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Health insurance options during pregnancy

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  • Health insurance options during pregnancy

    Hi! PGY-1 here. Considering having first child as a PGY-3. Right now, my residency health insurance covers my partner and myself. We are otherwise healthy and have few medical expenses. The high deductible, lower premium plan that is HSA-eligible is currently the best option for us. We are in the fortunate financial position to fully invest (up to the maximum allowed) into our HSA going forward. Is there any reason to consider a higher premium/no deductible plan (w/o HSA option) closer to when I would plan on becoming pregnant? I am not too familiar with the total cost of pregnancy. I would hesitate to lose out on the HSA option given all its advantages, but just want to make sure I'm not overlooking anything.

    (For reference, no deductible plan has an out of pocket max $6K/family. High deductible plan has a deductible of $2,800/family with out of pocket $6K. Premium is ~$1,300 cheaper annually on the latter plan.)

  • #2
    On the face of it, appears the HSA-eligible plan would be preferable (this goes against my general ROT, but you have the minimum required deductible for an HSA - mine is $5k single, $10k family!)
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    • #3
      I agree with Johanna. Your deductible is extremely low. Both out of pocket maximums are the same. If you are giving birth at your institution you are best positioned to know the costs - ask around and get EOBs from people. Heck, you'd probably be able to stop by the billing office and ask them about negotiated rates with your insurer (which may be your own institution). If the non-HDHP option includes a 20% coinsurance or something to that effect you can try to do some basic math on it for comparison. BTW, who contributes to your HSA - you or your employer? Keep in mind also that a new baby = new deductible.


      • #4
        Not too difficult to run scenarios on this. You didn't mention what coinsurance on each plan is, so for this exercise will assume 80% for both. Pick out an all-in expense for delivery + pediatric care at hospital, I'll say $4,000, which may be on the lower end of the reasonable range.

        PPO: all coinsurance, you pay 20% = $800
        HDHP: you pay 2,800 family deductible, then coinsurance on the remaining. $2,800 + 240 = $3,040.

        that's a lot of ground for lower premiums and HSA tax space to make up. It's possible. You'll also need to look at the cost of FAMILY premium, as you'll move from EE + Spouse coverage to Family coverage on delivery.

        Another few bits that could impact things. Some PPO plans have a copay for maternity, rather than paying the coinsurance rate. Also, talk to other residents who have delivered at your hospital. Could be that they write off the charges. The PPO plan could have an FSA attached to it that allows you to deduct tax-free money for medical expenses.


        • #5
          Thank you all for your responses! I dug into some more details with the insurance company.
          -There is a separate deductible for the HDHP as it relates to pregnancy charges- $1350 deductible for our uni-affiliates, then 90% coinsurance. The PPO for those affiliates would be 90%, no deductible. So at a glance, it would seem that the "HDHP" is still quite favorable.
          -Family HDHP premium (as opposed to EE+spouse) would be $2,400 vs PPO $4,025.
          -The PPO plan does have an FSA
          -It also appears that providers vary in terms of billing (per visit co-pays vs lump sum pregnancy charge) so I will need to take that into future consideration. Per some other residents on PPO plan, estimated out of pocket costs have been $5 co-pay visits plus $350 for delivery. Not yet aware of who has delivered under then HDHP plan.
          -Also, I would contribute to the HSA, not employer.


          • #6
            If you end up on a high deductible plan and all else is the same try to time the whole pregnancy and delivery to land within the same period so you do not get stuck potentially paying 2 deductibles.

            Obviously there are a lot more important factors that should be considered first in regards to timing.