Need Advice on Health Plans as We Start Planning for a Family
Hello everyone,
My wife (28F) and I (29M) recently got married this summer, and we’re now looking into health plans for next year as we plan to start trying for kids at the end of this year/early next year. We’re both small business owners with solid income, and we’re maxing out our solo 401(k)s and HSAs, so we don’t qualify for any tax credits. Fortunately, we’ve both been in good health so far, with just routine visits to the doctor and dentist. My wife also has two prescriptions from a dermatologist to manage acne.
For my health coverage, I’m considering an Allstate short-term medical insurance plan for 24 months. It’s an Enhanced PPO plan through the Aetna Open Choice PPO Network with a $70 monthly premium, $10k deductible, 0% coinsurance, $0 out-of-pocket after the deductible, and a $1 million coverage period maximum. We’re also planning to purchase CriticalGuard Critical Illness ($11/month/person), AccidentWise Plan 10000 ($15/month/person), and Hospital SafeGuard Plan B ($25/month/person).
For my wife, she could also go on the Allstate short-term medical insurance for $70/month with the same $10k deductible, 0% coinsurance, $0 out-of-pocket after the deductible, and a $1 million coverage period maximum. However, we’re leaning towards an ACA plan because of our planned pregnancy. Here are the options we’ve received:
Issuer
Aetna CVS Health
UnitedHealthcare
Aetna CVS Health
Ambetter
Blue Cross and Blue Shield
Plan
Bronze 2 HSA: Aetna network of doctors & hospitals + MinuteClinic + Virtual Care 24/7
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
Bronze 4: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7
Choice Bronze HSA
BlueCare EPO Simple Bronze HDHP
Premium
$312
$344
$349
$368
$459
Deductible
6,200
0
0
$7,250
$7,100
Max OOP
$7,500
$9,450
$9,400
$7,250
$7,100
Network
EPO
EPO
EPO
EPO
EPO
Primary Care
50% after deductible
$40
$15
None after deductible
None after deductible
Specialist
50% after deductible
$150
$100
None after deductible
None after deductible
Generic Drugs
$25 after deductible
$15
$40
None after deductible
None after deductible
Laboratory Outpatient & Prof. Serv.
50% after deductible
$20
$50
None after deductible
None after deductible
Emergency Room
50% after deductible
$2000 copay
$2,200
None after deductible
None after deductible
Urgent Care Centers or Facilities
50% after deductible
$100
$50
None after deductible
None after deductible
Hospital Stay
50% after deductible
$3000 per day
$2,500 per day
None after deductible
None after deductible
Given these options, which plan would you choose if you were in our position, and why? Our goal is to have solid coverage without sacrificing too much on the quality of care, especially as we plan to expand our family in 2025.
