Open Enrollment & Pregnant: Anthem or Kaiser? PPO, HDHP or HMO?

It’s quite the luxury to fall pregnant the month of open enrollment. This means hubby and I can (theoretically) make smart financial decisions when it comes to selecting health insurance for next year which covers both the birth of our first child and their first six months of medical care.

Even with this great fortune, it’s unclear which of our options is the right one. Luckily, my company provides relatively good insurance. Given how much health insurance costs in this country, the $200-$300 we’ll be paying a month as a couple (and $200 to $400 as a family) is nothing compared to what insurance on our own would cost. Still, I want to make a smart choice here.

It’s hard to make smart choices when the data is all hidden. Plus, not every decision in life should be based on financial impact alone. Delivering a baby is serious business, and having the option to choose my doctors (especially in case anything goes wrong) feels, to me, like a must have. My husband disagrees.

As a “Kaiser baby,” he speaks highly of the whole Kaiser health system (which also happens to be our lowest-cost option by far.) While some people report Kaiser is horrible, it seems to be that they have their shit together in California. Still, it makes me incredibly nervous to switch to a new health system now with its own style of care.

According to the calculator provided by the open enrollment system — with maternity care and other costs this year (for family of 2) our Kaiser total out of pocket costs would be $3000 or less for the year, whereas Anthem PPO (low deductible) would be around $5000-$6000 and Anthem HDHP would be $8000 (but also includes a $6900 contribution to HSA pre-tax, so that’s about a $3000 discount long term if we buy and hold.)

Financially-saavy me thinks — go for Kaiser — it’s clearly a lot cheaper and it’s not bad – just different. People who dislike Kaiser seem to have rare medical conditions that the organization doesn’t find fast enough since they have no incentive to spend more money on your health, and you have to advocate for yourself. Their maternity situation actually seems to be well regarded. It might not be a horrible idea to go to Kaiser and save $2000=$5000 next year. Lawrd knows we’ll need it for daycare* (more on that in another post.)

Before I was pregnant, I found an ObGyn who looks great (lots of 5 star reviews online) and she didn’t have an opening until January so I booked it a while ago. I planned to talk to her about infertility but now that I’m pregnant, it works out that it’s week 10 of my pregnancy and likely ok to be my first prenatal appointment (I’m assuming — especially since my Reproductive Endocrinologist provides ultrasounds and bloodwork until I’m turned over to the Ob.) I’m just not sure if that trade off is supposed to happen at 8 weeks or if 10 is ok… but I’ll find out.

So… I’m leaning towards Anthem… even though it’s a waste of money. If we start with Kaiser now, we’re stuck (I’ll have a pediatrician selected for my child through them, and unless that doctor is horrible, we’ll likely want to stay with that pediatrician for our child’s entire… childhood.)

Regarding the Anthem options – I’m torn between the HDHP and the PPO. The PPO is cheaper, according to the calculator, and for my husband it’s nice that it has a $250 deductible. The monthly cost is definitely higher and doesn’t include any company contribution, so that’s why it starts to even out. Then the HDHP has that HSA which I love so much, being able to invest nearly $7000 in pre-tax dollars in an account we can invest in and use for healthcare later in life. That $7000 invested over 10 years at 5% would be worth $9.4k – $2.4k back, plus the $3000 or so savings in taxes up front, which is $5.4k, which covers the cost of the difference between this plan and Kaiser.  And that’s with 5% growth and only over 10 years. So is Kaiser really cheaper? — That said, we’d have to pay $7000 up-front now out of our take-home income (though it would only feel like $3500 lost, comparable to the Kaiser costs, I think?)

Either way, I’m fortunate to have a job that pays well enough to be able to be able to decide on this. Keeping my job has never been this vital, and every day I step in the office I know I have to get my game face on and make this work. Somehow. I haven’t told my boss yet that I’m pregnant (one doesn’t do that until week 12 or so, apparently), but I’m nervous about sharing this news with him since I’m not covered by FLMA until 3 months after giving birth to my child. More on that, later…

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3 thoughts on “Open Enrollment & Pregnant: Anthem or Kaiser? PPO, HDHP or HMO?”

  1. Congrats on being pregnant! Very exciting. This to me seems like a no-brainer. First of all, you would like to be able to pick your doctor knowing that you are very early in your pregnancy and there could be complications along the way. Second of all, the HSA will win out in the long-term. That money is the only money that will go in tax-free, grow tax-free, and come out tax-free. For someone who has a long-term plan on investing, these advantages should be clear. Finally, with $500k+ in the bank, spending whatever the max out of pocket is next year (I assume $10k), can’t compete with $7k growing tax-free for 20 or 30 years. I think the situation would be different if you were strapped for cash, but in your situation, you can take the short term hit for the long term gain.

    1. Thanks! I’m not sure the numbers add up with the HSA. I figured out in California it’s not pre-tax or tax free… so it is only the federal tax deduction. Plus HSA fees are ridiculous. With both my husband and I on the high deductible plan, and with a pregnancy, we’d end up spending much more with the HSA over the year. Maybe long term the HSA federal tax savings would make up for it… but I’m not so sure. Still trying to run the numbers.

  2. I live in CO and had Kaiser while I was pregnant with my first child (and still have it now). I actually really like the Kaiser system and felt like I was well cared for. I started to dilate prematurely during my pregnancy and was pleased with their high risk maternity care as well. The difference between Kaiser & other systems, in my experience, is that you have less consistency with seeing the same doctor, although you can control that to a certain extent if you choose to make it a priority. Personally I didn’t mind seeing difference doctors & nurse practitioners before I entered the high risk practice. I was more focused on choosing appointment times that were convenient. In my experience your first OB appointment with Kaiser is at 8 weeks. In my case, the IVF clinic was happy to turn me over to my regular OBGYN at 8 weeks so I could have care that was covered by my insurance rather than paid out of pocket. Hope this helps – and congrats!

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