r/HealthInsurance • u/93ParkAvenueUltra • Apr 09 '25

Plan Choice Suggestions Please explain like I'm 5

I have two health plans to choose from.

Plan A: $11856 per year premium. Deductible is $1600 with 20% coinsurance afterward. Out of pocket max is $6250. Plan Type: PS1

Plan B: $8050 per year premium. Deductible is $7500. Out of pocket max is $7500. Plan Type: EP1

My wife wants to have another baby, but the last one she had pre-eclampsia and we spent a total of 3 weeks in the hospital.I am fairly confident that she will hit the Out of pocket max.

Question 1: Why does Plan B look like the better bet even though it is cheaper than Plan A? Am I missing something?

Question 2: Is the "out of pocket max" truly a hard limit? Or is there some way for them to weasel more money from us after that?

Question 3: I Plan to put the premium difference ($3805) in a HSA to offset the birth costs. Would it be wiser to go with plan A with less HSA savings? Or plan B with more HSA savings?

Sorry for the long first post and thanks for reading! I've been wracking my brain for hours and I think that I just need another set of eyes on it.

16 Upvotes

100% Upvoted

68 comments sorted by

View all comments

17

u/Mysterious_Luck4674 Apr 09 '25

Plan B is cheaper because the deductible is so high.

3

u/Mysterious_Luck4674 Apr 09 '25

The OOP max really is a max for things that are covered by your insurance - there might be certain drugs or treatments that aren’t covered at all by your insurance and would still cost you money. Anything else would be in the fine print. If you are going to spend the full amount put as much as you can in the HSA for the tax break.

1

u/RosyBellybutton Apr 09 '25

And the deductible is higher than the plan is cheaper. Wouldn’t that make A the better plan?

3

u/Mysterious_Luck4674 Apr 09 '25

OP will pay the entire deductible and says he will pay the OOP max either way. The total of those two amounts are cheaper for plan B

1

u/93ParkAvenueUltra Apr 09 '25

I'm aware of that, but if I know I'm going to hit the OOP limit, which plan would be the financially wiser move?

10

u/Mysterious_Luck4674 Apr 09 '25

Plan B since the OOP max plus premium is cheaper. You asked why Plan B looks like a better deal - it’s because most people don’t want that high of a deductible, but since you’ll meet it in any case that doesn’t matter for you.

2

u/93ParkAvenueUltra Apr 09 '25

Ohhhhh. Sorry I read your response wrong! I'm just worried that the OOP max has some hidden loophole or catch where they can still try and bill me for more.

4

u/Sea-Combination-968 Apr 09 '25

If you are confident you are going to have high expenses, then plan #2 with the lower premium and higher OPX will be the most financially beneficial.

I work for an insurance company and one of my teams designs plans so I spend lots of time looking at plan designs, pricing with actuaries, and reviewing financial performance of plan designs. By most measures (e.g., actuarial value) plan 2 is skinnier and on average will be less rich, but for someone that knows they will have very high medical usage it will be the most beneficial.