Traditional or High Deductible? Help!

[Traveler15]

Hi all,

My wife and I are due to have our third child in early 2017.  My new company has open enrollment that begins in a few weeks where we will make our health plan choices.  Can you folks help review the below figures to ensure we make the best choice?  Right now I assume the Traditional is the best path for 2017, but would love to hear your thoughts.  We moved last year, so I am not really sure what the full costs will be in our new city.

1.)  Traditional plan premiums would be $2,300 greater than the HDHP for the year.
2.)  Both the Trad and HDHP have pre-tax (FSA/HSA) options.
3.)  Co-insurance is 80%/20% once deductible is met for both plans
4.)  Trad details:
 
$600 Single (deductible
$1,200 Single+1 (embedded deductible)
$1,800 Family (embedded deductible)
 
$2,600 Single (Max out of pocket)
$5,200 Single+1 (Max out of pocket)
$7,800 Family (Max out of pocket)
 
5.)  HDHP details:
 
$1,600 Single (deductible)
$2,800 Single+1 (non-embedded deductible)
$4,200 Family (non-embedded deductible)
 
$2,500 Single (Max out of pocket)
$5,000 Single+1 (Max out of pocket)
$6,850 Family (Max out of pocket)
 
A few questions:
 
1.)  Any initial thoughts on the best option for us?
2.)  For a pregnancy, would my wife incur the full expense and fall into the Single category or would some of it go to the child and then essentially fall into the Family category?  That has always confused me. 
3.)  When it says Single, is that me since I am the "Plan-holder" or any individual in my family?
4.)  Should I go to the hospital we are considering and show them my options to figure out cost details?
 
Thank you!

[lemonlyman]

It's hard to say. My instinct is to go with the HDHP. The Family out of pocket is going to be hit with a pregnancy in that plan, but you have less risk with care for yourself and your other children happening the same year because the traditional has a higher Family Max out of pocket and higher premium. So I would take the max HDHP out of pocket of $6,850 - $2300 (difference in premium) to get the real max cost of the pregnancy of $4,550.00 +premiums. At that point, care for yourself, your wife, and your 3 children are completely covered for the rest of the year which isn't a bad deal. I might switch to the traditional again the following year when a large expense like that isn't likely.

It's a bit trickier to figure out the cost of the traditional especially with pediatric care after for your newborn. Going to the hospital might help, but I think it's likely they won't be able to help you that much. They won't want to speculate on the state of your Deductible at the time or guess how much your insurance's "allowed" amount will leave towards your coinsurance depending on which charges they use, etc. It's just really hard to tell.

Does your HDHP have access to an HSA? That would seal it for me.

[2Birds1Stone]

I don't see how a traditional plan will allow HSA.....it's not up to a plan to determine that but rather the IRS.

FSA should be available with both plans however.

I would do the HDHP

[Traveler15]

To answer both posters, both the Trad and HDHP have pre-tax options (Trad having only the FSA and HDHP having only the HSA).  Thanks for the thoughts.

[Gimesalot]

I also think that the HDHP with HSA is most likely a better deal.  As far as the pregnancy goes, my understanding is that the wife would incur all costs until the baby is born.  So you would have to get the Single+1 for both you and your wife to be covered, then you could add your baby once they are born, and move into the family plan.  If your wife works, you should see if it makes sense to have all of you on one plan.  Depending on here workplace offerings, it may make more sense to have you split plans.  This is because workplaces typical subsidize the cost of coverage at a higher rate for employees than spouses.  Therefore, the single in the plan is you, not any individual in your family.

I don't think you will get any answers from the hospital.  They typically have no idea what their services cost, since they have no details on how health plans work. 

Just as a side note, here is a list of essential services that should be covered, a lot at zero cost to the plan holder.  There is a lot of coverage for pregnancy and baby costs. https://www.healthcare.gov/preventive-care-women/ and https://www.healthcare.gov/preventive-care-children/