Hi All! I just had a baby and have an opportunity to change my insurance. Should I change from PPO to HSA, HDHP now or wait until open enrollment?

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If you do HDHp, will you be able to cover the high deductible before plan kicks in? HSAs are great for that and saving but again it’s a high deductible plan, so non-preventive/routine care will be out of pocket. Otherwise timing during the year makes no difference.

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I would stay with ppo. Too many doctors visit during the first 3 years with the baby.

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1. Are you sure you want to switch? I personally prefer PPO plan with kids as the premium is only marginally more expensive and out of pocket max is fairly low, so you should just check and do some comparisons if it makes financial sense. Also with kids I’ve gone to the emergency room + urgent care in the early years a LOT more than I would have anticipated so something to factor in cost-wise. The potential tax benefits to having an HDHP do not outweigh the benefit of being on my PPO plan.
2. If you’re sure you want to switch, consider doing it during open enrollment for the next year - you likely have contributed some towards the deductible / out of pocket max with labor + pregnancy costs this year, typically when you start a new plan you end up restarting the tally for out of pocket payments and deductibles. However it’s possible some insurance handle this differently, so do your research on the policy.

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Each employer will be different with their insurance plan costs. You have to compare both plans to compare costs to cover a family at the front end (premiums) and compare costs to cover a family at the back end, (premiums, meeting deductible, any employer contribution to HSA and max out of pocket) should something catastrophic happen.

The difference at the back end is key. A single employee with no dependents could be better off going with a PPO but a family might be better going off with a HDHP.

If the difference for back end makes little to no difference going with a HDHP over a PPO if something catastrophic happens, it’s better to go with the HDHP, pocket the extra money you’d save on premiums with the PPO and put it into your HSA.

Well baby visits and baby immunizations should be 100% covered in a HDHP. A visit to urgent care if baby stuck a bead up their nose will not be covered until the deductible is met.

If you don’t plan on going to doctor much, and your family is healthy go with the HDHP.
You will have better insight once you compare back end costs of each plan.

likehelpful

Bad pic from a comparison yrs ago but I did highlight cell I3 to show the annual OOP max calculation. The goal is to compare the amount in cell D5 to cell J5.

If I chose the more expensive plan (the Cigna 1000), I’d pay $2340 in premiums alone in D5. But if I went with the cheaper plan and something terrible happened, I’d pay $1660 more that yr in J5. In this example, the co pays for office visits and urgent care are the same on each plan. So in that case I pick the cheaper HDHP plan for family coverage. More expensive doesn’t always mean “better” so it’s important to check and compare. And it will vary because the costs for a family will be different than costs for a single person (in the other example below the single person would be better off doing the more expensive plan)

Total up the monthly premium of each plan and add their respective OOP limits to the premium total. If you stay in-network that will be your max liability for the year.

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If the birth was under current plan you probably reached your oopm, so rest might be free this year. If you change plan you reset your spending. Check what doctors and hospitals are covered as well. For example, GTs basic plan and insurer is not accepted at most of the doctors and hospitals we were going to or close to.

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Change during new enrollment. If you change now, you will on the hook for high deductible. It would have been ideal to enroll in HDHP last year when you knew of a baby on the way.
Some people saying stay with PPO because it’s good if you have kids…that’s not accurate. HDHP plans are fantastic whether you have kids or not. People just need to understand them better

likehelpful

Yes to this. If you change now it will be effective as of the date of the event, aka the birth. So you will be charged hospital bills for labor and delivery accordingly. Depending on when the baby comes/ open enrollment, it probably makes sense to wait for that. Also make sure you max out your HSA while on the HD plan

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1) Deloitte heavily subsidizes the HDHP such that it always wins out over the ppo except for folks that use between 70 - 95% of their deductible. 2) The networks are the same within each carrier so make sure your doctors/RX is with the carrier you pick. 3)I am not sure how off cycle deductibles work so would recommend looking at that (if not prorated - wait until open enrollment). 4) if you have extra cash you want to hide from taxes, using open enrollment now would allow you to put the full 7300 into your hsa (you should also ask Deloitte how their contribution works (full vs pro-rated)

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I think you did this backwards. Assuming you’re healthy and don’t have many health expenses you should’ve done HDHP with HSA before the kid and now should be switching over to PPO.

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PPO is great with kids

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I have hit the deductible on my HDHP plan every year since I started having kids. Switching to PPO next year. These kids are expensive!

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But won't thr PPO premium be the same as HSA plus HDHP

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A delivery usually maxes out all deductibles and co-pays in the year so stick with your current plan until renewal.

At this time I generally say get the HDHP and max the HSA as the mote traditional plans are usually priced to cost the same as HDHP plus HSA saving and in a good year you get to keep the HSA money to save for the future.

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