HDHPs and pregnancy

[Jack]

I'm currently covered by an HDHP at work, but was thinking about having kids next year. I assumed that switching to a regular (non-HSA) health plan is a smarter plan for that circumstance, but is that actually the case?

(I assume I'll need to provide more info to get meaningful advice; let me know what info you need.)

[Joel]

I've assumed this as well but have not yet done any research. Following.

[abhe8]

Not necessarily. I had better coverage with my hdhp + HSA then with my hmo. I would look up the details and run the math.

Sent from my XT1031 using Tapatalk

[forummm]

Yeah, you have to run the math. For me it worked better to have the $0 deductible plan, where the total pregnancy and birth and newborn care is supposed to cost less than $1k. Just a bunch of co-pays, even for the hospital. It wasn't that much more per month than the HSA plan. But since you have an HSA, you can use whatever funds are left in there for the costs of pregnancy even if you do change plans. Then you can change back if you want.

[justajane]

What's your deductible? What's the difference between premiums? What happens after you reach your deductible? What percentage do you pay? Your answer rests there. I don't think that pregnancy will change the math in any real sense, except that I guess you are guaranteed a minimum amount of ca. $4,000 in health care costs that year. Also, there's the issue of the pregnancy carrying over two years. I was lucky that I had a large pregnancy complication on January 2nd of the year in which I was to give birth. If it had happened a week earlier, I would have paid thousands more on the high deductible plan.

I guess if you have a plan for which you pay one $35 co-pay to have a baby (like some people used to do), then it would be worth it to switch, but many times the difference in premiums is so much that it makes sense to use the HDHP regardless, at least that has been our experience.

[mrsggrowsveg]

I found that my high deductible health plan with an hsa has been better during pregnancy.  It really depends on your plan. 

[rubybeth]

It would be the same as any high cost medical procedure or chronic health issue, which means: it depends. :)

Complications split between two years would not be ideal, but it all depends on your premium, deductible, and if it would be less to pay a higher premium to have a lower deductible/co-pay/max out of pocket/co-insurance. Really pay attention to the max out of pocket and the co-insurance. I recently compared plans for my husband who has a chronic issue, and it seemed the max out of pocket and co-insurance was the real kicker--a plan with 0% co-insurance and a max out of pocket that matched the deductible was our best option.

[NorCal]

It made sense for us to get a higher level of coverage when our daughter was born.  It was the difference between $300 and $3,000 in out-of-pocket costs for the year.

Your individual options will vary.

[skunkfunk]

Child births are expensive enough that it doesn't make much difference if they are similar coverage. My wife has a fancy insurance plan and the child birth actually cost a few hundred more than if she'd been on my crappy HDHP. I hate my plan, doctors especially hate it, and 99% of the time hers is better, but that thing would have blown through my deductible and then been covered anyway.

[Gin1984]

I found that oddly my HD plan was still better than the non-HD plan.  Run the numbers.

[I'm a red panda]

You need to compare the coverage.

A HDHP is often good if you aren't using it, or are using it a lot.  So it might work out to be better to stay on that plan.  Pregnancy is a "using it a lot" situation.

My last company a non-high deductible plan used to have 100% coverage for prenatal and birth- literally you paid $0, it didn't even apply to the deductible.  My current plan you have the $600 deductible and then has copays and coinsurance, and I will surely hit the out of pocket max on prenatal care, and then the cost of the birth alone will hit the out of pocket max too. (I'm due in January- so won't that be fun! I get to do this over two years of insurance!)

For ME, the out of pocket max ($3,000) is less than the deductible ($4,000) on my husband's HDHP, so it made sense for us to stay separate, but that may not be true for everyone.  So it is likely to cost me $6,000 to have this kid.  (Makes me miss the old insurance! That company had 5 weeks paid maternity leave too :( )

Once we add a kid, we will have to re-evaluate again whether we want to be on the same plan, or on separate ones with one of us taking the kid.  Both of our workplaces have high penalties for having a spouse with access to their own insurance on the coverage...

[Mississippi Mudstache]

You need to compare the coverage.

A HDHP is often good if you aren't using it, or are using it a lot.  So it might work out to be better to stay on that plan.  Pregnancy is a "using it a lot" situation.

Agreed. When I was single, I had a HDHP because I used it very little. We were expecting our first kid after 9 months of marriage, so I went straight to using it a lot without much in-between. I pretty much know that I'll be hitting the OOP max every year, no matter what, so it's really easy for me to compare health plans. I just add up the premiums plus the OOP max to get the total cost. I've been through three employers, and HDHP always wins. When you factor in the HSA, it's not even close.

