I am in open enrollment for my health plan through work, and have always gone with an HSA plan. But I’m working on getting pregnant, and am now considering whether the PPO plan would be better. My plan changes over in July, and trying to figure out numbers if I add a baby onto my plan later in the period is making my head spin. Any advice would be appreciated.
For context on my health, I am very healthy and have no chronic conditions requiring regular treatment. The only major medical I foresee next year would be pregnancy.
HSA plan (my current plan)
Premiums: me $30.92/week // me+baby $86.09/week
Deductible: me $1700 // me+baby $3400
OOP max: me $3400 // me+baby 6800 (aggregate)
10% coinsurance after deductible is met
$400 HSA match from employer for me // $800 HSA match from employer for me + baby
PPO:
Premiums: me $36.73/week // me+baby $90.90/week
Deductible: individual $750 // me+baby $1125
OOP max: me $3000 // me+baby $4500 (embedded)
$35 copay for primary care / $50 for specialist
20% coinsurance after deductible
5% coinsurance on xrays an labwork (deductible doesn’t apply)
20% coinsurance on major imaging (deductible doesn’t apply)
In both plans, preventative visits (such as well baby exams) and prenatal office visits are free.
Help deciding between HSA and PPO for a potential pregnancy year
byu/ksmo133 inpersonalfinance
Posted by ksmo133
3 Comments
Given the difference in OOP maxes, I’d go for the PPO with an expected pregnancy.
I always go with the lowest OOP number for pregnancy years but in your case with the employer match, I’d probably stick with the HSA.
PPO all the way. Your deductible is lower and you’ll definitely want it to start paying sooner with pregnancy and baby stuff. I changed from my HMO to PPO after one year, the next year my son started needing specialty care for a spell and I started fertility treatments so it was well worth the investment to be able to go out of network.