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/NysemePtem Apr 09 '25

Question 2: after hitting your out of pocket max you will still need to pay for your premiums, anything out of network, and my memory is that some UHC plans allow in-network doctors to balance-bill for some services.

1

u/93ParkAvenueUltra Apr 09 '25

How can I see what can be balance billed? We are on a tight budget so every bit helps.

1

u/NysemePtem Apr 09 '25

I'm honestly not sure, which is the biggest issue with any insurance plan, that it's all so opaque.

3

u/93ParkAvenueUltra Apr 09 '25

It's ass. This entire process start to finish is intentionally vague and clouded with the sole purpose of robbing every penny from the consumer.