Need some help deciding between plans (HDHP or Standard) with a pregnancy next year.

Family of 4, one on the way, live in central TX:

Myself – 33, I do therapy 1x a month and will get snipped early next year. Have GERD so see a specialist 1-2x a year.

Wife – 34, pregnant, and due in March

2 kids – 5 and 3

Income:

I will make approx $270K next year and my wife stays at home. I am due a large bonus in ’23, so trying to reduce taxes on it. Normally income is $160K.

full plan informational

Per Paycheck plan costs:

HDP – $199.13

Standard – $250.65

Buy up – $380.60

The employer also provides $1,000 benefit toward HSA funds (but it counts toward my contribution limit/tax deductions). So essentially the Buy up is $4,355.28 more costly annual, and $5,355.28 with that $1,000 included. The HSA plan ALSO has a limited purpose FSA for dental/vision up to $3,050 (my wife and I both wear glasses/contacts). The non HSA is eligible for $3,050 in FSA pre-tax contributions.

I am trying HSA for this year because of the tax benefits but my daughter wound up needing surgery and my son had an ER visit. My wife needed an ER trip due to the pregnancy (but all is well now) so we’ve been using all the funds. My current HSA balance is $262.53 and that’s with contributing $262.50 per check. It’s only non-zero because I just contributed on the 1st.

We hit our deductible so it hasn’t been terrible now that everything is 10%. I had to run up to UC for strep and it was only $20. Same for a specialist trip I needed last month for GERD. Those would be $100, $55 respectively with the buy up.

We have a free telehealth package we use when needed, available for either plan.

I’m leaning away from the HSA for next year because of how many trips we’ve been making, but the monthly premium and $1,000 HSA benefit has me second guessing.