HDHPs, PPOs, and pregnant wife

Hey all,

My wife is due at the beginning of February, and I currently have an HDHP and HSA through my work. My HSA has a current balance of $1500 and my employer contributes $1200 at the beginning of each calendar year. I am thinking ahead to open enrollment for next year and how I can minimize our OOP costs for delivery. My insurance also has an option for PPO… see details for HDHP and PPO below. Premiums are the same for both.

Benefit HDHP PPO Deductible $3000 $1400 Preventive Care Coverage 100% 100% Office Visits 20% after deductible $30 copay OOP Max, person/family $5000/$10000 $6000/$12000 Coinsurance 20% after deductible 20% after deductible

My plan 100% covers all preventive prenatal appointments through HDHP and PPO, so assuming all goes well with the pregnancy, we are only really worried about costs related to delivery which would be billed in early 2024.

My thought would be to change to PPO at open enrollment for next year to take advantage of the lower deductible. Because the coinsurance is otherwise the same between the two plans after deductible is met, I would be saving ~$400 of OOP costs (deductible difference between HDHP and PPO ($1600) less the $1200 that my employer would have contributed to HSA if I stayed with HDHP). The deductible WILL be met either way based on delivery estimates from her OB (~$4k). If I swap to PPO in 2024, I can use my remaining balance in my HSA (assuming no surprise medical costs from now to then) to fully cover the deductible so that I would only be paying coinsurance out of my pocket next year. I would likely stay on PPO for the remainder of the year in anticipation of frequent office visits for the baby. I also understand that I may actually pay more through the PPO if something expensive happens during pregnancy/delivery due to higher OOP max, but that is a risk I am willing to take since this pregnancy is considered low risk. Does this game plan make sense?

submitted by /u/johnblam
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