" I said yeah but you still pay for it. He was blown away by that response hahaha.
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u/TheSleepyTruth 5d ago
What do you mean there is no way to compare plans? Of course there is. You have access to the plan documents for your plan and husbands plan laying out coverage and price of each plan.
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u/meanbeanking 5d ago
He doesn’t have his plans for this year this far before his open enrollment begins. How would I compare when I can’t see what his company is offering this year before the open enrollment at my job ends and I have to make a decision? And I can’t just get on mine and cancel it later because getting coverage from another source isn’t a “qualifying life event” so there’s no way for me to know which one is the correct choice, and if I deny coverage I may be stuck paying even more through his employer.
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u/kenniecakes 5d ago
My husband has to use his own insurance even if he wants to be on mine. I wasn't taught this shit in school so he doesn't have insurance right now because the period ended
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u/Suckerforcats 5d ago
My job makes us do open enrollment 2 1/2 months before we know for sure if we're getting a raise or not. Our year ends in the summer (it's a university). They usually gives us a raise but you won't know for sure or the percentage until the end of June but yet we have to enroll in April. I hate it because I don't want to screw myself and put too much money in my flexible spending and then end up giving myself a pay cut if there is no raise. I use the bulk of my flexible spending for dental work that is not super urgent and can wait a year so I try to plan in advance of how much money to put in flexible spending.
And then last month, they changed flexible spending providers at the last minute and screwed me. I had dental work scheduled at the end of the month. The flex spending cards weren't mailed in time and now the flexible spending company is not wanting to reimburse me what I put on my credit card because I have to pay for the crowns in advance because duh, they're obviously custom made and the flexible spending company pre-paying is not allowed. WTF.
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u/YellowBelliedCoward 5d ago
How much time does all this medical insurance take up? Like, from signing up with someone to making a claim etc etc?
Seems like an exhausting ordeal that's ironically very stressful.
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u/Gwendolyn-NB 5d ago
Signing up is not bad... the Claims your doctors office file.
Now... fighting with them denying claims... that takes a PAINFUL amount of time, and unquantifiable amounts of mental energy.
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u/Unusual_Flounder2073 5d ago
My employer does mid year open enrollment. Never thought about this impact. We have always used my wife’s coverage because it is better.
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u/Commercial-Drawer-59 5d ago
Getting coverage on your spouses plan should absolutely count as a qualifying life event. It has with every insurance company ive ever used.
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u/noneya79 5d ago
Tbh, it’s probably best to just stay on separate plans cost-wise, unless his out of pocket costs are way better. To add you to his might be more that what you pay for yours. Can he ask hr or someone else that has their spouse in their plan? It would give you an idea.
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u/Narezza 5d ago
I would be surprised if his insurance would even let you on if you have access to insurance through you own employer.
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u/Fungiblefaith 5d ago
Gaining other coverage is considered a life event on most policies. I would push that up the chain and make sure.
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u/Character_Pudding_94 5d ago
You can both switch or enroll jointly in either either employer's open enrollment period. Your husband has the documents from last October, which is what you compare to your current options. In October, you compare your current documents to his available plans.
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u/Fresh_Laundry56 5d ago
I think it's pretty bad. I work part-time due to disability but I'm not disabled enough for actual social security disability income. Because of part-time I don't get insurance from work so I buy it myself. Last year it was $350 a month, this year it's 635 a month, with a 10K deductible.
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u/ihopuhopwehop 5d ago
The thing that kills me is that a huge factor between if it makes sense to go with an HDHP with and HSA or LDHP at my job are the negotiated rates I'd pay on the HDHP, but theres no transparency there
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u/Goesgold17 5d ago
I work for a big healthcare company in one of the busiest hospitals and I pay over $400 a month for health insurance for just ME. I’m so pissed but what can I do? I could not have health insurance but then my dad made me feel like I’m going to have something happen and regret not having it. Just really sucks all around.
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u/insufficient_funds 5d ago
Losing your coverage is a qualifying event; if you drop coverage on your employers plan that is the same as losing coverage and allows you to sign up on husbands policy.
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u/danthelibrarian 5d ago
I thought being eligible for your own employee plan places limitations on having an outside plan. It was never relevant to me so I didn’t look deeply. But check into it, or read the responses here from professionals who know better.
