Which Plan for Pregnancy - PPO or CDHP? What Was Your Experience?

I think that no matter how healthy you are complications can alway arise and you need to be covered. I was on BCBS for both my pregancies and love it. You will only have to pay up to you total out of pocket max which is nice to know. Also remember that you will have charges for the baby as well so that is another deductible and out of pocket max (which you will probably not meet that for his/her expenses). I was very healthy when I got pregnant, but had lots of little complications with both my pregnancies the cost add up quickly.

Hi!

What you want to look for on the CDHP is this:
OUT OF POCKET MAXIMUM.

This is a limitation to how much will come out of your pocket for the year should a crisis arise.

You will see these on PPO's as well as on the CDHPs. But typically, co-pays for Dr. visits and medications do not apply toward the out of pocket maximum for the year on the PPO's like they do on CDHP's.

I got forced onto a CDHP with my first pregnancy and it was a complicated one. I liked not having to front any money until the HRA was exhausted. Meeting the deductible and then paying the 10% co-insurance wasn't too bad either. Because once $5000 had been paid out of my pocket for the year, my care was covered at 100% and I didn't have to pay anything more after that happened. I looked back when deciding whether to try the PPO the next year and figured how much I would have paid for office visits, urgent care, and E/R co-pays and it definitely worked out to LESS on the CDHP than it would have been with the PPO.

The down-sides, especially with pregnancy:
1. You have to WATCH the EOB's like a hawk, both the provider and insurance companies make mistakes and you have to call them on it when they mess up. I spent a LOT of time and energy dealing with administrative hassle because of this. It's like a checkbook you have NO control over.
2. Once your baby is born, you will need to switch to the "family" plan which will change your deductible and out of pocket limits for the remainder of the year but they usually add funds to your HRA too if applicable.

With PPO's, the cons are that your co-pays don't go toward your out of pocket limit for the year. Also they usually have deductibles too, for stuff like supplies, drugs, labs, or even imaging like ultrasounds. Not always but I have seen some crappy PPO policies on these types of things. And you have to have the co-pay/co-insurance amount ready before you go to the Dr. If you are high-risk or have complications, anything not considered a "routine" exam is probably going to require a co-pay.

The quality of these plans vary from employer to employer. But if you have a good CDHP with an out of pocket limit that isn't too outrageous, I would say go for that.

Good luck!

S.,
I would look at what it will cost you in co pays and otherwise. I am currently on a PPO with Blue Cross/Blue Shield and I am due in February with my second child, we have to pay 80/20 for everything. This means I have to pay the ob almost 450 just to deliver the baby. Not to mention what the hospital will charge. I don't know anything about the CDHP plans, as our only other option is an EPO, which I am switching to so that after my co-pays they will cover at 100%. This is just my experience, every insurance is different, but I would take a close look at what you will spend out of pocket (not only the premium every payday)

Good Luck
N

I am not familiar with the CDHP, but just had a baby with UHC's PPO plan. While the per paycheck costs are more, the out of pocket expenses for the pregnancy was very minimal (less than $200).

If you have to get a referal to see a specialist (i.e., you have to choose a POC) for the CDHP, I would recommend against it for pregnancies. When you are in the hospital, lots of doctors will come in to visit and then charge you that doctor visit. I question a few of the visits, wondering if they were necessary or not. But becuase my insurance paid them, I didn't really worry about it. With a POC type of insurance, you have to police this yourself. That's the last thing you want to do while you are in the hospital. Also, for pregnancies, don't forget about the pediatricians as well. The doctor on call may not be covered under your insurance.
Insurance is such a pain to deal with, but it's still way better than none at all, regardless of the plan you choose. :)

I agree with HP to look closely at what you're going to pay in addition to the monthly premiums. There are lots of dr. visits with pregnancy and the baby's first year. Look at what they both cover with the hospital stay, and any complications (c sections are much more expensive). Sometimes a little higher premium is worth it, sometimes it's not.

We are Blue Cross Blue Shield PPO. I LOVE my PPO. We do pay a premium for it.

When I delivered our daughter in 1994 I only paid for the upgrade of $75 for a private room. In 2001, for my hysterectomy, again...all I paid was $75 for private room upgrade.

We are a healthy family of 3 and rarely visit the Dr unless it is annual testing, etc. if we go to the Dr. our fee is $20. My Rx is by mail 3 month supply of hormone $30. Unexpected trips to the pharmacy are not much more than $10 if at all. The ONLY thing costing more than $10 is my daughter's face cream at $50. I get that in 3 month supply now for $50.

I know a premium is paid by my hubby but the PPO is far worth it to us to know we are so completely covered.

Best wishes to you!