Help me choose between HMO or PPO (same premiums)
Hi, today is the first day of open enrollment! I’m struggling to pick a plan, I’m pretty sure I know what to do but I’m wondering if there’s something I’m missing. Both plans cost me the same amount per paycheck so that thankfully isn’t something I have to consider.
Plan benefit is October 1 2023 – September 30 2024. However, the deductible runs from January 1 – December 31.
I am pregnant and have already hit my deductible, currently at about $1300 total spent towards my OOP max. I will give birth in early/mid December so all labor/delivery expenses will count toward 2023.
Currently enrolled in a Tufts PPO plan. There is a $1000 deductible, and after that I pay 20% coinsurance. Out of pocket max is $2000.
Considering switching to a Tufts HMO plan. The deductible is still $1000, but 0% copay. Out of pocket max is $3000.
I am allowed to switch plans within the same carrier, and my deductible does NOT reset.
I feel like it makes sense to switch because labor and delivery won’t have any costs associated with it, since I’ve already hit my deductible and there is no coinsurance. If I stick with the current plan, I still have ~$700 left before I hit my OOP max.
I guess I’m wondering in what circumstances will I have to pay anything (or much) since I’ve hit my deductible? Besides any copayments for office visits ($30), specialists ($45), and any prescription drugs, I don’t see how I’ll accumulate any other charges for in-network care. Am I missing something?
(I was looking through the plan docs and again and my current plan covers out of network at 40% coinsurance. The new plan does not cover out of network. But I don’t see that being an issue).
Happy to answer any questions or provide more details from the plan benefits if that helps, thank you!!