Maximizing health insurance across incongruent open enrollment periods
Maximizing health insurance coverage across incongruent open enrollment periods
My spouse and I are considering a switch from my health insurance to his in order to maximize coverage for infertility treatments, and doing planning in advance of this year’s open enrollment period.
We are likely to max out coverage on my plan this year and if so, are considering a switch to his to essentially reset our coverage. I’m looking for advice given our incongruent open enrollment periods.
-My Open Enrollment: November 2024 for benefit period 1/1-12/31 2025
-Spouse’s Open Enrollment: February 2025 for benefit period 4/1/25-3/31/2026
(We are not recently married, etc so no basic QLEs apply)
In a worst case scenario, I could keep my coverage for next year, purchase an exchange policy effective January 1, and then cancel it and join my husband’s policy in April. This would ensure no period without fertility coverage, but it would mean possibly paying two out of pocket maxes (which are still cheaper than paying out of pocket if we are still receiving treatment.) That said, I am wondering if there is a better way, or something I am missing.
A few items I have tossed around:
-Would declining coverage under my employer during open enrollment (OE Nov 2024; coverage effective Jan 1 2025) constitute a QLE and allow me to join my husband’s plan effective Jan 1 2025?
-Is my husband’s open enrollment a QLE for me if I opt in to my plan for 2025? (I think not.)
-I *do also* have the option to purchase an independent policy during open enrollment which would provide fertility coverage, and then drop it once I have used what I need, but this is more expensive than my husband’s plan would be
-A tiny caveat is that I won’t know the exact plan being offered by my husband’s employer until February. (We live in a US state that mandates coverage for fertility treatment, but his employer is *technically* religiously-affiliated, meaning they do have the right to opt out. This would be highly unlikely, but if they were to cease offering the same/similar plan, how would that, if at all, impact the situation.)
I’m not so worried about a few hunded or thousand dollars here or there, just trying to think through how to maximize coverage/minimize cost while avoiding periods without fertility coverage, which would necessitate having to pay 100% out of pocket in any interim period. I’d love eyes on anything I am missing here, or recommended strategy.