Insurance Headache!

jlgriff11 · December 2015

I just wondered if anyone on this board knew a great deal about insurance, Obamacare, Medicaid, or CHIP?

Here's our problem. Hubby and I both currently work for the same employer. We are both offered insurance, but choose to cover ourselves individually, instead of through a employee+spouse plan. So I take my work's individual insurance plan, and he takes our work's individual insurance plan. We must change/keep our insurance by the first of the year to take effect, so we're in a time crunch to decide what we're going to do.

Here's the dilemma. And I apologize in advance that this is long, but I'm spending a lot of time stressed out about it and at least venting may help.

Right now we each pay around $90 each paycheck (bi-weekly) for each of us- amounting to about $360 a month in insurance premiums. Totally doable. The problem is, though, that I'm pregnant with twins. I could be put on bed rest basically at any time, could deliver early, could have babies in nicu for an extended period of time- I know these are all "maybe" but I expect I'll eat through my 12 weeks of FMLA long before I'm ready to. If I keep my insurance now, on the traditional plan, it's a $1,000 deductible, and a $5,000 out of pocket max. While I'm on maternity leave I'll be expected to either pay ahead my insurance premium or pay it all in a lump sum if/when I come back to work.

So then we thought, well, we'll just have my husband cover me on his plan so I don't have to worry about prepaying my 12 + weeks of non-working. So we thought we'd do a high deductible plan ($3,000) for both of us- and instead of paying $360/mo, we will pay about $400 paycheck (amounting to $800 a month) for the two of us. Still doable with two incomes, but a bit steep for my taste.

The real problem I'm having is once the babies are born, our premiums increase again. My husband would have over $650 taken out of each paycheck (every two weeks) for insurance for himself, me, and the babies. That's over $1,300 a month for a family of four with a $6,000 max out of pocket.

But what if I don't go back to work because I can't afford childcare or the babies are sick or because there are two of them and maybe I just want to stay at home? I don't know that I can qualify for Medicaid if my husband works at a job that offers us insurance, but $1,300 a month without two incomes (even with two incomes, that's absurd) would break us in half.I don't mind learning a budget, but I'm just so stressed about it. Everything on healthcare.gov says that we make too much money combined, which is obvious, but even if I buy private insurance with a lower monthly payment it's still a $10,000 + deductible.

While I want to be a SAHM I don't want it to be because it's the only way we'd be able to afford insurance. That just makes me feel like I'm playing the system. Is anyone else struggling with this right now? I'm so torn on what to do, and research is just making my head hurt.

megstervt · December 2015

I don't really have anything to add. You seem to already know my limited knowledge, but I get how stressful and overwhelming it is. I think if you are already interested and WANT to be a SAHM then this wouldn't be the only reason. Insurance is real, and expensive. It's a financial decision, you wouldn't be the first parent to stay home because it financially made more sense (not just insurance, but transportation to work, daycare cost, work clothing budget, etc etc).

acn5028 · December 2015

I hope you decide to do what is best for you and your family but I do understand the financial strain... mine is more on the side of daycare which is going to go up over $2k/month for 2 kids come July...

So my recommendation for now is to stay on separate plans - saving that $440/month that you would save each staying on the individual plan. THEN when it comes time to be out of work on leave you can easily pay your 3 months of benefits premiums and just have your husband add the twins to his policy AND IF you decide not to go back to work they will terminate your insurance and then you can jump on your husbands insurance (that is a qualifying life event) so then he would be insuring you and the twins as well at that time but it doesn't make sense to switch to one plan if you can save the money over the next 6-7 months... and only increase your premium when you ultimately need to.

Insurance sucks no matter how you slice it... and the costs have gotten outrageous so I do understand your concern. Hope this helps & congrats on your twins !

netsirk2013 · December 2015

Most states kids under 18 are 100% covered through medicaid. If you are pregnant they will cover you. So lost of insurance due to bed rest you could use medicaid. The fine for next year's Obama care for not having insurance is less than your premium now. (685 I think I read), but you can hop on your husbands. Both kids can be on medicaid. They have income based programs if you are over the limit for care. Each state is different, but as long as we make under 65,000 my son and this baby will be covered.

jlgriff11 · December 2015

So you can cover both children through Medicaid, if I'm not working, and just have my husband cover the two of us? I guess I just thought Medicaid was only available if there is no insurance provided through employment?

I don't know why it never occurred to me to just pay the damn three months which will be a LOT less than paying an extra $400 a month for us both to be on one policy.

