Cheap Health Insurance for Pregnancy

[paxprobellum]

My wife and I are planning to have a kid in the next 12 months or so. Unfortunately, she found out today that she is not going to be eligible for health insurance through her job, and getting on my insurance would be very expensive for lame coverage.

As such, we're looking into independent coverage. Unfortunately, we really can't get a 'high deductible, emergency-only' type insurance, since we're banking on incurring >$10k of 'routine' healthcare expenses in the next year (due to the expected pregnancy). Anyone been in this situation, or have suggestions about where to look for insurance?

For the record, we are located in Baltimore, MD.

[Seneca]

I don't really understand why the "emergency-only" coverage doesn't work for you here?

You're looking at $10-15k if it all goes well. If there is an emergency it explodes in cost.

My dad is self employed and insurance was always a challenge. He took a part time job with a grocery store to get insurance for a couple of years.

[RealPerson]

I second Seneca here. I am not sure if you can sign up for any plan at this point, since the pregnancy is a known fact. If you can sign up, I definitely would. Even though that is a high deductible, if there are complications you can incur many times that amount. Also, without insurance you will probably end up paying whatever the charges are. If you have a catastrophic plan, the charges will be adjusted according to the contract. We have such a plan and we have procedures that were adjusted 50% down. That alone can save you a bundle.

Also, I am not sure to what extent pre-existing conditions are an issue when Obamacare kicks in. Even if you can't get reasonable insurance right now, you may be eligible after January 1, 2014.

[paxprobellum]

Hm, I seem to have miscommunicated.

1) Not pregnant yet.
2) Will have insurance of some type
-> a) My work insurance ($395/mo, ~80% health coverage, no dental/vision)
-> b) Independent health coverage
--> --> 1) Since high deductible plans are a 'bad deal' if you plan to hit the deductible limit (especially if you are going to hit it exactly!), I'm looking for a 'semi high to low' deductible plan that has maternity coverage.

In short, I just wanted to know if anyone had a kid using independent insurance - If so, what plan? How much did you end up paying?

As an example, BCBS has a $2500 deductible plan with HSA for $166/mo. If we maxed the deductible on this one, it would be $4492 for the year. That's already less than just the premium on my work's insurance plan.

[Ego]

ACA (Obamacare) Maryland is here:
http://www.marylandhealthconnection.gov/

She is not pregnant yet, right? Not that it matters. In October she'll be able to register and in January she'll be able to buy insurance from one of the Maryland exchange providers. They cannot deny coverage for a pre-existing condition. So if she is pregnant she'll get coverage at the same rate that everyone else her age pays. You may want to choose carefully between bronze, silver and gold plans as the level of copays vary with each. You may want to buy the gold plan for the pregnancy year then change over to a cheaper plan the following year.

[jennypenny]

Since high deductible plans are a 'bad deal' if you plan to hit the deductible limit (especially if you are going to hit it exactly!)

Hmm, I'm not so sure I would make that assumption. I think it can depend on the providers as much as the type of plan. I would look at the details of both plans and consider the following...

1. Look very closely at what counts towards the deductible and OOP limit. When I compared a traditional and HDHP plan last fall (we always hit the deductible), at first blush it seemed like I would pay less OOP with the traditional plan. When I looked more closely, the traditional plan we were offered only counted medical bills toward the deductible, whereas our HDHP counted everything like prescriptions and other things I can't recall now. After I did the math, the HDHP would pay everything after $10K OOP, but the traditional plan would pay everything after about $15K OOP.

2. You have to factor in the baby's coverage. It used to be that the baby was assumed to be on the mother's coverage for the first month, and then you could switch to any plan including adding to yours (is that still the case?). Babies are wildcards in the health department. Even when they are healthy they go to the doctor all of the time (weekly at first I think) and get lots of vaccinations. Check the plans for that coverage also. Most HDHP plans have a zero copay for routine visits and required or medically recommended vaccinations. With our pediatrician, the only visit I pay for is a "sick" visit.

