what type of insurance do you have?

[Stingyshark]

We're on an EPO.

No referrals needed, but no out of network benefits.

[Deleted]

We have a high deductible health plan and really like it. The premiums are pretty high but my company deposits money every month for us and the deductible is $2500 per person ($3500 oop max). 100% covered after deductible is met. We max it out every year for the tax benefits.

[trafficgirl]

My company switched to an HSA with a PPO pay up option a year or two ago. I'm not a huge fan - we've got I believe a $2500 deductible and a $4000 out of pocket max (for a single person), which is higher for a family. I've already hit it with all my medical bills with these kiddos, but I'm honestly not sure I would have if I'd been on the PPO plan that cost more.

Most people I know who have switched to the HSA wish they hadn't.

[browneyedgirl9]

We have a PPO. I have been really happy with it. 100% of all my maternity care has been covered.

[soozy87]

We have an HMO. We are happy with it so far. We paid a $30 co-pay on our first visit with this pregancy and a few weeks later we received a $30 refund for the co-pay. The referrals may get a little annoying and we didn't get our first choice of hospital, but everything has worked out very well so far.

[vmars]

We have a PPO and a state benefits plan. It rocks. I am only OOP $45 so far this pregnancy.

[runblondie26]

I normally get PPO coverage for myself through my employer, DH and DD go on his employer's HSA plan. Knock on wood, they rarely need to see a doctor. I, on the other hand, always end up with at least one running injury and/or random health issue (kidney stones, recurring sinus infections, etc.) each year.

In our experience, HSA's are the way to go if you rarely need medical care. Since I seem to be in the doctor's office frequently, having a much lower deductible and OOP max with the PPO makes sense for me, even though the premiums are higher.

[lobstertail]

I have an HMO, which has been amazing with maternity care coverage. I work for a university, so the benefits have been very generous. It's fortunate, since pre-natal care for the twins has necessitated doctor visits every two weeks since week #10, with ultrasounds at each appointment. The only money I've spent OOP so far is to buy my vitamins.

[pitterwoo]

We have a PPO. It's only $10 per pay period (covers me only). The deductible just went up, but I don't remember offhand, $1500 maybe.

[mellimel19]

I have an HSA with a $3,000 deductible and $5,000 oop maximum for in network and $10,000 oop max for out of network. This was the first year I opted for this plan and I chose it because generally I very seldomly have a need to go to the doctor, I'm not on any prescription medications, etc. So it seemed like a way to save money on insurance and medical costs. Except that I ended up pregnant this year, and at times it's been a little bit of a struggle paying large expenses out of pocket, and in the long run for this year it doesn't seem like I'm saving any money. So I don't think I'll be choosing this plan again.

[runblondie26]

Oct 21, 2013 12:37:50 GMT -5 sameoldash said:

Oct 21, 2013 12:02:04 GMT -5 runblondie26 said:

I normally get PPO coverage for myself through my employer, DH and DD go on his employer's HSA plan. Knock on wood, they rarely need to see a doctor. I, on the other hand, always end up with at least one running injury and/or random health issue (kidney stones, recurring sinus infections, etc.) each year.

In our experience, HSA's are the way to go if you rarely need medical care. Since I seem to be in the doctor's office frequently, having a much lower deductible and OOP max with the PPO makes sense for me, even though the premiums are higher.

ok, this is what i always thought about PPOs. but comparing our two available plans, they have the same OOP max (6k) so it makes me think that the lower premiums might be better with the HSA plan, in a best case scenario. even in a worse case scenario, they'd seem to be pretty much identical. ??

thanks for sharing!

This is where it gets confusing comparing plans between employers. The specifics of your plan may be a lot different.

In our instance, the HSA comes with a high deductible. I'd have to pay $2,500 OOP to hit the individual deductible before they'd start covering me at 80%. With my employer's PPO, I only have a $300 deductible before they start covering me at 80%.

The OOP amount I have to reach before the PPO starts paying 100% is also lower than on the HSA. I'm not sure of those numbers off the top of my head. However, compared to the deductibles amounts, I don't think the difference between the two is quite as drastic.

2.5k is a hefty amount to pay before I start seeing any type of coverage. I can easily hit that in a coverage year, so the higher premiums still work out cheaper for me.

[grey56]

This is the 2nd year we've had the HSA plan and I really like it. Our deductible is $3K, but my employer puts $1500 into the HSA each year. We didn't dip into 2013's HSA so it will carry over into 2014, so essentially the deductible is paid for. Then the coinsurance is 10% with a max OOP of $7K. All the other plans had lower deductibles but higher premiums, then 20% coinsurance and higher max OOP rates. When I had my daughter, we paid $8K OOP (pregnant in 2010, birth in 2011, so we had to pay 2 deductibles) so even if we hit the max, this hypothetical 2014 baby will cost less. I'm calculating ~$1K so I put in an extra $500 into the HSA for 2014. I will revisit for 2015 but so far I really like it.