[clarkm04]

I'll echo what others have said, it really is plan specific.  Get your company's numbers and run them and see.

For my wife, the HDHP with HSA is better even during pregnancy, so we kept it.

This surprised me, since the prevailing logic amongst her coworkers was to try to time going to PPO for pregnancy.  I ran the numbers a few different ways and always got the same answer, the HDHP was always cheaper and has long as we were maxing out the HSA, we would never have to dip into other money as the HSA limit is higher than the out of pocket max.

[midweststache]

+1 on plan specific. Look into how your rates will change, what that will do to your AGI for tax purposes, and also the difference in deductible (be sure to think about in-network vs. out of network--our numbers below reflect in-network).

We're looking at the same thing, and though our pre-tax deductions would go up about $30, our annual out-of-pocket co-pay would be $400 vs. $2,800.

At a deductible of $400, all of the out-of-pocket costs will be covered in the HSA we currently have, so our short term savings, which is explicitly for purposes of having a family, will be mostly for baby purchases and time off work.

[MsFrugalista]

A HDHP is often good if you aren't using it, or are using it a lot.  So it might work out to be better to stay on that plan.  Pregnancy is a "using it a lot" situation.

This was exactly the reason why I stayed on my HDHP last year during my pregnancy and delivery. I could have switched over to my partner's insurance which is with a large integrated health system and closer to home. My employer matches the cost of my premium into my HSA, so that makes my premium effectively $0. My out of pocket maximum was $5,300 and I knew I would meet this easily during my pregnancy. If I had gone with the mid or high level plans or switched over to my partner's plan, I would have paid more than $5,300 if you included the premiums (when you take copays, premiums, and other out of pocket costs in account).

One thing I would check with your insurance is in the event that a provider (e.g. OB on call, anesthetist, other specialist that may be required during your delivery) at the hospital you are delivering at is OUT OF NETWORK, will they still bill you IN Network (assuming the hospital is in network). I triple checked this with my insurance. During delivery you are not going to ask them if the specialist is in network - you will have other things on your mind! My insurance assured me that I will be billed in-network.

Also, are you planning on insuring your newborn under your insurance? In my case, we were going to put our son under my partner's insurance. However, the newborn has be checked by a pediatrician and discharged before leaving the hospital. In our case, my hospital was not covered by my partner's insurance. However, my plan covered the first 36 hours of the newborn's stay at the hospital (as long as it did not go beyond the mother's stay). It took me 2-3 months to get this sorted out with my insurance as they had billed me separately for the newborn, which I was not going to pay! It was all sorted out in the end.

I was happy with staying on the HDHP and continue to be on it (the HSA is also great). However, everyone's situation is different. You will have to see whether you cross multiple enrollment periods - fortunately for me, 90% of my pregnancy and delivery fell into one enrollment period.

Do the math - work out multiple scenarios (you may need only 2 ultrasounds, or may need 5-6!).

[justajane]

Yeah, one thing that kind of sweetens the deal for us (and apparently others) is that my husband's company puts $1,500 into our HSA each year we choose the HDHP. This will probably go away, since I believe in a few years high deductible plans at his company will be the only option. It's hard for people to adjust to them, but that's because they are so used to higher premiums and thus having the cost hidden.

[Mississippi Mudstache]

Yeah, one thing that kind of sweetens the deal for us (and apparently others) is that my husband's company puts $1,500 into our HSA each year we choose the HDHP. This will probably go away, since I believe in a few years high deductible plans at his company will be the only option. It's hard for people to adjust to them, but that's because they are so used to higher premiums and thus having the cost hidden.

Won't necessarily go away. My company now puts $1100 in my HSA, and HD is the only option. My old company added $400 to my HSA after doing away with the PPO option, and when I worked for the state, they added $750 - though they still offer the PPO plan. It seems to be a fairly standard benefit these days.

[dbanta]

We did the math (monthly premiums, max out of pocket, and tax free HSA money!) and for me, the HDHP was best for pregnancy.  As someone else mentioned, ideally the majority of your pregnancy costs will be in the same calendar year so you can just work towards hitting a single deductible instead of spanning 2 calendar years (2015&2016) and 2 deductibles.

[mm1970]

I'm currently covered by an HDHP at work, but was thinking about having kids next year. I assumed that switching to a regular (non-HSA) health plan is a smarter plan for that circumstance, but is that actually the case?

(I assume I'll need to provide more info to get meaningful advice; let me know what info you need.)

Really depends on the plans.

