Switching plans after birth of daughter + confirming correct calculations
Hello!
My husband and I are on an Aetna PPO plan together through his company. We just had a baby on June 26, and assuming that all my math and calculations below are correct, I am planning to use the birth as a QLE to enroll myself and my daughter onto a BCBS PPO plan through my company for OOP cost savings. Can someone please check my math and assumptions below and let me know if I’m missing anything here?
Husband’s company Aetna PPO details:
Monthly cost for just husband: $0/mo Monthly cost for husband and daughter: $55/mo Family cost (husband, me, daughter): $786/mo Deductible: none Annual in network OOP max: $4500 individual / $9000 family Amount spent towards OOP max prior to birth: $760
My company BCBS PPO details:
Monthly cost for just me: $160/mo Monthly cost for me and daughter: $255/mo Family cost (me, husband, daughter): $430/mo Deductible: $250 individual / $750 family Annual in network OOP max: $2500 individual / $5000 family
Things to note:
Everything related to the birth and hospital stay are in network on both plans I’ve confirmed with both my company and BCBS that I can use the birth of my daughter on 6/26 as a QLE to enroll us both onto BCBS effective 6/26 Husband’s coverage for just me would drop effective 6/30
Questions I have:
Do my calculations make sense that it is much more cost effective for my husband to stay on his Aetna plan and myself and daughter to move onto BCBS? For the 4 days (6/26-6/30) where I’d be enrolled in both plans, I am assuming my new plan through work with BCBS would be the primary plan. Is this correct? Also for those 4 days where I’d be enrolled in both plans, is there any scenario where I would have to pay both plans’ OOP max for the same hospital bills? Or, any other negative scenario to having two coverages during those 4 days? Assuming myself and daughter each have ~$30k minimum in hospital bills and will definitely hit OOP max, on the new BCBS plan would we still only pay a total of $5k? Aetna has already started to process some of my claims for the birth and hospital stay. If I enroll onto BCBS, how does that get sorted out?
Thank you so much for any and all help here!
submitted by /u/double_e831
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