Medical Benefits: Know Your Options


Not only is it the holiday season, it’s also open enrollment season at many companies. For many families, this time can be stressful as costs rise forcing employers to cut their plans down making it more expensive for employees. For families with special needs concerns, open enrollment can be downright terrifying (and the cause for a glass of wine or two or six). What might have been covered last year may not now be covered, or may be more expensive.

Pretty much since we’ve been married, we’ve always been on my husband’s plan. Aside from my very very important benefit of reduced cost child care, my benefits just haven’t been worth the cost to us; his had better coverage at a better price. At his last job, the medical coverage was unbelievable…and we pushed them to the limit.  Medication that cost $22,000 a vial (that wasn’t a typo. That’s TWENTY TWO THOUSAND DOLLARS), they covered it. Visiting nurse to give injections, they covered it. Neurology visits, 1/2 year well visits, surgery, psychologists…you name it, they covered it. We never had to ask, they just did it and we sang the praises of his company and insurance plan each and every day.

Then we moved and my husband changed jobs. Honestly, we almost didn’t do it and prolonged the move for many reasons, but one of the major ones was we were afraid to lose our healthcare coverage. But alas, we moved and my husband got a new job with new healthcare…which he wasn’t eligible for for 30 days. And wouldn’t you know, during those exact 30 days I had a miscarriage and needed multiple doctor visits, bloodwork and surgery. We were able to get on my employer’s plan for the month gap, but it was after the fact resulting in paying high deductibles and still having hospital and doctor’s bills roll in 6 months after the fact. But his new plan isn’t the same as the old one and the deductible is really high. Not good. Also, they do not cover name-brand medication, even with an appeal from the doctor. Max cannot be on generic seizure medication, so his meds cost us $356 per month (and he’s on another one too, but at least that cost is less). Needless to say, our unexpected out of pocket medical expenses these past 6 months have been huge and have really thrown a wrench into our budget. We kind of thought we didn’t have a choice because the family plan at my employer was still more for the same coverage. Or so we thought.

Enter my co-worker, who called to ask me about pre-existing conditions. She was about to change from her husband’s plan to ours and was nervous about a pre-exisitng condition she has. After chatting about that and my insurance woes she told me that her husband was staying on his plan and she and her daughter were going on the Employee Plus One plan from ours. It was saving them $100 per month and the coverage was better for their more frequent appointments. That and name brand medications were covered if necessary. WHAT?? We never even considered splitting up our coverage. Since of course, our Open Enrollment ended that day I quickly got on the phone with my husband to crunch numbers. She was right, with the reduced cost of meds and deductible, we’d save $181 a month with me and Max on my plan and he and Ben on his.

So, the moral of the story is you may have to think outside of the box, but really know your options. Not everyone has to be on the same plan. Don’t just get in the rut of staying with the same plan because you think you have to. You may have more options than you know or have considered.So, this Thanksgiving, I’m not only thankful for the fact that we do have medical care, but for that friend who saved me much needed dollars.

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