Pregnant on high deductible insurance plan — The Bump
2nd Trimester

Pregnant on high deductible insurance plan

I have searched the message boards and most of the posts where people discussed this topic are a from a few years ago and the posters are no longer using this site.  Has anyone on here had a baby on a high deductible plan or currently pregnant on a high deductible plan?  I am trying to estimate my future costs and am finding it difficult.  I'm looking for others to discuss this topic with, especially now during open enrollment.  I know every pregnancy is different, but just to give you an idea I am at 18 weeks and so far have spent $1675.19 out of pocket.  I am posting this on the second trimester board because that is where I am at in my pregnancy and I didn't really see a message board for budgeting, medical expenses, etc.

Thanks,

Heather

Re: Pregnant on high deductible insurance plan

  • The max out-of-pocket cost should be the max you should expect to pay, I think. I would definitely plan to pay your full deductible. Because you'll presumably still be pregnant in 2017, you'll probably need to pay the full deductible again before your insurance starts paying in the new year.
    DD1: June '16 DD2: March ‘19 :::: Married since 2011 :::: USN Wife ::::
  • Mine is $1k... I haven't even come close yet (I guess my insurance still covers a lot of prenatal care). But, my baby is due 4 weeks after my new plan year starts... So I'll probably hit my $1k deductible with my prenatal care, then have to pay another $1k when baby comes.
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  • I have no regrets about choosing the high deductible plan for this year.  I did the math and figured out if I chose a more expensive low deductible plan and I went into catastrophic coverage I would only save $700.  Even with the pregnancy in 2016 I will meet my deductible, but not go into catastrophic coverage.  However, I'm on the fence for next year.  My premiums have gone way up since the affordable care act went into effect, so I'm trying to look at the entire bottom line including premiums, not just my copays and expenses.  If anyone else is in the same boat please reach out.  A typical high deductible plan has an annual deductible of $4500 individual and $9000 family for in network.  The max out of pocket is $5950 individual and $11900 family including deductible.  So next year could cost me anywhere from $6000-12,000 plus what I spend this year depending on what happens.  Just wondering if anyone had already been there and if they were at the lower end or higher end?  
  • I had my DD on a high deductible plan, and I still have one now and am pregnant again.  Do you contribute to an HSA?  They are great and carry forward year to year, so it's wise to put as much as you can afford to in there for future expenses (you never lose it like an FSA, it follows you for life, as it is attached to your SSN and not your job).

     

    Anyway, my plan (covered me and DH pre-DD, and then added DD when she was born in June) had a $3,800 deductible and a $5,700 out of pocket max (assuming all of the expenses were in-network, which they were).  After hitting the deductible, we paid 20% of normal expenses and 10% of maternity until the out of pocket was met.  We never hit the out of pocket max that year.  Obviously we did hit the deductible (I mean the epidural alone cost $6k, but I was in the 10% portion of the plan by that point, and it was the best $600 I ever spent).  So we paid for most of the pregnancy (including the anatomy scan), the delivery (went into labor on my own, vaginal delivery with epidural), my follow up appointments, and DD's doctor appointments for the first 6 months without hitting the out of pocket max.  DH wasn't at the doctor much that year, it was mostly me and DD.  We had more than the out of pocket max in our HSA so that covered everything.  I'm now due in June again.  I assume we'll have roughly the same situation this time, though DH might have to have some knee surgery, so I expect we'll actually hit the max next year.  Of course, if I need a C-section or to be induced, or this baby comes early and requires extra testing, etc, that cost could be higher, but you can't really plan for that.  we rolled a lot of HSA balance forward this year because we didn't have many expenses, so at least we'll be able to cover costs with money we've already saved.

  • Yes, I have about $14,000 saved in my HSA so I know that will help.  Thanks for the info.  I'm glad everything went smoothly for you the first time around.  I looked at my open enrollment carefully today and decided to go with the bronze plus instead of the bronze because the maximum out of pocket was not as crazy, but it is still considered a high deductible plan so I can take advantage of the HSA and the FSA.  My sticker shock is not as bad now.  
  • Mine is $2500 and 100% after deductible. DH plans would have been $2500 and only 70% covered after. 

    I was pretty excited until I realized My pregnancy is split between two years... 
  • Yes, I owe my max out of pocket cost for each pregnancy, which is $5k. To offset it somewhat, I choose the max for my health saving account that year which is $2600. 

    DD1 born 5/24/10.

    Missed M/C at 14 wks Feb 2012.

    DD2 born 5/14/13.

    Missed M/C at 9 wks July 2015.

    Expecting someone new 4/17/17.
  • fbmandy55 said:
    Mine is $2500 and 100% after deductible. DH plans would have been $2500 and only 70% covered after. 

    I was pretty excited until I realized My pregnancy is split between two years...
    Normally, practices bill pregnancy charges as a global charge at the end. So for example my office doesn't charge me for routine care until after I give birth. 

    DD1 born 5/24/10.

    Missed M/C at 14 wks Feb 2012.

    DD2 born 5/14/13.

    Missed M/C at 9 wks July 2015.

    Expecting someone new 4/17/17.
  • MWoodside said:
    fbmandy55 said:
    Mine is $2500 and 100% after deductible. DH plans would have been $2500 and only 70% covered after. 

    I was pretty excited until I realized My pregnancy is split between two years...
    Normally, practices bill pregnancy charges as a global charge at the end. So for example my office doesn't charge me for routine care until after I give birth. 
    My OB charges and sets up a payment plan before she'll start treatment. The hospital bills after the first of the year and it's two (minimum) separate charges, one for me and one for LO.

    Baby Birthday Ticker TickerBabysizer Geeky Pregnancy Tracker
  • Mine is 0% coverage to $1,500, and 80% coverage till $5,000. With my last pregnancy it cost around the full 5,000 out of pocket -- 30,000 or so before insurance for just my hospital stay, but I had complications and a week long hospital stay. From looking at things, id guess my out of pocket will be closer to 3,000 this time around if I have no complications and am in and out in a single night stay. 

    Not sure exactly what your question is?? As far as budgeting goes: Hospital billing is usually quite willing to work with you, min amount payment plans, financial assistance/bill deduction if you prove certain income for family size.

    And prices: I know it's rare, but the hospital I'm going through this time has every single procedure and price listed in a document on their website.  From a blood draw to a vaginal vs c-section birth. Maybe call and see if the hospital you are going through has something similar if you'd like to get a general idea for costs. 
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