IB113 · December 2015

So I don't have an answer about this, but before you do anything w/r/t changing your insurance, you should look into what the state requirements for medicaid are and/or confirm that you can be added to your husband's policy after a leave of absence. States vary widely on this and many have very minimal coverage, and then with very strict income limitations. Get written confirmations about things before you cancel anything or change anything lest you end up getting screwed because you didn't have the right or correct information.

oandmplus1 · December 2015

I think there are certain criteria for medicaid. I don't think you can just get it because you don't have insurance, especially if insurance is available through a spouse's employer.
Usually there are income requirements or medical diagnosis that qualify, but I could be wrong.

fantasticmrsfox · December 2015

You can get State insurance even if your spouse's job offers insurance. DH's job does, but DS has been on state insurance since he was born because that's what we can afford, and I just got on it too since losing my previous insurance. It really pays to look into it!

netsirk2013 · December 2015

Every state is different. I'm in NH and they will cover your pregnancy and the kids. Once you are nolonger pregnant you should look into hopping onto your husbands. If you were both working- many medicaid programs (my state anyways) will still cover the kids with you paying a %. Normally much cheaper than a work family plan offered. Apply and see what happens. You never know, there may be more that you qualify for to help relieve you. Twins are alot and the first year with a new child is the hardest on our wallets. We don't qualify for anything except my sons insurance and myself for temporary coverage. My husband averages about 45, 000 a year- we are lucky- but he's not offered insurance through work and the marketplace is insane. So maybe we are crazy for being uninsured, but the fee is still less than the cost of insurance. We take the hit

BostonBaby1 · December 2015

Do you have an HR department? Can you consult with them?

jlgriff11 · December 2015

I do, and she is great, I spent an hour with her, but she just tells me how the work plan isn't that bad, how many work plans are worse, and encourages me to stay working. They also can not talk to me about Medicaid and how it works, or other options, only our insurance plan. I know I should talk to a actual professional and not a bunch of moms on the internet, but I figured I couldn't be the only person stressing about insurance, and even some suggestions may point me in a direction I hadn't considered or thought of.

The problem is everyone (professionally) is really just trying to sell you their product. There's not many out there who are advocating for the consumer, so I'm trying to be proactive as I can and do my research myself.

Hence asking you ladies.

BostonBaby1 · December 2015

It does seem very difficult. I'm sorry I can't be of any help :-(

juliagulia38 · December 2015

Last pregnancy, DH had insurance through work for all of us. I got Medicaid also and they paid for certain things. I might be wrong, but I believe if you are pregnant Medicaid can't turn you down. I've always been on Medicaid during pregnancies. I haven't looked into it this time yet. The kids were automatically put on CHIP too once they were born.

AGaskins13 · December 2015

I am also having problems with insurance. I did not add myself to DH's plan fast enough after our wedding and this was a critical error (the grace period was 31 days and we tried to add 45 days out). My work also won't let me add the offered insurance as it has been too long since a life changing event has occurred and I denied the insurance upon initial hire three years ago because I was still covered under my parents. In September I was in a car accident and luckily it was not my fault as I broke my wrist and the medical bills have totaled over $1200. So with the help of a friend I applied for Medicaid last week and am still waiting to hear back. We live in Ohio and because both of our jobs won't let me add until open enrollment (February) I am hoping to be approved for Medicaid. I agree with @juliagulia38 I am pretty sure they can not deny Medicaid to a pregnant woman with no other option for insurance. Good luck insurance is a huge hassle and such a huge necessity.

taboullio84 · December 2015

jlgriff11 said:
So you can cover both children through Medicaid, if I'm not working, and just have my husband cover the two of us? I guess I just thought Medicaid was only available if there is no insurance provided through employment?

I don't know why it never occurred to me to just pay the damn three months which will be a LOT less than paying an extra $400 a month for us both to be on one policy.

You can be on Medicaid and have insurance if you qualify. Children are usually picked up if you make under a certain amount. I had it with my first child. Thankfully though we don't need it now , but it was a life saver then.

Croscrew · December 2015

Another thing to consider is your income and your hospital bills. I sometimes feel like a jerk for doing it since we are not anywhere near homeless, but our income puts us below most hospitals "poverty" line (and we both have master's...don't get me started). Our DD eye surgery was about $5000 and we applied for assistance and they wrote off 30%. Same thing happened when she was born and that hospital stay. High deductible plans will save you money in the long run, but only if you can afford the high cost at first. Good luck on your decision!

kja2011 · December 2015

Look at your state's Medicaid website. It is possible for your babies to qualify based on your husband's income, even if private insurance is offered. I see this all the time at my job.
CHIP may also be possible, but has more qualifiers (but goes to a fairly high income as well).

Where I could see it being trickier is if you work up until the twins are born. You might need your no income to qualify for Medicaid, and if you are still employed until birth, might be hard to get retroactive coverage to cover hospital fees.

