PPO vs. HMO: Health Insurance and Pregnancy

It’s that time of year again when companies hold their open benefit time period, where you have the option to stick with your current provider or switch to a different health insurance plan. I’ve written in the past my choice to pay more for health insurance, but our future family plans have altered our outlook on things. It’s no secret that my husband and I want to start a family at some point, but we have no set timeline—only a laissez-faire “one to two years from now” approach. That being said, our decision to start a family definitely affects which health insurance we choose.

Pregnancy and PPO insurance

The pros of a PPO policy is that it will grant you the choice to go to any doctor within your network, which is typically more expansive than an HMO network. The cons of a PPO policy when you’re pregnant is that you will have to pay 20% of all maternity care and hospital costs, in addition to your deductible. While most plans typically have a max out of pocket cost, they tend to be quite high, such as several thousand dollars. It’s important to look at your max out of pocket costs, because if you end up with a high-risk pregnancy or some other unexpected medical need, you could be liable for your total out of pocket max. PPOs also typically have higher premiums than HMOs, costing you more out of pocket. For example, our PPO plan is $120 a paycheck, vs. $15 a paycheck with an HMO.

Pregnancy and HMO insurance

The pros of an HMO plan is the cost, which normally have lower premiums than PPO—it really depends on your employer. Also, many HMO plans completely cover the cost of maternity care, or a large portion of it. However, the cons of having an HMO health insurance plan during pregnancy is that you are restricted to your primary care physician. While you can switch primary care physicians at any point, they must be within your network.

PPO vs. HMO: What We Decided

I originally was extremely gung-ho about having midwives because I’m absolutely petrified of hospitals and avoid them at all costs. However, in the end, I was more terrified of being stuck with an $8,000 bill should anything go wrong. For this reason, we decided to switch to HMO. We’ll be saving $200 a month in health insurance premiums, in addition to not paying anything out of pocket for maternity care. I made this choice to finally give myself peace of mind, as I didn’t want to be thinking about it while pregnant.

After all, stress during pregnancy is bad for the baby, so the happier I am with my health insurance, the less likely it becomes that something will go wrong. Only time will tell if I have made the correct choice on this matter, but for now I am completely satisfied with the decision that I have made. In addition, I plan on doing other things to reduce my stress levels, such as exercising, practicing yoga, asking my husband for an occasional massage, and drinking green tea.

I’ll just have to do my research and find a doctor that I really love. Luckily, I have a while before we even plan on trying to start a family, but it gives me great piece of mind to think that health insurance coverage won’t be one of the reasons that stalls our decision.