You have to sit down with the options and crunch the numbers.  I switched to the "better" HMO plan when I was pregnant with my 2nd, and it was a much better deal.

A regular childbirth, one night in hospital, no epidural (too fast!) came in at $14k.  When I crunched the numbers for my particular plan options, it was way better to go with HMO.  The HSA deductible was in the thousands.

[Jack]

Okay, I'd been putting it off because it's a pain in the ass, but here's a table of my insurance plan coverages.

Generally speaking, I understand what each of these individual coverage types is, but what I don't understand is which services would be used during a pregnancy. In other words, I'm not sure how to "do the math."

By the way, my company does a once-per-year contribution to the HSA, but it's only something like $150.

	Regular plan		In-network only plan	HSA
	In-network	Out-of-network	In-network	In-network
Individual Deductible	$0	$2000	$0	$1300
Family Deductible	$3500	$4000	$0	$2600
Individual Out-Of-Pocket Maximum	$3500	$7000	$1300	$2600
Family Out-Of-Pocket Maximum	$7000	$14000	$2600	$5200
Lifetime Maximum	Unlimited	Unlimited	Unlimited	Unlimited
Inpatient Hospital Services	Plan pays 100% after the deductible is met	Plan pays 80% after the deductible is met	Plan pays 100%; $300 per admission deductible	Plan pays 90% after the deductible is met
Primary Physician Office Visit	$30 copay	Plan pays 80% after the deductible is met	$30 copay	Plan pays 90% after the deductible is met
Specialist Physician Office Visit	$40 copay	Plan pays 80% after the deductible is met	$40 copay	Plan pays 90% after the deductible is met
Diagnostic X-Ray Lab	Plan pays 100% after the deductible is met	Plan pays 80% after the deductible is met	Plan pays 100%	Plan pays 90% after the deductible is met
Outpatient Surgery	Plan pays 100% after the deductible is met	Plan pays 80% after the deductible is met	Plan pays 100%	Plan pays 90% after the deductible is met
Prescription Drugs	$15 / $35 / $60	Not Covered	$15 / $35 / $60	$10 / $25 / $45
Emergency Room	Plan pays 100% after the deductible is met	Plan pays 100% after the in-deductible is met	$50	Plan pays 90% after the deductible is met
Urgent Care	$20	Plan pays 80% after the in-deductible is met	$40	Plan pays 90% after the deductible is met
Ambulance Services	Plan pays 100% after the in-deductible is met	Plan pays 100% after the in-deductible is met	Plan pays 100%	Plan pays 90% after the deductible is met
Mental Health In-Patient	Plan pays 100% after the deductible is met	Plan pays 80% after the deductible is met	Plan pays 100%; $300 per admission deductible	Plan pays 90% after the deductible is met
Mental Health Out-Patient	Plan pays 100% after the deductible is met	Plan pays 80% after the deductible is met	$40 copay	Plan pays 90% after the deductible is met
Substance Abuse In-Patient	Plan pays 100% after the deductible is met	Plan pays 80% after the deductible is met	Plan pays 100%; $300 per admission deductible	Plan pays 90% after the deductible is met
Substance Abuse Out-Patient	Plan pays 100% after the deductible is met	Plan pays 80% after the deductible is met	$40 copay	Plan pays 90% after the deductible is met
Physical, Speech & Occupational Therapy	Plan pays 100% after the deductible is met	Plan pays 80% after the deductible is met	$40 copay	Plan pays 90% after the deductible is met
Durable Medical Equipment	Plan pays 100% after the deductible is met	Plan pays 80% after the deductible is met	Plan pays 100%	Plan pays 90% after the deductible is met
Home Health Care	Plan pays 100% after the deductible is met (40 visits per plan year max)	Plan pays 80% after the deductible is met (40 visits per plan year max)	Plan pays 100% (60 visits per plan year max)	Plan pays 90% after the deductible is met (60 days per plan year max)
Employee Contributions
Husband & Wife	$332.30		$252.81	$167.38
Family	$432.35		$328.66	$217.60

[forummm]

I'm assuming you're a man ("Jack") and your wife (since you're talking about having a covered party give birth) is also on the policy and doesn't have other insurance available.

How often are the employee contributions made (weekly, biweekly, monthly, etc)?

[forummm]

I'm assuming the network for the HSA and the in-network only plan are narrow networks. Otherwise I'm not sure why they would be cheaper than the "regular plan" that has higher deductibles and OOP caps.

Are you OK with the providers in those 2 plans? The OB/midwifery practice and hospital you want should be in that plan for sure (unless you don't care about providers). But your wife probably wants someone she'll be very comfortable with. Having a baby is a serious deal.

