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October 2018 Moms
tropical1982
member
Medical Insurance - Newborn
tropical1982
member
We have 30 days to add baby to our insurance after birth. Right now DH carries the kids and I'm on a plan by myself.
1. If DH adds baby to his plan, the monthly premiums won't change but they are nowhere near meeting deductible since they haven't encountered any major medical expenses this year.
2. If I add the baby to my plan, I'll switch from employee only to employee plus kids plan. So my monthly premiums will go up and so will my deductible, but I'm deep into my deductible so it'll be an extra grand maybe.
I've never had to do the math separately for baby and mom for L&D but in an uncomplicated birth, what do they bill for baby? Just room and board at the hospital?
1. If DH adds baby to his plan, the monthly premiums won't change but they are nowhere near meeting deductible since they haven't encountered any major medical expenses this year.
2. If I add the baby to my plan, I'll switch from employee only to employee plus kids plan. So my monthly premiums will go up and so will my deductible, but I'm deep into my deductible so it'll be an extra grand maybe.
I've never had to do the math separately for baby and mom for L&D but in an uncomplicated birth, what do they bill for baby? Just room and board at the hospital?
Re: Medical Insurance - Newborn
I am so afraid of this. Trying to read through my insurance stuff is like decrypting a code. Do hospitals lay out cost ahead of time?
ETA: "They" refers to the hospital. Words are hard.
Edit spelling
If you add baby to yours, you will meet the deductible no issue this year. When is your plan year up? Is it 1/1? If you think of it, you're only increasing your premiums for Oct-Dec then, and meeting your deductible. It will most likely be less than meeting DH's deductible and yours.
Is there a reason you are separate? I would look into all going on one plan for the upcoming year. Usually once you had more than one dependent premiums are a "family" rate, unless there's a difference for not having a spouse. You can also drop baby off yours and put on DH's at the next enrollment period as well.
I'd be happy to help you look at things in detail regarding premiums and deductibles if you'd like.
When does your insurance plan restart for the year? January? Mid year?
Also, are you coming up on open enrollment for you or your H towards the end of the year? You could always add to your plan through the end of the year then switch for next year, depending on your open enrollment and coverage cycles.
I’m told most hospitals should give an estimate of total costs based on insurance plans, but we all know an estimate is just that - an estimate. I’m personally choosing the “ignorance is bliss” standpoint and looking at said estimate, but expecting the final bill to be more $$. I’d rather over estimate in my head and be pleasantly surprised if I’m wrong than under estimate and be shocked at the final cost.
Your plan has a MOOP (maximum out of pocket). You will most likely meet your individual MOOP when you have the baby (your hospital treatment, room and board, all medical services L & D). You can call your insurance carrier and find out how much $ you have to spend to meet your MOOP. That will most likely be what you will owe for your birth for yourself. Once you meet your MOOP all of your services are covered at 100% for the rest of the year. Now comes baby's services. This will apply to baby's insurance on their own deductible. They will also have a MOOP limit, so you can at least budget to pay that full MOOP, though it probably won't be that expensive.
I would compare the individual MOOP on your plan and your husbands to determine which is lower and then add the baby to that plan. Also compare what the "inpatient hospital" benefit will be. His may be a flat copay where your plan may be subject to the full deductible.
You also have an SBC (summary of benefits and coverage) for each of your plans (required by law to be provided to you so ask both of your employers for it). There is actually a cost estimator example on the last few pages and one of the scenarios is the birth of a child. That may help you out as well.
Feel free to message me any private questions, happy to give my insurance knowledge to any mom's with questions. I know it's a scary time when you think about the cost and I'm always happy to give advice
Both of us have plans that give the option of Employee only, Employee plus kids, Employee plus spouse, employee plus family. Employee only is the best option but someone has to carry the kids. He has BCBS and his coverage/cost is better so he carries the kids. I ran the numbers and it's more expensive to do all of us on one plan vs me on a separate plan. Our family deductible would be way high. I'm the one with more medical expenses in a given year, so I meet my deductible and don't need to meet the family deductible.
I'm good with numbers (accountant) but the complications of insurance companies drive me crazy!!! For my previous births I think I've managed to pay about $3-$4k OOP total. Usually $2k for OB prenatal care and then since I've met my deductible I pay about 10% of L&D. So around $20k for L&D. Problem here is I have no idea what the breakdown was for me vs baby. The prenatal care is obviously for me but the L&D I don't know how much of the ~$20k was for each.
Assuming a healthy baby, this baby will go on DH's plan next year. Most visits will be well-visits 100% covered by insurance.
Regardless of deductible, my cost for delivering the baby is $500. I am pretty sure that is just the cost of my being admitted into the hospital per my insurance. Maybe the other cost is never an issue because I always hit my 'share' of the deductible by the time I deliver.