Do you have a county health department? They usually have Medicaid/CHIP enrollment specialists to help to navigate the process (vs you work's HR)

Good luck!

ceillyang · December 2015

From my understanding of insurance, if your family deductible is $3,000, then it's really $1,500 per person which is higher than your current plan. Typically people only pay a higher premium because they want a lower deductible.
In regards to Medicaid, you might qualify but it's based on income and house hold size. You should be able to check online to see if you qualify, and for what, and for how much.

pourmeanothermocktail · December 2015

I got in touch with an assistant/agent at Walmart of all places that helped DH sign up for an Obamacare plan with a subsidy because he doesn't make much $, and then me & LO onto medicare. She was very helpful and it didn't cost a thing to meet up with her and go over things. She literally had a table set up near the check outs at our local Walmart.

kepsmom · December 2015

We have been frantically researching on the marketplace for the last week. One thing you need to keep constant track on is if your doctors snd the hospital you want to deliver in are in-network with the plan you choose! My husbsnd has carried our insurance always and this year the premiums rose to over a thousand monthly, double what we've paid in past with doubled deductible too. Make time to call your doctors and ask ehat plans they do accept or which ones they don't.
We think we have settled on a high premium low deductible because after the math: premium (for son and me) x 12(months) + max out of pocket induvidual (pregnancy, baby delivery rough estimate) + husbands work insurance = a thousand dollars less than about 10 different combinations of who's covered with who and the cordinating MOP and premiums. I have 2 more calls today to get a quote on premiums for adding the baby and a more detailed list of things that are covered while pregnant (breast pump, ultra sounds, lab work, etc.)

I wish you luck! Be detailed, think it through, and think out of the box to get the best deal. We have very low income, basically just the husbands because mine is under $500 a month which half goes to preschool tuition and then groceries. And the high premium is going to suck, but compared out it was the lowest dollar amout over the whole year. Let that mommy instinct drive you for the details!!

stephweinstein · December 2015

Be as thorough as possible. I had a high deductible plan with my first son. Our medical bills were significant because I had a C-section and my son was in the NICU for about 6 days. Because we had selected the HD plan we had to pay the family out of pocket max before my 90/10 coverage kicked in. We paid well over $8,000 for the birth of my son and for his care and mine afterwards. Especially with the high likelihood that because you are having twins you may have a c-section and your children may spend some time in the NICU I'd advise you to consider not taking a high deductible health insurance plan.

stephweinstein · December 2015

netsirk2013 said:

Every state is different. I'm in NH and they will cover your pregnancy and the kids. Once you are nolonger pregnant you should look into hopping onto your husbands. If you were both working- many medicaid programs (my state anyways) will still cover the kids with you paying a %. Normally much cheaper than a work family plan offered. Apply and see what happens. You never know, there may be more that you qualify for to help relieve you. Twins are alot and the first year with a new child is the hardest on our wallets. We don't qualify for anything except my sons insurance and myself for temporary coverage. My husband averages about 45, 000 a year- we are lucky- but he's not offered insurance through work and the marketplace is insane. So maybe we are crazy for being uninsured, but the fee is still less than the cost of insurance. We take the hit

Be wary of this. Your insurance may not consider the end of your pregnancy a qualifying event to terminate the plan.

jlgriff11 · December 2015

stephweinstein said:

Be as thorough as possible. I had a high deductible plan with my first son. Our medical bills were significant because I had a C-section and my son was in the NICU for about 6 days. Because we had selected the HD plan we had to pay the family out of pocket max before my 90/10 coverage kicked in. We paid well over $8,000 for the birth of my son and for his care and mine afterwards. Especially with the high likelihood that because you are having twins you may have a c-section and your children may spend some time in the NICU I'd advise you to consider not taking a high deductible health insurance plan.

The high deductible health plan has a max out of pocket of $6,000 for a family, but our traditional $1,000 plans have a max out of pocket of $5,000 per person. Our traditional plan has a FSA, but does not include co-pays, labs, or scripts toward deductible, but the high deductible plan includes all of that toward the deductible. I could get a HSA with the high, but not a FSA, which I prefer. Anyway, I thought the traditional plan would be beneficial too, a higher premium, but my boss has really pushed me to the high deductible plan since I'll obviously max it out anyway between birth and the twins.

m8881 · December 2015

I don't know what to advise you to do but I just wanted to gripe along with you for a second. Our insurance starts over July 1 and I am due July 7, I'm having my third C-section. We will have already met our deductible and probably some of our out of pocket. If I don't have the baby before July 1 I'm paying the deductible and out of pocket again. I'm praying that I'm a little further along than my initial early u/s indicated because it would save us 4-6 grand to have the baby June 28 or so vs July 1st.

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