We are relatively healthy with no prescriptions that we take routinely. We have enough in our savings to pay for the max OOP minus the HSA, so it just made sense for us.

[Jalapeñomel]

HMO, we do need a referral for most things except oBGyN, pedi and mental health.

No co-pays, no deductible, supposedly full coverage for all in network docs.

It's is supposed to be the best part of DH's benefits package.

[chicago]

I have a PPO through my employer, they pay the monthly premium for just me. H and LO will be on his company's HMO. Pretty sure my deductible is $500, 85% coverage, and max oop is $2500. Sometimes I wish I had the HMO - my friend paid exactly $10 for the birth of her child. I love my OB group though, and I don't think they work with BCBS HMO, so I'm good with it.

[degal99]

I have a PPO mainly because I prepare for the worst, and would rather have the higher premium but better coverage, then have a lower premium and higher OOP costs. I've also had several medical issues that make it advantageous for me. I can imagine someone "healthier" than me might like an HSA type insurance. However, the higher premiums are also pre-tax, so they do lower my taxable income.

[IndiaInk]

We currently have a Blue Cross/BC EPO. It pays 100% of covered expenses, $20 copays on some things, $10 prescription copay, and $2000 out of pocket max/individual, but it only covers in-network providers. In the course of my three pregnancies, two of which resulted in miscarriages with an ER visit, I've been out of pocket exactly $0. As far as premiums go, we pay $158/month for the two of us, and DH's company pays $771/month for us.

I love our plan SO much. Even Blue Cross tells us we have basically the best insurance they offer. But we are considering switching to their PPO plan this year because we may decide to use an out-of-network Birth Center. It's a tough choice.

[osulori]

Oct 21, 2013 11:36:20 GMT -5 @publius said:

We have a HSA/PPO with a high deductible ($3k). It's great for us because the premiums are really low and the max OOP is the same as the deductible. I've got medical issues that require at least one set of MRIs to the tune of $15k a year so hitting the max OOP is something we'll do on an annual basis. H's company adds half if our annual max OOP to our account each year, so what we have to spend is even less.

Everything medically related is covered.

Our plan is similar to this, I think. The $$ contributed by my employer covers OOP costs until that $ runs out and then the deductible kicks in. Of course we went through the employer $ by the time AJ was born, but I still like the way the plan is set up. Everything has been covered, no questions asked.

[speyedr]

We have a PPO with $1k deductible and $2750 OOP max. I have a 20% coinsurance for my hospital expenses next year for the delivery. I think I will be $1400 OOP for the pregnancy/doctors fees and then my deductible plus 20% of the hospital fees next year after delivery. We pay less than $100 a month for medical/dental/vision for both DH and me.

[degal99]

Oct 21, 2013 17:38:06 GMT -5 @publius said:

Oct 21, 2013 16:51:06 GMT -5 degal99 said:

I have a PPO mainly because I prepare for the worst, and would rather have the higher premium but better coverage, then have a lower premium and higher OOP costs. I've also had several medical issues that make it advantageous for me. I can imagine someone "healthier" than me might like an HSA type insurance. However, the higher premiums are also pre-tax, so they do lower my taxable income.

it really does depend on the plan though. I also have medical issues but the PPO offered by H's employer would be way more OOP than the HSA. With the PPO we'd be on the line for 15% of everything above our deductible. With the HSA our spending is capped at $3k (which is really $1.5k because H's employer contributes the other half). With the PPO we'd have already spent way more than $3k on healthcare since July alone.

Very very true.  Basically it really does come down to the specifics of the plans.

[allibee8]

We have a PPO and I am glad we do. When my last pregnancy went off the tracks all of a sudden at 34 weeks, we ended up with $400k in hospital bills. We paid about $200. Our premiums are high, but with a young and growing family, we've decided the coverage is worth it.

[Jalapeñomel]

Oct 21, 2013 18:36:41 GMT -5 @kirkette said:

PPO - Most doctors in our area will not accept HMO patients.

Really?  I wonder why.

HMOs seem to be the norm here, but that's probably because the City of New York provides HMOs, and most people take it (it's the best option with the least amount of OOP costs).

[Jalapeñomel]

Oct 21, 2013 20:46:01 GMT -5 MNH2013 said:

I just posted this below in the Monday Random post:

H just got his open enrollment information. We looked at the HMO plan as it would cost us $0 to have this baby vs. the $4000 it is costing us on my insurance.


I made all the calls to ensure they would accept my already pregnant self at the Dr I am at now and hospital we will deliver at and everything is a go. I am so nervous to actually pull the trigger and do it.

When we were picking plans, everyone I talked to said that when you are pregnant, HMOs are the best way to go.