But I would imagine the cost would be into the tens of thousands of dollars, so I'd assume you would hit the deductible on your husband's side, and would compare that to the increase in your premium.
This isn't really what you asked, but is it not less expensive for you all to be on the same plan? Tell me to mind my own business if you want. I'm just curious.
They also sent me information on pregnancy and birth coverage once they started seeing claims from my OB and ultrasounds.
BUT not all insurance companies are so forthcoming...
Are you close to meeting your individual deductible or the family deductible? Because the baby won’t apply to your deductible once they’re born - they have their own deductible to meet and then there’s also a family deductible (unless you have a plan that is family deductible/OOP only). I would also check with your insurance company to see what baby’s coverage looks like once they’re born.
Literally everything they do for/to baby is billed to them as an individual patient. From the time they’re out, they’re their own person and their care is no longer bundled into mom’s. So hearing tests, heel stick, vitamin K, newborn check, circ (if applicable), room and board, etc for baby is all applied to them. And it’s important to note that there will be multiple providers billing your insurance company - the hospital, the pediatrician that does the newborn check, the lab that processes their blood work, the group that performs their hearing test. It’s not bundled into one, so you could be receiving bills for multiple providers for months. Also remember that the EOB you get from your insurance company stating that “you may owe this provider x amount of money” isn’t a bill. It’s just a statement explaining that the provider billed your insurance company a certain amount and the insurance company paid the provider the ECR minus any deductible/coinsurance/copay that you’re responsible for, and the difference is x dollars so you might owe that amount to the provider. Don’t panic about costs until you receive an actual bill from the provider who performed the services.
I know now that a large number of employers will not allow an employee to add their spouse to their plan if the spouse has access to health insurance through their company, or they charge an astronomical monthly premium if they will allow it, so I would reach out to your husband’s HR for information on that if you’re wanting to go on his plan.
I would personally not put some of the kids on one plan and some on the other. There’s no sense in paying a higher premium for a couple of months worth of coverage.
The hospital can give you a rough estimate of your cost for the baby based on their ECR (estimated contracted rate) for an uncomplicated newborn stay, but it’s important to remember that it’s a VERY rough estimate because there’s no telling what complications could arise or what additional services might be needed.
Since I switched jobs, now I carry the kids on my plan. I paid $600 OOP for the part due to my OB for prenatal and labor and delivery costs already, and I think 3.0's charges will be around the $1.5k mark again this time. I have an HSA again, and I'm honestly not too worried about the costs since I put the OOP max into the HSA every year, so no matter what ends up happening cost-wise, it won't ultimately be a hit to our bottom line since that money is already in savings.
I would say whomever has the lower deductible on a family plan generally works out best, but get all the info you can. We had an ER visit for my husband this year, and multiple ultrasounds bc i'm old AF, so we hit our deductible in April, lol.
The only advice I can think to give is to make sure he hospital knows up front (and keep reminding them if you need to) that baby will go on your husband’s insurance. The hospital we delivered at assumes baby goes on mom’s plan if you don’t tell them where to bill so much of the initial bills were sent to my insurance and kicked back since we didn’t add her there. Lots of fun phone calls followed to get everything untangled.
Similar situation to you. Both DD and this babe will be on DH’s plan as I have free health insurance for just me with my employer. If I add people to my plan the cost goes from zero to a lot, so there is no reason for me to be switch to DH’s plan or add anyone to mine.
I honestly don’t really remember offhand the numbers for DS’s birth, but would have to look it up on my charts later. I have no clue what the final bills were from the hospital and all the doctors, but I want to say that I paid about $400 for DS’s bills, and a little under $1000 for mine.
Not sure what it will be for me this time since I’m on different insurance now, but I know that as of today I only have like $800 left in my individual out of pocket max, so my bills won’t exceed that (minus any other prenatal care that I pay for before October). Not sure what baby’s bills will be, but after I hit my out of pocket max, there will only be like $1200 left on the family
out of pocket max, so I know it won’t be more than that either.
That reminded me, even though I had amazing insurance the first time around, they initially denied my claim (talk about utter panic moment when that $14k bill showed up). Apparently the hospital didn't send them my admissions forms, and that amounted to no prior authorization (insert eyerolls here). Keep calling and keep being a thorn in their side (both the hospital and the insurance company) if you have questions or concerns. It took me forever, but I finally got to talk to a person with a soul at the insurance company and they straightened things out. Prior to getting that person, I couldn't even get the hospital to talk directly to my insurance and vice versa. When you do get that person with a soul, get their name, direct line, everything. They are worth it.
TTC since 2016
Due: October 12, 2018
Location: Ontario, Canada
We we got lucky that both pregnancy fell entirely within one colander year so our deductibles/out of pocket never reset.
Me 32 and DH 40
Fur-baby named Bella
1 MC Nov. 2013
DD born Nov. 2, 2014
Little 2 EDD Oct. 1