3. Don't forget to factor in the tax break for using an HSA when you have a HDHP. The family limit is $6200 this year (I think) for families. You can put the money in pre-tax. IIRC, you can roll money in from an IRA if you don't use an employer-sponsored plan, but that didn't apply to us so I might have that wrong. If your wife gets on a HDHP for the rest of this year, I think she can put some money into an HSA this year as well. This year's HSA deposit plus next year's might cover most of your deductible with pre-tax money.
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My suggestion would be to have your wife call her OB/GYN's office and ask them what their experience is with both types of plans. They might even have some suggestions for specific providers. I would also contact likely pediatricians and do the same thing. When I called our doctors last year and asked for their recommedations, they were more likely to recommend a specific provider (in our case, Aetna) than a specific plan.

[jennypenny]

I just saw your second post. Our HDHP plan has two limits--the deductible (for us $2600 pp) and the OOP limit. I pay 100% of my medical costs up to the deductible, then I pay 10% of my costs up to our OOP annual limit (for us, $10K). Are you factoring in both limits? Will the baby have it's own deductible on that plan once it's born so you'd have to pay the first $2500 of the baby's bills also?*

I'm not trying to be a downer. I just think you have to add up all of the possible bills assuming a worst-case scenario if she's pregnant, and see which could be the most OOP at the end of the year.

*The baby will have it's own hospital and doctor bills right away, so I'd check and see if the plan you're looking at would have a deductible for the baby's bills. I'd guess it does, which means another $2500 in bills right away.

[Seneca]

Hm, I seem to have miscommunicated.

1) Not pregnant yet.
2) Will have insurance of some type
-> a) My work insurance ($395/mo, ~80% health coverage, no dental/vision)
-> b) Independent health coverage
--> --> 1) Since high deductible plans are a 'bad deal' if you plan to hit the deductible limit (especially if you are going to hit it exactly!), I'm looking for a 'semi high to low' deductible plan that has maternity coverage.

In short, I just wanted to know if anyone had a kid using independent insurance - If so, what plan? How much did you end up paying?

As an example, BCBS has a $2500 deductible plan with HSA for $166/mo. If we maxed the deductible on this one, it would be $4492 for the year. That's already less than just the premium on my work's insurance plan.

I got what you meant.

In case you haven't drilled in to the level of detail, babies are not like heart attacks, so they work a bit different with insurance cos usually. Most friends have told us a normal pregnancy and vaginal birth is in the $10,000 out of pocket range no matter the insurance- I thought this was what you meant. We have a fancy-pants group policy through work and are having our first child in the next few weeks. I maxed out our HSA ($5k in my case, IIRC), which you can use to pay the hospital, and they allow us to borrow against future contributions for the year to pay the hospital's basic delivery fee. Talk to your OB and shop hospitals, there was a significant difference in cost. We also had much bigger copays to the OB/GYN than a normal doc visit.

Look in to exactly what you are getting from your 80% work plan, also ask if there is a yearly maximum (there usually is). Also ask if baby stuff applies to your deductible, and what applies.

Pregnancy can cause very expensive complications for both baby and mother, this is why I don't agree if you spend $10k on a regular delivery, that you necessarily got a bad deal with a catastrophic care policy. You made sure the potential emergency situation was covered regardless.

[paxprobellum]

I'm not trying to be a downer. I just think you have to add up all of the possible bills assuming a worst-case scenario if she's pregnant, and see which could be the most OOP at the end of the year.

I understand I appreciate it!

I just saw your second post. Our HDHP plan has two limits--the deductible (for us $2600 pp) and the OOP limit. I pay 100% of my medical costs up to the deductible, then I pay 10% of my costs up to our OOP annual limit (for us, $10K). Are you factoring in both limits? Will the baby have it's own deductible on that plan once it's born so you'd have to pay the first $2500 of the baby's bills also? ... The baby will have it's own hospital and doctor bills right away, so I'd check and see if the plan you're looking at would have a deductible for the baby's bills. I'd guess it does, which means another $2500 in bills right away.

Yeah, I'm looking at some plans that are 80%/20% (you pay 80% up to deductible, then 20% up to OOP limit), but the plan I was referencing is 100%/0% (you pay 100% up to deductible, then insurance covers the rest. OOP = deductible). HOWEVER -- I didn't know about the "baby has a new deductible" thing. I would imagine I would have to call, but the plan does say the OOP limit is "$2500 for an individual, $5000 for family.", so they probably stack another $2500 on that. Thanks for the info.