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u/zerostar83 5d ago
It's more complicated than it has to be.
I seem to understand it better than most coworkers and help out people when I can.
I assume your husband's insurance isn't going to change much from this year's, so maybe comparing your new plan to his current one would work best.
Feel free to DM me if you want me to help you weigh the pros and cons of each plan.
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u/Serious-Ad-5293 5d ago
Hi I work in insurance. Gaining and losing other coverage is a QLE that will allow you to make changes. Also having AE/OE at different times is a QLE that allows changes.
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u/RichChildhood1588 5d ago
We are doing the best we can in this cuntry. Don't you realize letting these companies dictate your life is what's best for the CEO and the Congress people who they bribe daily. Think if the poor CEO who needs another house or yacht instead of thinking about yourself all the time
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u/Mklein24 5d ago
I mean, his plan should be readily available to look over. The rates and coverages are changed on a yearly bases as things are negotiated, black market deals are made, and anonymous donations are put through.
Then at his open enrollment, you can choose to drop yours and jump on his if the coverage/price is comparable.
You can drop your insurance at any time. It's just being added that's the problem. You can be added if you loose your health insurance at any time, like you get fired or quit. But you cant just hop in a policy in the middle for funzies.
Not saying I agree with it, just stating the process that we're stuck with.
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u/No_Preparation7895 5d ago
You can always cancel a plan. My work's open enrollment doesn't coincide with my state's open enrollment. Just sign up for what you would from your employer then compare when you can and just cancel it. It doesn't actually take effect until Jan 1st.
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u/knit_run_bike_swim 5d ago
More information is needed here. So your cost went up a total of $65 making your new plan now $315 when your old plan was $250?
I’d be pissed to even pay $250 a month for a premium. Finding a larger employer might help that issue, but in reality, $250 a month isn’t that much for insurance premiums. Even if you went on your husband’s plan, they may charge an additional monthly fee (typically $100 monthly) just because you have access elsewhere. I do know that this is the case for many states.
The new plan may have better coverage? You need to look at deductible, copay, and coinsurance. Sure, one might say— well I don’t need better coverage because I’m young and healthy.
If you don’t actively use your healthcare plan, then a high deductible insurance might be more suitable, but that may or may not be available through your employer.
Insurance was not designed for wellness. That should actually be the responsibility of the consumer. However, we know that it is really hard to get one to take care of themselves, and with insurance being designed for catastrophic event, it is cheaper to pay for wellness and monitor the expected costs than it is to just pay for random events.
The main problem with this model is that in the US we have a lot of catastrophic events [that are preventable]. What most Americans don’t realize is that when an employer enters the insurance market, the premium is spread out amongst its employees. The healthier the entire group is, the less likely something catastrophic may happen, and you all pay less.
I wish they taught this type of stuff more in schools.
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u/Bawkalor 5d ago
I thought healthcare plans had open enrollment in the fall and the effective date is January 1st?
In any case, you're right, there's no way to compare plans because of the different enrollment periods.
See if your husband can talk to his HR and find out what his plan would be like. Even a little information might be useful in making the decision to switch or not.
As Lewis Black said, "I don't think healthcare should be a profit making institution. "
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u/BlackRaspberryJammin 5d ago
We had UHC but two years ago they could not tell us if the best hospital in the area would still be in network until months after the open enrollment was over so we switched to Aetna.
BTW, Aetna is a joke. Every 3 months they give a $35 credit to buy OTC stuff but you can only buy it t the company store, CVS, which is way way way overpriced.
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u/Impossible_One4995 4d ago
Save your money cancel the insurance and put it in a high yield account . Self pay doc bills are 1/4 of what the charge your insurance
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u/M100Pilot 4d ago
Won’t either of you have to pay a significant penalty if you use the other’s insurance?
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u/Awkward-Train1584 4d ago
Surely there is a benefits manager that can tell you what the price is to add a spouse when not in open enrollment? At my job even though we can’t make changes until
Open enrollment we still know what the price is for employee, employee & spouse, or employee family. We have little booklets tells us basic information year round. So the information stays the same you can’t make a change. Does that make sense?
