Open Enrollment Next Week, Baby Due in September…
Hello all!
(Edit based on automod suggestions: I’m 26, my wife is 26, we live in New Jersey, pre-tax income is roughly $90k between my salary and her PhD stipend)
My wife and I are expecting our first baby in September (woohoo!) and my company’s open enrollment period happens to be next week, so I’m curious to hear people’s opinions based on my situation on if switching plans might be a good move for me right now to minimize the total out of pocket cost.
Currently, my wife and I are on my company’s United Healthcare HDHP with an HSA account attached to it (which currently has about $4.5k), but I’m considering switching to a PPO Plan. (Another note on the HSA: each month I’m contributing 1/12 of the annual max, so shouldn’t have tax issues if I abandon the HDHP early). Essentially, I’m working under the assumption that between ultrasounds, other prenatal visits, and the birth itself, we will hit my wife’s out-of-pocket maximum this year. I’ll break down the main differences between the two plans below.
Annual Cost:
Annual Deductible:
HDHP: $2,000 individual, $4,000 family
PPO: $1,250 individual, $2,500 family
Annual OOP Maximum:
HDHP: $6,000 individual, $12,000 family
PPO: $4,000 individual, $8,000 family
Okay, now for the math…
For the HDHP, annual cost ($3,500) plus individual OOP maximum ($6,000) would be $9,500 total cost for the birth, right? Also, because we’ve already had our 8 week and 12-week ultrasounds (plus bloodwork and things like that) while on the HDHP plan, she already has about $1,500 towards her deductible/OOP max, so in a sense her remaining OOP max is only $4,500, which would mean $8,000 remaining overall.
For the PPO, the annual cost goes up ($5,500) but the individual OOP max goes down ($4,000) for a total of $9,500. Also, research tells me switching to this plan means that $1,500 we’d already put towards her OOP maximum would essentially be wasted.
Obviously, the family OOP maximum is $4k lower with the PPO plan, so that might be important for all of the follow up visits with Baby after the birth. But based on individual out-of-pocket maximums and annual costs (plus the benefit of getting to keep making contributions into the HSA), it almost seems like sticking with the HDHP could be the most cost-efficient option for me, especially since we’ve already paid towards the maximum some? I feel like a PPO should theoretically make things cheaper overall, so again I’m curious for any insight into my math or if I’m misinterpreting or oversimplifying anything.
Thank you!!
Some other differences between the plans that don’t weigh in as much assuming we do hit her OOP maximum:
Doc Office Visit Costs
Diagnostic Labs
ER Visit
Urgent Care
