Need advice for USA Health Insurance. Expecting a child next year

[dontajohnson]

Plan A

- Monthly Premium: $220

- Deductible: $4,600 individual / $9,200 Family

- Out of Pocket Max: $4,600 individual / $9,200 Family

*No charge once deductible/max hits.

Plan B

- Monthly Premium: $360

- Deductible: $0 individual / $0 Family

- Out of Pocket Max: $5,500 individual / $11,000 Family

*$5 copay per office visit

*30% coinsurance for childbirth/delivery facility services

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We are both self-employed and looking for insurance through the marketplace. My husband thinks Plan A is better than Plan B because we are most likely to hit out-of-pocket max on either Plan A or B. So it's better to choose on lower premium and out-of-pocket max . I am not 100% comfortable with Plan A because we have to pay everything out of pocket until maximum hits without copay or coinsurance.

I heard that once a child is born, the bill at the delivery hospital will be charged separately to the mom and baby. It is our first child. I would appreciate any advice here.

 

[zpupster]

@dontajohnson It just depends.

The benefit of the first one is 0 charges after you pay your deductible

The benefit of the second one is there is no deductible to be met but you have regular fees for whatever you end up doing medically.

So it just depends on what you plan to do medically.

For me I probably would go with tbe first one since it's just me and I'm kid less and I don't seek out a lot of medical stuff constantly so I'd save money.

 

[dontajohnson]

@zpupster

If you fear that paying the full contracted rates until you meet your deductible- as in a $150 doctor visit would be devastating/hard vs a $5

Thank you!

 

[foreverthankful]

@dontajohnson This is the question everyone asks- which is "better" for me.

If you fear that paying the full contracted rates until you meet your deductible- as in a $150 doctor visit would be devastating/hard vs a $5 copay... then I think plan B works better for you.

Now, if you already know you're needing an expensive service- surgery, child being born, etc. and you anticipate meeting the OOPM for the year- then go with the plan that's less for annual premiums + OOPM (in this case, plan A)- that will give you the lowest annual liability for the year, doing easy math.

The only way to know FOR SURE which is better is to spreadsheet out what your annual medical uses are per year (how often you have a non-preventive visit, how much are your medications- if any, how much will the birth of the child cost you? etc.) and then add that all up for the year under each plan's benefits.

Is Plan A a HDHP-HSA eligible plan? If so, you can open an HSA and put aside pre-tax dollars to help you pay for your services while you're working towards the deductible- that's your money, it doesn't expire- you can use it in 2024, 2025, 2050- it's yours for life.

Once the child is born, hospitals/providers treat baby as if they are on the parent's insurance- this is a courtesy they extend, but you must be sure to add the baby to the insurance plan or they'll have to reprocess the baby's expenses and care as if they did not have insurance- so be sure to add the kiddo (usually a 30/31 day window to do this).

 

[dontajohnson]

@foreverthankful It is not HDHP. Thank you for your advice.

 

[vhenebere]

@dontajohnson What's the state ?
In CA, 30K is normal delivery bill. Pre natal visits and checkup extra.

In either case, you should be prepared to pay OOP max.

So, IMO, go for plan 1, less OOP max, less premium. Just keep putting money in an HYSA account upto OOP max to pay bills when it comes

Enjoy!