PM me if you want to ask about midwifery in ATL. We're having one this year.

[Jack]

I'm assuming you're a man ("Jack") and your wife (since you're talking about having a covered party give birth) is also on the policy and doesn't have other insurance available.

How often are the employee contributions made (weekly, biweekly, monthly, etc)?

Yep, coverage would be for me and my wife, and employee contributions happen biweekly.

I'm assuming the network for the HSA and the in-network only plan are narrow networks. Otherwise I'm not sure why they would be cheaper than the "regular plan" that has higher deductibles and OOP caps.

Are you OK with the providers in those 2 plans? The OB/midwifery practice and hospital you want should be in that plan for sure (unless you don't care about providers). But your wife probably wants someone she'll be very comfortable with. Having a baby is a serious deal.

PM me if you want to ask about midwifery in ATL. We're having one this year.

Honestly, I have no idea what providers are in-network -- I haven't even checked. I had assumed I'd pick an in-network provider and that the "network" itself was the same between all three plans, so I figured it didn't matter much.

I'm reasonably sure my wife would have an opinion, and is interested in midwifery / different birth options. I certainly have no idea of how to go about choosing, though, and I'm not sure she does either. I'm very much a "planner" type of person, but I'm so unfamiliar with this sort of thing that I have no idea what questions to ask or where to start researching.

[I'm a red panda]

I had assumed I'd pick an in-network provider and that the "network" itself was the same between all three plans, so I figured it didn't matter much.

Do check what the billing policy is if a non-network provider has to step in at last minute.

I have heard horror stories when someone's OB couldn't make it to the hospital for some reason, and then the on-call one turned out to be out of network, even though the hospital itself was in network.

Apparently, in some cases, they do bill in network rates as a courtesy, but sometimes they do not.

[forummm]

OK, biweekly for H&W means annual premiums:
Regular $8,639.80
In-network only $6,573.06
HSA $4,351.88

Assuming DW hits individual OOP max (probably a good assumption) and you have $0 in expenses
Regular $8,639.80 + $3500 = $12,139.8
In-network only $6,573.06 + $1300 = $7,873.06
HSA $4,351.88 + $2600 = $6,951.88 (and you get the employer paying a little of this through the HSA)

This ignores the kid's expenses. Depending on when it's born, they will be minimal or could just be some wellness visits (which should be free due to ACA).

So it's a network decision at this point.

[acroy]

I found that my high deductible health plan with an hsa has been better during pregnancy.  It really depends on your plan.

Same here - but you have to apply the numbers to your own scenario!

[Jack]

So when the HDHP says "Plan pays 90% after the deductible is met" what it means is that it pays $0 until I've paid $1300, then it pays 90% until I've paid $2600, then it pays 100% after that?

Also, how do y'all think the plans stack up for "typical" (if there is such a thing) infant/toddler/small-child health care expenses?

[forummm]

So when the HDHP says "Plan pays 90% after the deductible is met" what it means is that it pays $0 until I've paid $1300, then it pays 90% until I've paid $2600, then it pays 100% after that?

Also, how do y'all think the plans stack up for "typical" (if there is such a thing) infant/toddler/small-child health care expenses?

You have to meet your deductible (plan pays $0 until you've paid out your deductible). Then the plan pays some percentage or fixed amount until you hit your annual OOP max. Then the plan pays 100%. The exceptions are if you use out-of-network care (then it depends on the plan), and for preventive care (which is free in-network for certain preventive care and preventive visits if the plan is nongrandfathered).

Preventive well-child care, including the office visit, should be free if it's a non-grandfathered plan (plan materials must state if they are grandfathered). When the kid is sick, you'll have to pay.

[Gin1984]

So when the HDHP says "Plan pays 90% after the deductible is met" what it means is that it pays $0 until I've paid $1300, then it pays 90% until I've paid $2600, then it pays 100% after that?

Also, how do y'all think the plans stack up for "typical" (if there is such a thing) infant/toddler/small-child health care expenses?

After my daughter was born we used our insurance ALOT.  Multiple appointments to figure out one issue and an ER visit.  I would assume that at least the first year you pay your out of pocket max.

[forummm]

So when the HDHP says "Plan pays 90% after the deductible is met" what it means is that it pays $0 until I've paid $1300, then it pays 90% until I've paid $2600, then it pays 100% after that?

Also, how do y'all think the plans stack up for "typical" (if there is such a thing) infant/toddler/small-child health care expenses?

After my daughter was born we used our insurance ALOT.  Multiple appointments to figure out one issue and an ER visit.  I would assume that at least the first year you pay your out of pocket max.

