Insurance

polyhymnia23 · January 2013

Hello friends! I am an attorney and work from home (for a firm in New York) part-time. Unfortunately, I do not have the ability to take my wife's insurance benefits (Michigan doesn't allow it and she is a government employee). The cost of insurance is ridiculous and it almost doesn't make sense to pay for insurance when the out-of-pocket would be less expensive. However, I need insurance!

Do any of you hold insurance that is NOT through your employer? If so, do you find it makes financial sense for someone who will be TTC, or should I stick to paying out of pocket when the time comes?

Thanks!

JoySeattle · January 2013

I am self-employed and always have insurance. When not ttc I changed my policy to closer to a catastrophic plan (high deductible, but still had doctors visits included at a co-pay). The month we began ttc I increased my coverage, the reason being that may insurance companies get around the per-existing condition thing by not refusing to cover pregnancy, but refusing to cover delivery if you weren't insured 9 months prior to delivery. Once you have coverage, you can switch to a different similarly plan but if you don't have maternity coverage from the get-go when you get pregnant, it could be tricky. This may be changing with the ACA, but this is what we did as a CYA more than anything.

Best of luck!

2MamazInSeattle · January 2013

Hiya! When I was self-employed I never went without insurance either. Here's a couple reasons (in addition to Joy's points above) I would seek out insurance.

When I first went to an RE I expected to just do IUI but wanted a fertility check as I was 40 (follicle count, AMH, etc.). I had been watching a "mass" on my right fallopian tube for years so we looked at that too...well, the HSG procedure proved that my right tube was blocked, and the left one wasn't great either. Enlarged tubes (I learned from my RE) cause miscarriage about 70% of the time, so my RE would not move forward with our IVF treatment plan until I had my tubes surgically removed. Which is where the insurance came in handy - removing my tubes was "medical" and not a fertility treatment - the surgery would've been $30K+ out of pocket, but was covered by insurance as the removal of a 'mass.'

Second, along those same lines, a lot of drugs used during fertility treatments are not actually classified as fertility drugs. If a plan excluded fertility treatments, you may still get coverage. So, for example, the estrogen patches I slap on every 2 days would run me about $600 out of pocket per month, but are seen as "hormone treatment" and not considered fertility drugs - so even a plan that didn't cover fertility treatments would possibly cover some of your meds. I know other bumpies had this experience with Lupron, for example.

So, there could be some good cost benefit to having insurance regardless of it's inclusion of fertility treatment or not, as you just never know. I thought we'd do a few IUI's and I'd get knocked up easily. We ended up having my tubes out first, then having to do IVF and use an egg donor to boot! Not the "simple plan" I envisioned at all.

Last thought - in WA where I live, there are non-profit insurance brokers who help you navigate the available plans to individuals within the state. I used one when I had my own business and it was awesome! She narrowed down 5 best options for me after an extensive interview, my health/doctor habits, etc. and helped me see how spending another $10/month gave me massively better coverage with one provider over another. So, you may want to look into what is out there in that regard in your state. It was free to me and a huge help!

Hope that helps a little! Best of luck TTC!!!

JGY · January 2013

One quick additional note, and this is just top of mind for me based on a conversation I happened to be a part of about an hour ago.

Anything can happen, and you just never can predict with any accuracy what you might need with these kinds of things. So make sure to also look into insurance for the potential Baby when the time comes. We are just right now working on figuring out whether our little guy can go on my Wife's insurance (I am currently on her plan as a DP in MN), even though he won't legally be her child until 2nd parent adoption is finalized. I have the luxury of being able to insure him through my work as well if necessary, but I would ABSOLUTELY want to have that figured out prior to his birth, as a NICU stay can cost around $50k a DAY! I don't know anyone that can afford that kind of a bill OOP.

Perhaps I'm missing some critical info., again we're only just starting to look into that stuff and I'm not 100% positive whether that kind of bill gets paid for from Mom's insurance or baby's, but either way it's definitely a reminder to have a solid plan in place.

Good luck!

polyhymnia23 · January 2013

Thank you for all of your input. Crazy thing happened today: The Michigan Supreme Court ruled that it is not the State's business to mandate who can and can not share benefits. With that said, they struck down the law that banned it. My wife is a State employee and although her Union doesn't expressly state that she can cover me, Michigan has at least given us a little leeway into requesting that I can be covered.

I know it is tax heaven for the State, but it would be nice just to have insurance and not have to come up with $300 a month. I am self employed and my work is not consistent, so this is at least a little hope for us.

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