Choice Between UHC Gold HDHP or Platinum PPO for Pregnancy

Hey everybody! My wife and I are expecting a baby next July, and our organization is switching from an Aetna HDHP plan, to UHC, with choices of a Silver or Gold HDHP, or Platinum PPO.

With the upcoming expenses of prenatal care, labor, delivery, and postpartum care, we are looking carefully at each plan's deductible and oop maximum. What is interesting to me is that between the Gold HDHP and Platinum PPO, the deductible and oop max on the Gold plans is the same or lower.

Here are the numbers (wife is currently hired as employee only):

Gold HDHP (In-network)

Deductible: $2000 (Employee Only); $4000 (Family); Aggregate

Co-insurance: 20%

OOP Max: $4000 (Employee Only); $8000 (Family)

Office/Specialist Visits: Co-insurance

Hospital stay: Co-insurance

Diagnostic Test/Imaging: Co-insurance

​

Platinum PPO (In-network)

Deductible: $2000 (Employee Only); $6000 (Family); Embedded

Co-insurance: 20%

OOP Max: $6000 (Employee Only); $12000 (Family)

Office visit: $25 copay

Specialist Visit: $75 copay

Hospital stay: Co-insurance

Diagnostic Test: No charge

Imaging: Co-insurance

​

Again, the biggest differences I see is that the Gold Plan's OOP max is lower than the Platinum's. But I also see that the office and specialist visits are copays, and diagnostic testing is free under the platinum's.

My sense is that we will already be hitting our out of pocket maximum quite easily with delivery, and all the added prenatal care, so it seems like we should go with the Gold HDHP plan since the OOP max is lower. Does this sound right?

But what I'm also wondering about is when baby gets added onto my wife's plan, how does the baby affect the deductible/oop max amount after we have paid for prenatal care and delivery? If we pay $4000 for prenatal care and delivery, does that mean that baby will start to be covered under the $4000 deductible as well under the family Gold HDHP plan when they are added?

Thank you! I can add any information I am missing if needed.

submitted by /u/WillowKitten
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