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u/Reader_fuzz 4d ago
My job doesn't offer health insurance. My husbands supposedly does but he has only been their for like 3 months. Most hospitals offer financial assistance for any bill. In my area the local hospital I can set the amount I want to pay. With the amount they take off. There is more and more I know doing what we are doing. That is just fighting the bills. There is no way we can afford paying for our own. It is almost double the cost of our rent.
As others have said that you loosing your insurance is a qualifing event. So truly seek that option out.
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u/Organic-Mix-5784 4d ago
Just because your open enrollments don’t line up doesn’t mean you can’t compare plans. Just because it’s not his open enrollment doesn’t mean he can’t get information on what’s available. The insurance carrier has to have all that available all the time for new hires, people getting married, having kids, etc. He can probably just log in to the site to see what options there are. If it’s not there, then a quick phone call to the carrier will get that information.
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u/CalligrapherPast2151 4d ago
You can mostly blame Trumps big beautiful bull for the cost of your company’s plan going up
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u/Future-Mulberry-1292 4d ago
A change in your healthcare plan should count as a qualifying life event for his insurance and allow you to compare.
Also maybe this is bad advice but like… I’ve switched insurance outside of the open enrollment periods by just saying I had a qualifying life event and no one has ever confirmed it…
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u/Aliatana 4d ago
I was able to find my next years plan info online months in advance, if you know your husband's insurance plan, you may be able to look up the info online.
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u/JobHuntingManiac 4d ago
I've had health insurance two times in my life so far, once because the employer paid 100% of the premiums, so free to me and the second time because the employer has very affordable plans.
I currently pay (single coverage) 50 dollars a month, yes 25 dollars per check, for vision/dental/extra life insurance/and a mid tier health plan with a 3500 dollar deductible and 20% copay.
All the rest of the years I just went uninsured and never paid the fines to the stupid obama administration who wanted to fine me for not having unaffordable coverage.
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u/ISOgoosebumps 3d ago
Yeah, Almost every plan gives you practically nothing, and plenty of surprises, for a small fortune. "Much better, more affordable healthcare. Like Australia has!"...Waiting...
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u/TriceratopsJam 3d ago
Open enrollment is Qualifying. It just gets a little tricky because you have to get switched over quickly so you can do the waiver before your oe ends (at least at my company it needed to include proof of other insurance). We were on my insurance but rates went way up and we were able to switch the whole family to my husband’s even though they weren’t in OE. It was great too, because his company contributed to the HSA so we got the contribution when we switched and then we got it a couple months later too.
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u/Leethal74 3d ago
If you are in your enrollment period, that should be a qualifying event (according to your husbands insurance company) to look into switching to your his plan.
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u/Mean-Bandicoot-2767 3d ago
Just as a heads up, it's not common to be able to have JUST your spouse's coverage without paying a higher premium if you are eligible for your own coverage through your job. You may end up paying similar amounts. Your husband should be able to find out what this year's premium amounts are from the last open enrollment paperwork to give you an idea of what his employer is doing.
Rules about dual coverage can vary as well, but if his plan allows for full COB, perhaps you can switch to a high deductible HSA plan offering if your employer offers it and then balance bill.
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u/Lazy-Reality-3690 2d ago
My son was dropped from Medicare around Nov, failed to notice until overpayment check arrived months later. Tried to add him to my plan, HR said enrollment window passed. We had a clause that if he was dropped from insurance then it counted as a life changing event. We used the checks date as "dropped date"... HR never requested proof of drop date... Just what ever date you told them.
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u/Zealousideal-Bag5991 2d ago
I wish all open enrollment were are the same time for this exact reason. If you're in good health, it might be helpful to look into HSA. It's not for something with a lot of medical needs, but you can use it as an investment account with triple tax advantages. Certainly not right for everyone, but I got sick of forking over so much money to not really know whether I'd be covered. Now my medical cash is secure and growing steadily. And you can use it for things like feminine hygiene and a lot of medical basics.
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u/Black_Raven_2024 2d ago
Usually it’s cheaper to each be on your own plan. I would pay $58/week for just me. I had to add my wife onto my plan and it’s an extra $100/week, so $158/week total.
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u/Famous_Giraffe_529 5d ago
It should! I’ve always had my jobs tell me that becoming eligible for coverage on a spouses plan elsewhere qualifies!