I'm new to the US and about to enroll my pregnant wife (5 weeks) and I in either Aetna's PPO 300 or EPO 0 plans. These seem to be the best plans available to me through my employer (and have the highest premiums).

In short, I'm trying to understand how necessary it is to have 50% coinsurance for out-of-network healthcare (available through PPO 300) if my wife is expecting in February, 2024. The plan with 50% coinsurance for out-of-network care requires us to pay 10% coinsurance on nearly everything (PPO 300), while the plan with no out-of-network coverage typically covers 100% of in-network care.

We plan to use exclusively in-network providers and an in-network, licensed birthing center (or hospital). I've heard others say that it's not unheard of for out-of-network providers to support during childbirth (e.g. anesthesiologist, nurse, etc.) even if we haven't consented to out-of-network care. We're nervous about being stuck with a bill from an out-of-network provider for which we have no coverage (under EPO 0), but if we can stay with only in-network providers, it seems EPO 0 makes much more sense financially (and we might not hit the OOP max.).

Below are more details about each plan. Any insights you can offer about these plans, or prenatal, childbirth, or postnatal healthcare in the US, and the likelihood that we'll accidentally incur costs from an out-of-network provider, are greatly appreciated. Thank you all very much.

PPO 300

Basics:

Premium = $250.40 (semi-monthly) The plan pays 90% of in-network eligible charges and 50% of out-of-network eligible charges for most covered expenses. Office copay: in = $20, out = no copay Deductible: in (indiv./family) = $300/$900, out (indiv./family) = $1.2K/$3.6K OOP Max.: in (indiv./family) = $3K/$6K, out (indiv./family) = $6K/$18K

Maternity

Hospital Stay In-network: the plan covers in-network hospital charges at 90%.First you have to pay the plan's deductible. You have to have an in-network hospital stay preapproved before you are admitted to get full benefits. Generally, the plan will only cover the cost of a semiprivate room in-network. Out-of-network: The plan covers out-of-network hospital charges at 50%. First you have to pay the plan's out-of-network deductible. You have to have an out-of-network hospital stay preapproved before you are admitted to get full benefits. Generally, the plan will only cover the cost of a semiprivate room out-of-network. Baby's First Exam In-network: Plan pays 90% after deductible Out-of-network: Plan pays 50% after deductible Midwives In-network: The plan covers charges at 90% after in-network deductible . You have to have an in-network hospital stay preapproved before you are admitted to get full benefits. Out-of-network: The plan covers charges at 50% after out-network deductible . You have to have an out-network hospital stay preapproved before you are admitted to get full benefits. Prenatal Visits In-network: The plan pays 100% after you pay the $20 PCP copay or $40 Specialist copay Out-of-network: The plan pays 50% after deductible Durable Medical Equipment In-network: Plan pays 50% after deductible Out-of-network: Plan pays 50% after deductible

EPO 0

Basics

Premium = $183.10 (semi-monthly) The plan pays 100% of in-network eligible charges for most covered expenses, but nothing for out-of-network charges. Office copay: in = $20, out = N/A Deductible: None OOP Max.: in (individual/family) = $3K/$6K, out = N/A

Maternity

Hospital Stay In-network: the plan pays hospital charges at 100% after a $300 copay per admission. Generally, the plan will only cover the cost of a semi-private room. Out-of-network: N/A Baby's First Exam In-network: Plan covers 100% after $300 per admission copay Out-of-network: N/A Midwives In-network: Plan covers 100% after $300 per admission copay Out-of-network: N/A Prenatal Visits In-network: The plan pays 100% Out-of-network: N/A Durable Medical Equipment In-network: Plan pays 50% Out-of-network: N/A submitted by /u/flipn-eggs_kickn-ass
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