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.

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u/[deleted] Apr 09 '25

Is the deductible and max oop family amount or individual

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u/93ParkAvenueUltra Apr 09 '25

Individual. The way I understand it is that each person has their own individual deductible, then it's 100% covered for that individual on the plan.

1

u/[deleted] Apr 09 '25

Is one a PPO and one a HMO? Does your employer sponsor any of the money into the HSA? Are you positive both plans have HSA? Sometimes the better plans do a FSA. Lots of things to consider like besides the pregnancy do you or your spouse have any other health issues?

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u/93ParkAvenueUltra Apr 09 '25

Both plans are considered High deductible and offer HSA. I currently contribute $4500 yearly to my HSA. I dont know if it is ppo or hmo. It only says PS1 and EP1 under their respective plan types.

We are fairly young with no heath issues. If it wasn't for the thought of a baby we would do the cheapest plan possible.

Edit: I'm not sure what you mean by employer sponsor. They don't contribute to it at all.

1

u/6g_fiber Apr 09 '25

Your employer doesn’t contribute anything?? If that’s the case you should do a marketplace plan. Have you recently had a qualifying event? (Like the recent loss of your previous insurance?)

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u/93ParkAvenueUltra Apr 09 '25

Yes, my wife did! I've considered it, but I'm unsure if those plans are also pre-tax dollars.

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u/dehydratedsilica Apr 09 '25

In general, they are not. (They can be if you qualify for the self-employed health insurance deduction.)