Insurance

colorsplashstudio

Looking for ideas from those who have individual insurance plans. We currently have a high deductible accident/injury policy that is grandfathered in until the end of 2014 in which they pay 100% after we reach our deductible. Our current plan however does not cover the hospital bill of our birth, which is obviously the most expensive part. If I have an emergency c-section or something goes wrong it kicks in and covers, but if it's a planned c-section or a "smooth" birth nothing is covered. We are prepared for that, but I'm wondering about taking out a secondary policy with obamacare now having to cover maternity? We are looking at around 10-15k out of pocket if all goes well right now, I am thinking if I pay a high premium for an obamacare plan and we are stuck with copays and 20% of a 10-15k hospital bill we would come out ahead, and then if something goes wrong we will use the high deductible plan we have. Anyone have any experience/thoughts or how they are planning with this?? 

nycAug14

I don't know what state you live in so I cannot advise on your plan options specifically, I just wanted to comment on a few things. Would picking up a second plan be helpful or would it make more sense to just switch to the Obamacare plan? Also, if they cover 80% of the bill, this is not the full billed amount, this is the negotiated rate if you are staying in-network, which is a lower cost. What type of plan are you on that doesn't cover a birth? Sounds like you will need a normal plan that covers all medical expenses once the baby is born any way. I would get one one of the Obamacare plans before the open enrollment period is over. Hope this helps!

FemShep

I'd check on a few things before you make your decision:

-See what a better plan would cost you through your state's exchange.  Calculate the deductible as well as % of payment covered in addition to your monthly premiums.

-Call your hospital's billing office, explain the situation, and ask if they'll bill you at reduced rates.  Insurance companies very rarely pay the full amount on the bill because they've negotiated discounts; see if you can do the same.

Once you've had both of those discussions, you can more accurately calculate the "true" cost of the different options available to you and make a better decision.  Good luck!

Blackvelvet

stoofewok said:

Hubby and I have been trying to plan out our insurance costs and we are on a high deductible plan that we've calculated will cost us a MAX of 6k out of pocket. However, we're going to see if we can switch to a more inclusive coverage plan for the next year throughout the pregnancy. 

Is this a possibility for you as well? Is your accident/injury policy through you or your husband's work? Sometimes insurance plans will let you change your insurance for major life/health changes (pregnancy should qualify here) even during a period of time where there is not open enrollment to employees. 

being pregnant is not a qualifying event on most insurance the addition of the baby when it's born is.

BlckRoses

stoofewok said:

Hubby and I have been trying to plan out our insurance costs and we are on a high deductible plan that we've calculated will cost us a MAX of 6k out of pocket. However, we're going to see if we can switch to a more inclusive coverage plan for the next year throughout the pregnancy. 

Is this a possibility for you as well? Is your accident/injury policy through you or your husband's work? Sometimes insurance plans will let you change your insurance for major life/health changes (pregnancy should qualify here) even during a period of time where there is not open enrollment to employees. 

I just want to point out that pregnancy itself doesn't qualify as a major life event under the IRS guidelines to make changes to pre-tax insurance plans.  Once the baby is born, that will qualify as a life event and you can makes changes, however this won't allow you to cover the birth on the new plan.

This link talks a bit about FSAs (Flexible Spending Accounts), but the list of Qualifying Life Events are the same for medical plan changes: https://www.fsafeds.com/forms/qscfact.pdf

colorsplashstudio

Thanks. Yeah we are aware of the cost out of pocket and have talked with a few different hospitals. All the hospitals here aren't real organized with a prepay plan, maybe Michigan is too poor of a state and no one does that here is why? I have found it pays to just wait until the end and they give a discount. Although our only hospitals here with a NICU only give a 10% discount anyway. We are looking at getting me switched onto a new plan before the 1st of the year so any birth costs count toward our max out of pocket and deductible. Considering BCBS right now. I'm thinking of just going on an individual plan so our max out of pocket is only 4-6k instead of the family max since it's just he and I and we are a family of 2. The max out of pocket doubles then so we would still be looking at up to 12k if we did a family plan.

colorsplashstudio

Well, there are really only two major hospitals in our area. I called them both and I got numbers yes, for vaginal delivery/c-sections, etc, but they didn't have any when I asked about a discount for a prepay plan. It's quite a task even getting to the person who can give you the straight numbers and cost. Their answer is always to send you a medicaid app. One had "sort of" a 25% prepay discount plan, but it just sounded disorganized. There was a smaller one that did have a super significant prepay plan, like a fraction of the cost, but there is only one hospital where we live with a NICU so they all tell you if you go into labor early you have to go to that hospital. I actually tried the smaller one when I miscarried and the billing was so messed up. I feel slightly more confident for some reason that a larger hospital is also is better at billing. Just in my little experience so far with the smaller cheaper one and now larger one.  I'm not really as worried about prepaying now with all the new plans that cover maternity. We learned our lesson not knowing a thing the first time so we've saved up quite a bit this time around now that we know the cost range.

Thanks for clearing up the deductible thing. I guess I got a little confused thinking I just have to keep paying out of pocket to reach our max family out of pocket even after my deductible.