I am currently in open enrollment with my employer for a plan year beginning 7/1. My wife is pregnant with a due date of 7/15. My options are essentially these two:
Copay Plus plan with $750 individual deductible/$1500 family embedded deductible with 20 percent copay and annual out of pocket max of $3500 individual/$7000 family embedded deductible. The monthly premium is $388.
HDHP plan with $3000 aggregate family deductible with $8000 aggregate family out of pocket max. The monthly premium is $197 and employer puts in $60 per month to HSA.
We already have $4k in the HSA and are thinking of putting in additional money into the HSA before the beginning of the next plan year. By my rough math with the extra $3000 in premiums in the copay Plus plan, if our out of pocket costs in that plan exceed $5000 we would be better off with the HDHP plan.
I tried getting estimates for childbirth and it sounds like it would be about $2000 out of pocket in the copay Plus plan and about $6500 out of pocket in the HDHP for a standard delivery. Total estimated costs without insurance are about $12000.
I would expect we would hit our out of pocket max in the HDHP plan and would expect my wife would probably hit her individual out of pocket max in the copay Plus plan. I know some of the infant wellness exam are considered preventative and would have no charges but I would expect other items to come at a cost.
Does anyone know how likely we would be to have over $5000 in out of pocket expenses over the baby’s first year? I don’t have any major health issues so I’m not factoring much of my own care or expenses into this but obviously anything could happen.
submitted by /u/jaydubbles
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I am currently in open enrollment with my employer for a plan year beginning 7/1. My wife is pregnant with a due date of 7/15. My options are essentially these two: Copay Plus plan with $750 individual deductible/$1500 family embedded deductible with 20 percent copay and annual out of pocket max of $3500 individual/$7000 family embedded deductible. The monthly premium is $388. HDHP plan with $3000 aggregate family deductible with $8000 aggregate family out of pocket max. The monthly premium is $197 and employer puts in $60 per month to HSA. We already have $4k in the HSA and are thinking of putting in additional money into the HSA before the beginning of the next plan year. By my rough math with the extra $3000 in premiums in the copay Plus plan, if our out of pocket costs in that plan exceed $5000 we would be better off with the HDHP plan. I tried getting estimates for childbirth and it sounds like it would be about $2000 out of pocket in the copay Plus plan and about $6500 out of pocket in the HDHP for a standard delivery. Total estimated costs without insurance are about $12000. I would expect we would hit our out of pocket max in the HDHP plan and would expect my wife would probably hit her individual out of pocket max in the copay Plus plan. I know some of the infant wellness exam are considered preventative and would have no charges but I would expect other items to come at a cost. Does anyone know how likely we would be to have over $5000 in out of pocket expenses over the baby’s first year? I don’t have any major health issues so I’m not factoring much of my own care or expenses into this but obviously anything could happen.
submitted by /u/jaydubbles [link] [comments]Read Morer/HealthInsurance