Seeking help picking insurance for baby arrival late January

[durgha]

Hello, I am having my first baby late January (healthy pregnancy thus far, 24 y/o, no complications.) Please help me decide which family insurance is best for myself, husband, and baby. Thanks in advance! Prego brain is making this difficult.

Plan 1: Traditional - Embedded calendar year
Individual deductible: $1,500
Family deductible: $3,000
Individual out of pocket max: $5,000
Family out of pocket max: $10,000
Premium paid weekly: $191.21
Kids' office visits: $0 Copay

Plan 2: Traditional - Embedded calendar year
Individual Deductible: $2,500
Family deductible: $5,000
Individual out of pocket max: $8,150
Family out of pocket max: $16,300
Premium paid weekly: $162.21
Kids' office visits: $0 Copay

Plan 3: High Deductible - Aggregate calendar year
Individual deductible: $2,000
Family deductible: $4000
Individual out of pocket max: $6,550
Family out of pocket max: $8,000
Premium paid weekly: $167.04
Kids' office visits: Deductible + %20

 

[resjudicata]

@durgha Premiums paid weekly? Yowza! That’s some underhanded marketing right there to hide the monthly rates.

 

[durgha]

@resjudicata My husband is paid weekly, I believe that's the reason it's listed that way.

 

[resjudicata]

@durgha To answer your question, would you rather spend $120 more a month to hit your deductible faster? It really depends on how much healthcare you expect to consume.

If you don’t go to the doctors often, plans 2 and 3 are better.

If you have existing health concerns you that require ongoing treatment, option 1 is better.

But they are all very similar.

 

[durgha]

@resjudicata We don't have any conditions that require us to go to the doctor, but will have three prenatal appointments in january, hospital delivery, and routine checkups for baby approximately six times in the first year and one or two postnatal checkups for myself. We'll have better income in the first 3.5 months because I'll be receiving short term disability checks for maternity leave, then after that I'll be working only a few hours a week.

 

[4l3x]

@durgha plan one then

 

[lostandinsecure]

@durgha Ouch...I feel for you, OP.

You are likely to hit your OOP max with the baby, so I would look at getting the lowest OOP max plan. I would go with the high-deductible plan. 8000 OOP max for a family plan isn't terrible, and the premium is not too bad.

 

[resjudicata]

@durgha Ouch..birth in January..that sucks..

I would also go with the high deductible plan.

Your guaranteed to hit the max family OOP between you and the baby.

$8000 is better than $10,000 and it's only $5 dollars more, or an extra $260 in premium over the year.

Next plan year, assuming everyone is fine and healthy, I would go with plan two.

Now, of you and your spouse works, nothing says you have to be on a family plan. The ACA requires employers to subsidize employee's only. So employers often offer a Employee+ child option. The premiums are much cheaper because children are less of a risk insure.

So the kids will be carried on the plan with the less expensive premiums or more generous benefits, while the spouse has their own coverage.

If one spouse loses their coverage, it opens a special enrollment period of 30 days for everyone to jump on board the other plan.

So if you both work, keep that strategy in mind at open enrollment at both you and and your spouse's open enrollment.

You are paying a premium to be on one plan as as family

 

[munyaku]

@durgha Lowest total cost - sum of premiums and OOP. You're hitting a deductible and virtually guaranteed an OOP with birth.

 

[durgha]

@munyaku Do I calculate that based upon Individual or family OOP? If based upon individual OOP, plan 1 is the cheapest. but going by family OOP, plan 3 is the cheapest.

 

[munyaku]

@durgha You yourself are definitely meeting the ded and likely oop, baby will incur some amount of claims to at least the ded. Once they're out they will be billed independently of you.

 

[healthchristian]

@durgha Something to consider that you don't mention. Do any of the plans offer an FSA or HSA? Especially if an HSA is available, that's often the best choice because you can put away money pre-tax. This lowers your taxable income and can be treated as a secondary retirement fund, or used to pay for medical care. Many larger employers will also contribute to your HSA, which is always a plus.