Hi everyone! TIA for looking over my healthcare options for next year and helping me pick which one. I’m currently at 6W pregnant (haven’t gone in for a dating scan yet, I know when my O day is and estimated I day based on temping), which will make me 15W at the beginning of the year and giving birth around July 1st. Based in Virginia.
This year I’m on a low deductible plan ($2750 deductible, then 25% copayment and ~$6.8k out of pocket max), but I’ve only used about $30-40 of my deductible so far this year so I’m trying to minimize as much money as possible. I’m planning on getting a dating ultrasound from a free clinic, a nuchal scan + bloodwork from a random OBGYN, and then looking to spend the bulk majority of my medical expenses next year.
Next year, I can either stay on a low deductible PPO plan ($2750 deductible, 25% copayment, ~$6.8k OOP max), or switch to a high deductible plan that allows me to use a HSA ($3000 deductible, 25% copayment, $6.6k OOP max). With the low deductible PPO, all of my prenatal office visits are covered, but with the high deductible plan, I would pay for 100% of the cost of office visits until I hit the deductible, then switch to 25% copay. When the baby is born, the family plans are double the individual plans ($5500 deductible and $13.6k OOP max for the low deductible PPO, and $6000 deductible, $13.2k OOP max for the high deductible plan). There’s also a HMO option, but I’ve heard that Kaiser gives out really bad care and I should spend the extra money in exchange for not potentially risking my life receiving worse care.
My income is too high for any sort of non-employer based subsidized healthcare. Below is the breakdown of the options available to me, with what services I will actually use:
High deductible plan w HSA Low deductible PPO Premium plan HMO Kaiser Cost of biweekly premium – just myself 35 31.4 88.8 60.2 Cost of biweekly premium – myself and kid 55 50.3 125.2 81.5 Annual deductible – just myself 3000 2750 1750 1500 Annual deductible – myself and kid 6,000 5,500 3,500 3,000 Annual OOP maximum (in network), just myself 6,650 6,850 6,850 6,850 Annual OOP maximum (in network) myself and kid 13,300 13,700 13,700 13,700 Office visits for prenatal care? Not covered until deductible, then 25% copay Covered, no charge Covered, no charge Covered, no charge Blood tests Pay OOP until deductible met, then 25% copay Pay OOP until deductible met, then 25% copay Pay OOP until deductible met, then 25% copay Covered, no Charge Ultrasounds Pay OOP until deductible met, then 25% copay Pay OOP until deductible met, then 25% copay Pay OOP until deductible met, then 25% copay Covered, no Charge Delivery, professional services/facilities fee Pay OOP until deductible met, then 25% copay Pay OOP until deductible met, then 25% copay Pay OOP until deductible met, then 25% copay Pay OOP until deductible met, then 25% copay
Some questions about minimizing expenses this year and how to plan out for next year:
Aside from getting the dating ultrasound done at a woman’s clinic so it’s free, what else can I do to minimize costs this year since I’m basically paying for everything out of pocket given I still have $2700 left before I hit my low deductible? Are there any tests I can forgo since I just had bloodwork and a pap smear done at my annual physical half a year ago? What plan should I choose for next year? Let’s say that the medical expenses up through the moment of birth costs $5000 for deductible + 25% copay, and a baby is added to my insurance plan. Using the PPO family plan as an example, does that mean I would have to contribute another $500 100% OOP to meet the family deductible before we can start just paying the 25% copay again? Or would we need to contribute another $3000 fully out of pocket to meet another deductible before we start paying the 25% copay again? Let’s say that I switch insurance plans after giving birth, such as going onto my husband’s. Since the new insurance plan is retroactive to the date of birth, does that mean that things that happened on the date of birth would go onto my old insurance plan or onto the new insurance plan? Assuming the delivery date is July 1st, does that mean that my old insurance’s last day of coverage would be July 1st, or that the new insurance’s first day of coverage is July 1st? If the latter, would the new insurance then be subject to my delivery fees and hospital/facility fees on July 1st? Is there any part of prenatal care I can skip? Do I really need monthly doctor’s appointments and biweekly ones once I get to W30? How many times will I need blood tests and ultrasounds after the 20W anatomy scan? To my understanding, only the office visits are considered “preventative” under the PPO and the scans, tests are all elective. Under the high deductible, all of them are OOP.
