Open Enrollment Questions

I’m sure I’m not the only one working through my choices, maybe we can bounce some ideas off each other?


I need to look at whether we have any changes on ours…

I’m trying to evaluate whether I need to change anything based on:

  • Likely husband becoming self-employed at some unknown point during the year.
  • Likely attempting to create fetus at latest starting in November.

I believe that husband going self-employed would open up a special enrollment period, so we don’t have to worry about that until it happens?

And trying in November would mean unlikely to be high expenses due to pregnancy in 2021 and would be more important to get good coverage for 2022?


Here is my situation:

I basically have two insurance options worth considering. Anthem PPO and Kaiser HMO.

Same OOP max (3k/6k in network), 500/1500 deductible on PPO, NO deductible on Kaiser. 20% coinsurance on PPO, 0% on Kaiser. Premiums are $10/week cheaper on Kaiser.

The key difference, to me, is that Kaiser locks you into their system, vs picking any in network doctor, specialist I want to see. So far (2 years), that has won out over $520/year.

However…I have taken, I hope, my last hormonal bcp for a while. :partying_face: I am giving my body a few months to figure things out, then trying to make a human sometime in 2021. (I knowww! :scream:) It seems like this process might be a lot cheaper under Kaiser, and also price differences get more significant for family plans and kids/babies go to the doctor a lot… So like, it all still feels far away, but if I’m going to change I should change now?

People who have been pregnant, how do you find out pertinent info? People who have not been spoiled by PPO insurance for decade(s), how is HMO care? Anyone use/have Kaiser?

[ETA footnote, we also have an Anthem HMO option but it’s like $3-4/week cheaper and that doesn’t seem worth it…? Coverage is comparable to the PPO, 20% CI, etc I lied! It is comparable to Kaiser, w/ 0% CI, but more expensive and harder to figure out who is in network. The other one is the CDHP with higher deductible but employer HSA…either way…I think I’m down to PPO or Kaiser.]

I have heard OBs don’t like to take patients partway along? So I feel like whatever insurance/network I have starting out I will need to stick with…may not be true for your options?


It’s interesting we have similar concerns health insurance wise. Wonder if you’ll be in the 2021 baby cohort or if we’ll both end up in the 2022 cohort (hopefully we’re both lucky enough for it not to be later than 2022 but could be the case with me since not definitely starting before November)

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Who knows! :blush: I just know I’m too afraid to wait much longer…

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I’ve been eyeing age 30 like it’s a reproductive time bomb… Starting at 30.5, lol close enough!

(Though bestie is 32 and got pregnant super fast so shouldn’t be worried…)

Sorry will attempt to stop turning this exclusively into a pregnancy planning thread.


@galliver I would highly recommend starting a threat for this in the parenting thread, lots of people with experience will be more likely to chime in over there, or mention your plans to get pregnant in the title of this thread. I know some who rave about how amazing Kaiser is but mostly for those areas where Kaiser has a LOT of providers around anyway.

I can’t help since I’m in Australia but from what I’ve gleaned listening to the USA’ians talk, look at which hospitals and OB/midwives around you provide the kind of care and labour options you want, and then pick a healthcare option that works with that.

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Congratulations on the possible pregnancy decisions.

I switched OBs at 30ish weeks last pregnancy (their office sucked), and I’m planning on switching again this time (moving). It hasn’t been any issue whatsoever, just get the old one to fax your records to the new one. I think it happens all the time honestly.

I don’t have any experience with Kaiser at all, but a friend from the Other Forum is totally obsessed with them (in a good way), and has hated navigating regular healthcare this year when she was forced to use another plan. If you PM me, I will give you her username and you can PM her over there, or look up her journal in which she talks about it a lot.

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Kaiser isn’t in my area. We had to switch OB/gyn midway with first kiddo because first doc was called up (reserves) and honestly got a much better doc than the one we started with. I don’t remember it being a big deal to switch at all.

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I’m sure you have HMOs though. I’m also interested in that experience, broadly. If you use one, what’s it like to gate all your care through one doc and not just…go to a dermatologist or ENT or whatever if you need?

No personal experience with HMO. We’ve always had more of a PPO style insurance plan.

Our primary care doc is in a large health system but we’re not tied to using their referral and specialist system if we don’t want to. Edit: but usually we do because in general it’s a high quality system (med school) and there’s convenience in having shared charts.

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Former partner had Kaiser for a bit. They ended up with a really complicated wrist fracture and really appreciated that everyone involved with fixing it was in one building and always on the same page. They had terrible experiences with Kaiser’s mental health care. This was in Ohio where Kaiser isn’t very popular. I would bet that in CA their mental health services would be way better.

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I feel like some of the other bad stories I’ve heard about Kaiser have been on the mental health side rather than the medical side.

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I didn’t find many (well rated) therapists in the area that took insurance at all though, so that may not be much of a loss…(I wasn’t looking for me.)

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I have Kaiser HMO in Southern California, and I thought it was great for my pregnancy. Thoughts below specifically for pregnancy and baby care. I haven’t used them for anything else. Also my point of comparison was Anthem HMO which sucked…

Online interface super easy to use, easy to email doctors, get lab results, etc.
Easy to get referrals. I was able to get PT during pregnancy, got referral to allergist for baby, etc.
Flat co-pay for baby delivery of $250, no matter if vaginal or c-section. Majority of prenatal care had no copay. If baby needs NICU, another flat copay of $250, regardless of duration of stay.

Need to deliver at Kaiser hospital. Nearest location may not be super convenient. Not as many options for birthing centers, etc. Depending on hospital, may end up spending almost as much as copay on parking.
Likely not to have your OB deliver because there’s like a million OBs at Kaiser.
Depending on your situation, may not have as many options and choices for delivery. I knew really early on that I had to have a c-section so I didn’t care. There are a few midwives on staff I think.


I have had Kaiser multiple times in Oregon, where they are pretty big, and I had a lot of good experiences with them. They were the first system that I had for health care once the ACA passed and I got health care, and I was really disappointed once I switched from a HMO to a PPO because I had gotten used to everything being in one building - pharmacy, PC, Rheumatologist, labs, flu shot, billing. I first got treatment for my RA there, and the fact that records are standardized and shared between all providers was AMAZING.

But I was lucky in particular because I worked just a few miles away.

It was mildly annoying because I had to bike there every month to pick up my prescription because it was refrigerated and couldn’t be mailed, not authorized for more than 4 week supply at a time. And I couldn’t pick it up from a non-Kaiser pharmacy. That being said, now that I’m on a PPO it has to come from a specialty pharmacy who drops it off at my house every month in ice packs and charges a pretty penny for that and I have no option to pick it up on site.

My boss had breast cancer with Kaiser and found it a good experience but she said “pretty much I think they’re just a conveyor belt with breast cancer since it’s often quite standardized treatment protocol”.

I never used mental health care on Kaiser, though. I have used it on Providence PPO and have had a fine experience, but was VERY paranoid about finding someone on my PPO list.


Thanks, that’s exceptionally helpful! (I am in SoCal. LA area.) Also Anthem HMO is one of my other options but it seems less convenient (and more expensive).

Did you ever need to seek care while out of state? Or @anomalily?

I think that might be Kaiser specific, not just HMO?

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Umm, literally not a single health insurance plan available on the marketplace in my state covers non-emergency out of network providers, and therefore it’s useless even on my PPO to go out of state. So unfortunately, no.

SO, umm. America sucks.

Did have a friend who had a VERY serious bike crash on Kaiser (pre-ACA) and was taken to a non-kaiser hospital because it was an emergency and she said she never felt like they pressured her to move hospitals in recovery or anything. So that’s good?