Question
HSA versus PPO - what's better for Pregnancy?
My wife is hoping to get pregnant this year and have a baby. Thru my employer, I have a choice between an HSA plan that costs me $0 or a PPO that costs $1850. The HSA has $1100/$2200 ind/family deductible with an out of pocket limit of $2000/$4000 ind/family. Deductible counts towards the limit. 100% coverage on maternity, surgical, inpatient and outpatient services after that (if in network). (BCBS of IL - BlueEdge HSA 100/80 Plan). The PPO has $250/$500 deductible, and limits of $1000/$3000 for indiv/family. $10 copays with 100% coverage on maternity, and 90% on surgical, inpatient, & outpatient services. Deductible does not count towards limit. 70% coverage if out of network. (BCBS of IL BlueAdvantage Entrepreneur PPO 90/70 Plan). My thought is that on the HSA, I will save $1850, then have to pay $2200 for family deductible...after which it seems like everything would be covered. Net cost $400 + 20% of prescriptions. PPO seems like $250 x mom + baby = $500, plus copays (20x?) = $200, plus some more. We are very healthy and have no preferences for doctors yet, so don't expect there will be a reason not to be in-network. As long as I stay in-network, HSA seems surprisingly better - does that seem right? Average pregnancy costs $10,000+ from what I can tell. Also, the $1850 is what it costs me to signup for the PPO through my employer. Otherwise its $0 for the HSA. This is what it seems like to me: PPO: $1850 + $500 + $200 + other stuff at 10% up to $1000 per individual? HSA: $0 + $2200? (as long as in network) PPO: www ... HSA: www ...
11 months ago - 2 answers
Best Answer
Chosen by Asker
When you run the numbers the HSA will come out on top in most cases and with most people. (just for your information the HSA is a PPO as well.) I have an HSA for my own policy because I know in the long run I'll pay less. One flaw in your figures with the HSA is you need to add the co-insurance. So if your wife has a baby she'll pay the $1100 deductible plus $900 co-insurance for a total of $2000. After paying that she won't pay anything more for her health care for the rest of the year. You and the new baby will still have to pay the deductible and co-insurance. However, anything paid for each of you goes toward the family limit so the most you will pay as a family in any one year is $4000. The PPO has a $3000 family maximum plus the $500 deductible plus the $1850 premium for a total of $5350 per year. With the PPO even though you've reach the maximum you will still have to pay the $10 co-pays. With the HSA if you reach the maximum everything is covered at 100%. If we look at another scenario; if neither of you have any medical costs during the year you save the $1850.
Source(s)
Independent Agent
by Zarnev
11 months ago
Asker's Rating: 
Other Answers
Go with the PPO. You can pay that 1850 on a payment plan with most doctors. Your lucky, my Doctor wanted 2600 out of pocket. The HSA has a enourmous deductable. I doubt you will ever reach it before you can use the 100/80.
by bewitched- 11 months ago