Thanks!
submitted by /u/Sudden_Profile_2513
[link] [comments]Hi everyone! TIA for looking over my healthcare options for next year and helping me pick which one. I’m currently at 6W pregnant (haven’t gone in for a dating scan yet, I know when my O day is and estimated I day based on temping), which will make me 15W at the beginning of the year and giving birth around July 1st. Based in Virginia. This year I’m on a low deductible plan ($2750 deductible, then 25% copayment and ~$6.8k out of pocket max), but I’ve only used about $30-40 of my deductible so far this year so I’m trying to minimize as much money as possible. I’m planning on getting a dating ultrasound from a free clinic, a nuchal scan + bloodwork from a random OBGYN, and then looking to spend the bulk majority of my medical expenses next year. Next year, I can either stay on a low deductible PPO plan ($2750 deductible, 25% copayment, ~$6.8k OOP max), or switch to a high deductible plan that allows me to use a HSA ($3000 deductible, 25% copayment, $6.6k OOP max). With the low deductible PPO, all of my prenatal office visits are covered, but with the high deductible plan, I would pay for 100% of the cost of office visits until I hit the deductible, then switch to 25% copay. When the baby is born, the family plans are double the individual plans ($5500 deductible and $13.6k OOP max for the low deductible PPO, and $6000 deductible, $13.2k OOP max for the high deductible plan). There’s also a HMO option, but I’ve heard that Kaiser gives out really bad care and I should spend the extra money in exchange for not potentially risking my life receiving worse care. My income is too high for any sort of non-employer based subsidized healthcare. Below is the breakdown of the options available to me, with what services I will actually use: High deductible plan w HSA Low deductible PPO Premium plan HMO Kaiser Cost of biweekly premium – just myself 35 31.4 88.8 60.2 Cost of biweekly premium – myself and kid 55 50.3 125.2 81.5 Annual deductible – just myself 3000 2750 1750 1500 Annual deductible – myself and kid 6,000 5,500 3,500 3,000 Annual OOP maximum (in network), just myself 6,650 6,850 6,850 6,850 Annual OOP maximum (in network) myself and kid 13,300 13,700 13,700 13,700 Office visits for prenatal care? Not covered until deductible, then 25% copay Covered, no charge Covered, no charge Covered, no charge Blood tests Pay OOP until deductible met, then 25% copay Pay OOP until deductible met, then 25% copay Pay OOP until deductible met, then 25% copay Covered, no Charge Ultrasounds Pay OOP until deductible met, then 25% copay Pay OOP until deductible met, then 25% copay Pay OOP until deductible met, then 25% copay Covered, no Charge Delivery, professional services/facilities fee Pay OOP until deductible met, then 25% copay Pay OOP until deductible met, then 25% copay Pay OOP until deductible met, then 25% copay Pay OOP until deductible met, then 25% copay Some questions about minimizing expenses this year and how to plan out for next year: Aside from getting the dating ultrasound done at a woman’s clinic so it’s free, what else can I do to minimize costs this year since I’m basically paying for everything out of pocket given I still have $2700 left before I hit my low deductible? Are there any tests I can forgo since I just had bloodwork and a pap smear done at my annual physical half a year ago? What plan should I choose for next year? Let’s say that the medical expenses up through the moment of birth costs $5000 for deductible + 25% copay, and a baby is added to my insurance plan. Using the PPO family plan as an example, does that mean I would have to contribute another $500 100% OOP to meet the family deductible before we can start just paying the 25% copay again? Or would we need to contribute another $3000 fully out of pocket to meet another deductible before we start paying the 25% copay again? Let’s say that I switch insurance plans after giving birth, such as going onto my husband’s. Since the new insurance plan is retroactive to the date of birth, does that mean that things that happened on the date of birth would go onto my old insurance plan or onto the new insurance plan? Assuming the delivery date is July 1st, does that mean that my old insurance’s last day of coverage would be July 1st, or that the new insurance’s first day of coverage is July 1st? If the latter, would the new insurance then be subject to my delivery fees and hospital/facility fees on July 1st? Is there any part of prenatal care I can skip? Do I really need monthly doctor’s appointments and biweekly ones once I get to W30? How many times will I need blood tests and ultrasounds after the 20W anatomy scan? To my understanding, only the office visits are considered “preventative” under the PPO and the scans, tests are all elective. Under the high deductible, all of them are OOP. Thanks! submitted by /u/Sudden_Profile_2513 [link] [comments]Read Morer/HealthInsurance