Maximizing Health Insurance Coverage with Different Open Enrollment Periods
My spouse and I are considering switching from my health insurance to his to maximize our coverage for infertility treatments. We want to plan ahead for this year’s open enrollment.
We expect to max out my plan this year, so we’re thinking about switching to his plan to reset our coverage. Here are our open enrollment details:
My Open Enrollment: November 2024 for coverage from January 1 to December 31, 2025.
Spouse’s Open Enrollment: February 2025 for coverage from April 1, 2025, to March 31, 2026.
Since we aren’t recently married or experiencing any qualifying life events, those options don’t apply.
In the worst-case scenario, I could keep my coverage for next year, buy an exchange policy effective January 1, and then cancel it to join my husband’s plan in April. This way, I would avoid gaps in fertility coverage. However, I might end up paying two out-of-pocket maximums, which would still be cheaper than paying out of pocket for treatment. I’m wondering if there’s a better option or if I’m missing something.
Here are some questions I’ve considered:
If I decline my employer’s coverage during open enrollment in November 2024, would that count as a qualifying life event (QLE) that allows me to join my husband’s plan starting January 1, 2025?
If I choose my plan for 2025, would my husband’s open enrollment count as a QLE for me? (I think it wouldn’t.)
I could buy an independent policy during open enrollment that provides fertility coverage, then drop it once I use it, but this would cost more than my husband’s plan.
One concern is that I won’t know the exact plan offered by my husband’s employer until February. We live in a state that requires fertility treatment coverage, but his employer is religiously affiliated, so they could opt out of this requirement. If that happens, how would it affect our situation?
I’m not too worried about minor costs; I just want to maximize coverage and minimize expenses while avoiding gaps in fertility coverage. I would appreciate any insights or strategies you might have!
If I decline coverage under my employer during open enrollment (November 2024; coverage effective January 1, 2025), would that count as a qualifying life event (QLE) that allows me to join my husband’s plan effective January 1, 2025?
Declining your coverage might trigger a QLE, allowing your husband to enroll you in his plan outside of the open enrollment period. However, check your husband’s summary plan description documents for this year to confirm.
If I choose my plan for 2025, does my husband’s open enrollment count as a QLE for me? (I think it doesn’t.)
Not in the sense that you can unenroll from your plan. Even if your husband adds you to his insurance, your plan remains the primary insurance until the next open enrollment. You might have another opportunity to unenroll if you have a baby, which could create a QLE for both of you.
Also, be aware that your husband might have to pay a penalty to carry you on his insurance for the year since you declined your employer’s plan.
Thank you! I need him to do more research on this. His small employer hasn’t been very responsive about providing documentation outside of open enrollment, but I’ll encourage him to follow up.
Regarding primary insurance, any claims would need to go through my insurance first and be declined before the secondary policy would cover them, right? I know this process can be slow and complicated. Is that the main concern? Am I missing anything else? (I’m not overlooking the hassle of billing ; I just want to make sure I cover all angles.) Thanks!
Claims must go through my insurance first and be declined before the secondary policy covers them, right?
In theory, claims denied by the primary insurer can sometimes be paid by the secondary insurer. However, it’s more common for claims that are processed towards the deductible or denied as non-covered by the primary to also be denied by the secondary. This information is usually detailed in the summary plan description documents he received when he enrolled. You’ll need to get those documents. Typically, HR can provide them, but your husband can also try logging into his insurance’s online portal to find them.
Thanks! Yeah, I work for a big tech company and have easy access to all docs but his is small and it’s like pulling teeth to get info. And there is no portal to log into right now because he doesn’t have coverage through his employer at the moment (covered under my, generally better, plan.)
I’ll have him track it down, though. Thanks!
Hello! I’m happy to answer your questions. If you’re trying to join your husband’s plan, you’ll need to wait for his Open Enrollment or qualify for a QLE.
Would declining coverage under my employer during open enrollment (OE Nov 2024; coverage effective Jan 1, 2025) count as a QLE to join my husband’s plan effective Jan 1, 2025? No, that’s a voluntary termination of coverage. It won’t allow you to join your husband’s plan.
Is my husband’s open enrollment a QLE for me if I opt into my plan for 2025? Yes, if your husband adds you to his plan, you can drop your work plan for a coverage start date of April 1.
I can also buy an independent policy during open enrollment that provides fertility coverage and then drop it once I’ve used what I need, but it costs more than my husband’s plan. That’s an option too—just make sure you can drop it mid-year.
I won’t know the exact plan offered by my husband’s employer until February. We live in a state that requires coverage for fertility treatment, but his employer is technically religiously affiliated, so they might opt out. If they do, how would that impact me? If they choose not to offer it, that’s their decision. I recommend staying on your current plan and getting the independent fertility policy. That way, if your husband’s company doesn’t offer fertility care, you’ll still have coverage.
Thank you! Based on this, it seems as though my best option may be to purchase the independent plan regardless. That ensures that we retain fertility coverage for as long as I/we need it. I’ll have a better idea of what his plan can offer in February and from there can decide whether to keep that plan or drop it.
Does that sound like the best strategy from your perspective?
One follow-up. In that scenario, would I be best to decline coverage from my employer? There is a decent $0 HDHP that I would be eligible for but that would mean I couldn’t drop it and would spend the year dealing with two insurance providers which could get messy? Lmk if that doesn’t sound right though!
Are you planning to completely decline coverage from your employer? Or is the HDHP from your employer as well? I couldn’t tell from the context— you mentioned not being able to drop it. You can drop a marketplace plan whenever you want, but if it’s through work, you can drop the HDHP plan when you join your husband’s plan in April.
Coordination of benefits applies when you have dual coverage. The HDHP would be your primary insurance (since you secured it as the member), and your husband’s plan would be your secondary insurance. If your husband’s plan isn’t an HDHP, that would disqualify you from contributing to your HSA while you have disqualifying coverage. You could contribute to the HSA from January to March, but if you add your husband’s insurance on April 1, you’d need to stop contributing to the HSA. The main advantage of an HDHP is that it allows you to contribute to an HSA. That’s why HDHPs require you to hit your out-of-pocket maximum first before they start paying anything.
; I just want to make sure I cover all angles.) Thanks!