XP: Which health insurance plan?

[Ashley&Scott]

It's open enrollment time & I'll soon be adding DH to my plan since he's losing his job. Which would you pick & why?


Option 1: HMO (*network = my state)
(*this is the plan I currently have)
$340/mo
Deductible: $1,000 Individual/$2,000 Family
Annual OPM: $3,000/$6,000
Coinsurance: 20% (no out of network coverage except for emergency)
Copays: $20/$40
ER copay: $200
(ETA- no referral needed to see an in-network specialist)


Option 2: PPO
$393/mo
Deductible: $1,500 Individual/$4,500 Family
Annual OPM: $3,000/$9,000
Coinsurance: 30% in network/40% out of network
Copays: $25/$50
ER Copay: $250


This will be for me, DH & M (3.5yo). We travel out of state at least a few times a year to visit DH's parents. Now that M is older we will start traveling OOS for vacations too. Trying to decide if having out of network coverage would give us more peace of mind. Currently if we needed major medical treatment at an out of network provider we would not have any coverage. (except in emergency cases)

[longtimenopost]

For the HMO, what's the annual OPM for out of network? And for the PPO, is the OPM higher for out of network? It seems like anywhere you go out of state, you'd go to the ER if you needed medical treatment and it would be considered emergency.

[Ashley&Scott]

longtimenopost - there is no out of network coverage for the HMO. OPM is not higher for the PPO, it's the same $3,000 indvidual & $9,000 family.

Some more new info I just received: Maternity coverage (I'm not pregnant & we are not TTC but you never know what 2016 might bring)
HMO coverage:
Prenatal & postnatal care - no charge
Delivery & inpatient services - 20% coinsurance

PPO coverage:
Prenatal & postnatal care - 30% coinsurance in network/ 40% out of network
Delivery & inpatient services - 30% coinsurance in network/ 40% out of network

[Ashley&Scott]

In regards to the ER: yes, ER services would be covered as long as they deem it an emergency.

[longtimenopost]

With that info and the update for maternity services, I would go with the HMO. It's possible you'd be out more with the HMO if you had an out of network incident, but it's certain you'd pay more with the PPO if you don't.