My husband and I keep our finances separate – trying to make the best healthcare selection for us. Need help choosing between a PPO and HDHP plan for 2024 (a bit convoluted).

I’ve crunched the numbers for my personal scenario 100 times but need confirmation that I am not crazy! My company only offers a very expensive (premium) PPO plan or a very affordable HDHP plan. I am pregnant and due on the cusp of calendar years, so trying to make the best decision for all of us.

Initially I planned to do a PPO plan for myself + baby, leaving my husband on his own HDHP plan with his employer. However, I believe the HDHP Family plan makes the most sense for all of us on my company’s plan. The caveat is that because of my personal medical costs (i see a therapist weekly and hope to do pelvic floor therapy once the baby is born) – I understand that I will pay for these services out of pocket until I absolutely hit my embedded OOP max of $3500. The other point to consider is that with a family HDHP plan, my company will contribute $1500 annually into an HSA account for us.

My husband is currently on an HDHP plan. His costs are $188/month for himself. If we weren’t having a baby, I’d be on my own PPO plan which would cost me $229.18/month. We have agreed to split the cost of insurance to add baby, which is where I am focusing my math.

If I do a PPO Plan for myself + baby, the monthly cost is $559.36. This means it will cost an additional $330 or so from what I would be paying for myself to add a dependent to my plan – meaning we would split that cost, and each add $165 to what we are already paying. Making my monthly contribution $394 (total of $165 for baby + my previous cost of $229) and my husbands monthly contribution would be his $165 for baby – plus, his existing $188/month plan – totaling $353 for his costs.

Alternatively, we can do a family HDHP plan that covers all of us at a monthly rate of $341.54 – meaning we are each responsible for around $171 each. This saves my husband $182/month and it would save me $223/month.

Now, this figure should not change for my husband in terms of premiums and savings, especially knowing that he is on an existing high deductible plan. He is already planning to pay out of pocket for costs until he hits a potential deductible or OOP max which he likely won’t, as he is one of those people who rarely sees a doctor. On the other hand – this will be different for me. I know I am saving monthly – but it will also cost me an additional $3500 guaranteed as I will pay out of pocket until I hit my embedded OOP max in that amount. If I am saving $223/month – that means I am saving $2,676 a year on premium costs. However, I have to pay an additional $3500 OOP guaranteed. When I split the difference it tells me the HDHP will actually cost me an additional $824 within a calendar year after I reach my OOP max.

However – factoring in the $1500 annual HSA contribution that my company is making – I will, in fact, save money. $1500 – $824 = $676. So by that logic – yes, I will owe a lot of money up front for my own healthcare costs, and the HSA will accumulate slowly over the course of a calendar year… but ultimately, I will be spending $676 less within the 2024 calendar year than I would be if I were paying the other premium (and that doesn’t include copays and other minimal costs I might have on the PPO plan within a year).

I know that none of this includes costs that can accrue for the baby under the HDHP plan – but most of that should be preventative and covered at 100%. In the event we did have a large claim for either baby or my husband – OR if I do in fact deliver in the 2024 calendar year – the OOP max for a family on this plan is still lower than the PPO. The OOP family max here is $7K, where as the embedded OOP max for me and baby on the PPO would be $8K (and individually, still a higher embedded figure of $4K each). So in a worst case scenario, this still seems like it will save us money.

Sorry for all of the breakdowns – my husband and I do keep our finances split for the most part so I am trying to tailor these figures to both of us and compare against existing individual costs. It seems like a no brainer for my husband to do this plan – he concretely saves nearly $200 a month no matter what. For me, it still seems like I will be saving money – but I would need to pay more up front.

Am I missing something, or does this break down and make sense to you as well? I have never had a high deductible plan before and it feels engrained in me that with a baby on the way, I should pick the “better” plan with coverage – AKA, the PPO. However, the OOP max is the same as the deductible in the HDHP plan – and those figures are lower than the PPO. Especially when you factor in the astronomical difference in premiums!

Let me know if this is too much, doesn’t make sense – or if I am in fact, dead wrong and crazy. Lol.