Having a baby and I’m confused about how that will impact our deductible.
My husband (28M) and I (28F) are on an Aetna PPO plan through his employer. He works remotely, and we live in Tennessee. I’m trying to figure out how our plan will change by adding our babe on the way.
Deductible:
In-Network: Individual $750/Family $1,500 Out-of-Network: Individual $2,250/Family $4,500
“Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay. If you have other family members on the plan, each family member must meet their own individual deductible until the total amount of deductible expenses paid by all family members meets the overall family deductible.”
Out of Pocket Maximum:
In-Network: Individual $3,000/Family $6,000 Out-of-Network: Individual $8,000/Family $16,000.
“The out-of-pocket limit is the most you could pay in a year for covered services. If you have other family members in this plan, they have to meet their own out-of-pocket limits until the overall family out of-pocket limit has been met.”
Currently my husband and I have both met our $750 deductibles this year, so we’ve collectively met the $1500 total. I’ve hit $1249.45 of my $3000 out of pocket max, and between the two of us we’ve hit $2382.29 of the $6000 total out of pocket max.
What I’m trying to understand –
I am reading this to mean our baby will have his own deductible and out of pocket max, but our overall family deductible and out of pocket will not change? Is this correct? Meaning our out of pocket max for all three of us would remain $6000, meaning we still have $3617.71 left to meet that max? Or would his individual out of pocket max add on to our family’s max taking it up to a $9000 family maximum?
I’m sorry if this is one of those really obvious things that I should understand, but my brain just can’t seem to wrap around this one and I just want to be prepared so we aren’t screwed over by the hospital bill in a few months. I appreciate any insight!!!!
submitted by /u/ilikebison
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