I know I'm not the first to post this question, and I know it varies by plan and you just have to do the math. But as I've never had a baby before, I'm not sure I understand exactly how the billing works and want to make sure I'm doing that math correctly. It's open enrollment at work, and as my husband and I are currently trying to get pregnant, I want to make sure I select the best health plan should that happen next year. I'm currently on a HDHP+HSA with my employer (individual, as DH is on his own plan with his employer). I'm trying to determine if it's best to stay on this plan, or if a PPO would offer better coverage during pregnancy and delivery.
Premiums
HDHP+HSA: $20.40 biweekly ($530.40 annually); Maxing out HSA with $3,500 in annual tax-free contributions
PPO: $49.08 biweekly ($1276.08 annually)
Coverage: See attached
After reviewing these for several days, I can't see a situation in which the PPO wins. Both plans have the same deductible, both plans have 80/20 coinsurance once the deductible is met, and the HDHP has a lower out-of-pocket max. The only way I can see that the PPO might win out is if somehow the Primary, Specialist, or Routine Lab & X-Ray co-pays kick in somewhere the HDHP would otherwise have me paying 20% co-ins. I contacted my OB to get an idea of charges, and they said they do "Global Pregnancy" which is basically one lump sum bill (which exceeds the deductible of both plan options). I imagine since this is one lump sum bill, co-pays would not apply even in the PPO? Then I imagine outside of the OB bill, I'd be responsible for 20% of the hospital bills under both plans as "Inpatient Hospital Services," which is why I think the HDHP wins in that I hit the max out-of-pocket sooner.
I just want to make sure I'm not missing something, that there's not something I'm completely unaware of about having a baby that somehow means the PPO might actually be better. For instance, if the newborn would have separate bills that mean I actually have to hit the family deductible/OOP (even though I'm on an individual plan), and that the PPO would cover some of that with co-pays vs co-ins?
Any insight is appreciated.