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HDHP vs In-network PPO

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  • HDHP vs In-network PPO

    It is open enrollment and I have to decide whether to continue with my HDPD or change to a regular PPO.

    I've been an attending since August. My health care plans covers my wife and I. We don't have any children yet.

    For 2018, the HDPD details are:

    $490 per month for both my wife and I. If we add a kid, it goes to $840

    Deductible  $5,000/$10,000

    Out of pocket maximum: $5,000/$10,000


    The In-network PPO details are:

    $640 per month for wife and I. If add a kid, we would pay $1,100

    Deductible  $2,000/$4,000

    Out of pocket maximum: $6,350/$12,700


    Both my wife and I are healthy and rarely go to doctors other than regular preventive care routine visits which are 100% paid for in both plans.

    However; what *may* change this year is that we are going to try to have children. So there may be a pregnancy/pre-natal care/etc involved.


    Should we continue with the HDPD or should we switch to a regular plan? Any other details I can provide to help with advice?



  • #2
    Assuming you get pregnant in 2018, with the HDHP, you would potentially pay $6k OOP, while saving $150/mo, or $1,800 on premiums. You would also get a $6,900 deduction for contributing to an HSA. Don't know your state, but assuming 40% state + federal, that would save you $2,760. Total savings of $4,560.

    I haven't calculated all of the details (such as increase in premiums for adding the baby to the plan or the difference in OOP maximum), but 2018-2019 would probably be good years to change to the traditional plan if you are going to have a baby especially assuming an early 2019 birth. If you get lucky early in the year and have baby before eoy 2018, then reassess.

    The above also assumes you are not affected by the last month rule.
    My passion is protecting clients and others from predatory and ignorant advisors 270-247-6087 for CPA clients (we are Flat Fee for both CPA & Fee-Only Financial Planning)
    Johanna Fox, CPA, CFP is affiliated with Wrenne Financial for financial planning clients


    • #3
      thanks joanna!


      • #4
        Oh my gosh, why are these plans both so terrible? I thought HDHP were supposed to be cheap? And regular plans more expensive with low deductible and OOP max? Anyway I'd go with the HDHP since it's less expensive with a lower OOP max.


        • #5
          Had colleague who did all these calculations and they chose HDHP.   Got preggers faster than planned and delivered before year's end.  Thankfully nothing wrong and pregnancy and initial months all smooth.  Ended up cost neutral.

          Up to you and most things work out; it's the 2+ Standard deviation stuff that we worry about.   Normal Pregnancy isn't cheap.