My wife recently got pregnant and will be giving birth next year, so I need a little help to decide between a high-deductible health plan with an HSA and PPO plan for my wife and kid. I am on a different plan provided by my employer and we will not all move to same plan.
Here is the summary of both plans my wife’s employer provides:
HSA:
• Employer contributes $700
• She will contribute $7600 for total of $8300
• Family deductible = $6000 in-network
• Coinsurance = 20%
• Family out-of-pocket maximum = $13300 in-network
• Out-of-pocket maximum per person = $6650 in-network
• All office visits and ER visits are “20% after deductible”
• Monthly premium = $130 (wife + kid)
Traditional PPO:
• Employer contributes $500 to HRA
• Family deductible = $3500 in-network
• Coinsurance = 20%
• Family out-of-pocket maximum = $13700 in-network
• Out-of-pocket maximum per person = $6850 in-network
• All office visits and ER visits are “20% after deductible
• Monthly premium = $300 (wife +kid)
The HSA is $170 cheaper per month, but not sure about childbirth related services cost so it’s hard to chose.
Note: I am on a HSA plan , so I think I can use that to pay for both the wife and kids deductibles as we pay taxes jointly.
That PPO looks awful, I’m not even sure of the benefit to using it.
An uncomplicated pregnancy will include 10-15 prenatal visits, 11+ tests for prenatal labwork, 2-3 ultrasounds, and a hospital stay of minimum 48 hours if doing a hospital birth. If nothing goes sideways and no epidural is used this may keep costs to $10-12k. I’m estimating the OOP would be $5200 on the PPO and you’d hit the individual max on the HSA.
If any complications arise- your wife needs more monitoring, appointments, MFM, ultrasounds, longer hospital stay, c-section, NICU stay- you can easily blow way past the family out of pocket max. It’s a difference of a few hundred dollars, but the HSA high deductible plan has the lower out of pocket max.
It looks like the slight potential savings on the PPO if nothing goes wrong isn’t worth the $2000 in savings from having a lower premium. Not sure who that PPO is designed for. I’d go with the HSA plan.
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