The timing of the birth is important. If you have the HSA and the kid is born in March you'll have hit the family OOP max for the year and your visits for the kid would be free until January.

[Jack]

How long after birth until the health care costs start to taper off? 6 months? 1 year? 18 years?

[forummm]

How long after birth until the health care costs start to taper off? 6 months? 1 year? 18 years?

On average they start pretty high, drop down for a bit, and then increase slowly but substantially and spike right before death. But for a particular person, it varies dramatically. Hence insurance.

[Bob W]

Don't forget to shop providers --- medical prices can vary drastically from one to another.  For some reason people are reluctant to shop medical costs?

[forummm]

Don't forget to shop providers --- medical prices can vary drastically from one to another.  For some reason people are reluctant to shop medical costs?

One reason is that the prices don't matter in many circumstances since insurance will be paying for it. After OP hits his annual OOP max (which he will with a child birth), it's all paid for. Another is that it's insanely difficult to shop prices because no matter what info the providers give you, it's most likely to be wrong. Especially for something that can be very complicated like child birth.

[La Bibliotecaria Feroz]

How long after birth until the health care costs start to taper off? 6 months? 1 year? 18 years?

On average they start pretty high, drop down for a bit, and then increase slowly but substantially and spike right before death. But for a particular person, it varies dramatically. Hence insurance.

Don't ALL plans now cover well-baby visits and other preventative care totally free?

Something to keep in mind is that you might be able to switch plans after the baby is born--it's a life event and many HR departments will let you not just add baby, but actually switch plans. You might want to ask yours. That's what we did. We had the gold-plated plan when I was pregnant (I actually got knocked up during open enrollment) and then once I was safely delivered of a healthy baby, we down shifted. NICU care, God forbid, is hella expensive. And when I was in labor and decided that maaaaybe an epidural would be an excellent idea after all, it was really nice not to be wondering what it was going to cost me.

[forummm]

Don't ALL plans now cover well-baby visits and other preventative care totally free?

No.

Preventive well-child care, including the office visit, should be free if it's a non-grandfathered plan (plan materials must state if they are grandfathered). When the kid is sick, you'll have to pay.

More info at www.cdc.gov/prevention

[little_brown_dog]

when i got pregnant and was looking at switching plans, i called my midwife, the 2 hospitals i was most likely to deliver at, and another large ob/midwife practice in the area to make sure they were all in network. specifically, i confirmed with my preferred hospital and midwife practice that all of the midwives/obs at that practice (and in that maternity ward) were in my network. that way, it doesn't matter if my specific provider isn't on that night/day - someone else who is in network will be.

definitely follow up on maternity coverage specifically (you may have to call for this). there will be a policy that outlines exactly what is covered for maternity services. the strongest plans will have all standard prenatal and postnatal visits, testing, etc. covered and will have you only covering a small % of the birth/hospital stay after deductible.  if your in network plan offers fully covered prenatal/postnatal care and you have alot of in network hospitals/providers, that might be the best option.  in the healthiest pregnancies, most women have at least 10 prenatal visits, an ultrasound or two, multiple blood/urine samples, a glucose test, and a strep test before even making it to the delivery day.


Since you are a planner, here is a rough breakdown of typical pregnancy visits/expenses that you need to cover or have insurance cover:

Pregnancy confirmation blood test (some providers no longer do this). Some states require mandatory HIV testing and other blood tests upon confirmation of pregnancy.

Prenatal visits every 4 weeks until 32 weeks, then every 2 weeks until 36 or 38 weeks depending on provider, and then every week until delivery (est 10 visits if she starts them around week 8 or 10). Standard visits include vitals, fetal heart beat check, and tummy measurements. Most do not have labs.

20 week fetal anatomy ultrasound (1 hour visit)

28 week glucose test and blood panel (for anemia, etc)

TDAP vaccine for mom and dad

Final month strep test

Final month ultrasound (to check baby's likely birth position)

Birth/delivery costs

Baby's 2, 4, 8 week appointments

Mom's postnatal OB/midwife appointment


Additional considerations that frequently occur:

If your wife has complications like spotting/threatened miscarriage or trouble identifying when her last period was, she may receive an extra ultrasound early in her first trimester. 

Miscarriages often require blood tests every 2-3 days to check hormone levels.

If there are complications on the 20 week ultrasound she will need a follow up scan.

If she fails the glucose test, she will have to do a more in depth 3 hour glucose test for gestational diabetes.

If the baby is breech, she may opt for an additional "turning" procedure to try to move the baby into head down position.