Having a baby -- [PPACA]

Non-investing personal finance issues including insurance, credit, real estate, taxes, employment and legal issues such as trusts and wills.
Post Reply
Topic Author
boglerocks
Posts: 675
Joined: Sun Apr 03, 2011 9:08 pm

Having a baby -- [PPACA]

Post by boglerocks »

My wife and I are California residents but we would like to have a baby in Hawaii. We're both 32 with no health insurance. I'm self-employed and my wife works for me. We've lived in Hawaii before and I remember Blue Cross Blue Shield and Kaiser are the only choices. BCBS requires waiting 12 months after signing up before maternity is covered and Kaiser doesn't cover maternity there at all. Doesn't [the PPACA] make maternity coverage mandatory in 2014? If so, is that the 1st of the year?
Grt2bOutdoors
Posts: 25617
Joined: Thu Apr 05, 2007 8:20 pm
Location: New York

Re: Having a baby -- Obamacare?

Post by Grt2bOutdoors »

boglerocks wrote:My wife and I are California residents but we would like to have a baby in Hawaii. We're both 32 with no health insurance. I'm self-employed and my wife works for me. We've lived in Hawaii before and I remember Blue Cross Blue Shield and Kaiser are the only choices. BCBS requires waiting 12 months after signing up before maternity is covered and Kaiser doesn't cover maternity there at all. Doesn't Obamacare make maternity coverage mandatory in 2014? If so, is that the 1st of the year?
Don't know the particular rules, but from looking over your past postings you state you have $750K+ in CD's! :moneybag Don't work on starting a family until you get health insurance. :oops:
"One should invest based on their need, ability and willingness to take risk - Larry Swedroe" Asking Portfolio Questions
User avatar
zebrafish
Posts: 531
Joined: Sat Nov 24, 2012 9:28 pm
Location: Inside the tank

Re: Having a baby -- [PPACA]

Post by zebrafish »

Why wouldn't Kaiser cover maternity in Hawaii?

As far as I know, they do.
Topic Author
boglerocks
Posts: 675
Joined: Sun Apr 03, 2011 9:08 pm

Re: Having a baby -- [PPACA]

Post by boglerocks »

Don't know the particular rules, but from looking over your past postings you state you have $750K+ in CD's! Don't work on starting a family until you get health insurance.
That's what this thread is about. :) We haven't had health insurance because we've been traveling and haven't lived in the US in awhile.
Why wouldn't Kaiser cover maternity in Hawaii?
They confirmed on the phone in 9/2011 that none of their plans in Hawaii offer maternity coverage.
User avatar
White Coat Investor
Posts: 17338
Joined: Fri Mar 02, 2007 8:11 pm
Location: Greatest Snow On Earth

Re: Having a baby -- [PPACA]

Post by White Coat Investor »

Why not just use less than 1% of your net worth and pay cash?
1) Invest you must 2) Time is your friend 3) Impulse is your enemy | 4) Basic arithmetic works 5) Stick to simplicity 6) Stay the course
Topic Author
boglerocks
Posts: 675
Joined: Sun Apr 03, 2011 9:08 pm

Re: Having a baby -- [PPACA]

Post by boglerocks »

Why not just use less than 1% of your net worth and pay cash?
Well, if we can get insurance that covers maternity, it will be much cheaper. Plus I read online that having a baby can cost as much as $250k in the US. Of course that would be a catastrophic event but those things happen.
Grt2bOutdoors
Posts: 25617
Joined: Thu Apr 05, 2007 8:20 pm
Location: New York

Re: Having a baby -- [PPACA]

Post by Grt2bOutdoors »

It can cost up to $250K to raise a child from birth to age 18. Can it cost $250K to give birth to a child? Perhaps, but that is if you have a premie or newborn with multiple conditions. Get the health insurance for your wife, use some of that cash now, delaying because your waiting for some government policy to come into existence is foolish.
"One should invest based on their need, ability and willingness to take risk - Larry Swedroe" Asking Portfolio Questions
livesoft
Posts: 85971
Joined: Thu Mar 01, 2007 7:00 pm

Re: Having a baby -- [PPACA]

Post by livesoft »

It can cost $20 co-pay to have a baby.

To raise a child from birth to age 18 can cost about $1,000 more than you would have to pay without a child.
Wiki This signature message sponsored by sscritic: Learn to fish.
User avatar
dm200
Posts: 23214
Joined: Mon Feb 26, 2007 1:21 pm
Location: Washington DC area

Re: Having a baby -- [PPACA]

Post by dm200 »

zebrafish wrote:Why wouldn't Kaiser cover maternity in Hawaii?

As far as I know, they do.
That puzzles me as well. I did check Kaiser individual coverage in Hawaii, and (from the web sites I looked at) that Kaiser does not cover maternity in Hawaii.
Leesbro63
Posts: 10581
Joined: Mon Nov 08, 2010 3:36 pm

Re: Having a baby -- [PPACA]

Post by Leesbro63 »

boglerocks wrote:
Why not just use less than 1% of your net worth and pay cash?
Well, if we can get insurance that covers maternity, it will be much cheaper. Plus I read online that having a baby can cost as much as $250k in the US. Of course that would be a catastrophic event but those things happen.
But if you get coverage after knowing about the pending claim, isn't that the opposite of how insurance is supposed to work?
fulltilt
Posts: 271
Joined: Thu Dec 01, 2011 1:23 pm

Re: Having a baby -- [PPACA]

Post by fulltilt »

Grt2bOutdoors wrote:It can cost up to $250K to raise a child from birth to age 18. Can it cost $250K to give birth to a child? Perhaps, but that is if you have a premie or newborn with multiple conditions. Get the health insurance for your wife, use some of that cash now, delaying because your waiting for some government policy to come into existence is foolish.
+1

I personally know someone whose baby had complications and racked up $250K in hospital bills. Luckily, he had good health insurance and he probably ended up paying only ~ $5k.
Walk a single path, becoming neither cocky with victory nor broken with defeat, without forgetting caution when all is quiet or becoming frightened when danger threatens. -- Jigoro Kano
Topic Author
boglerocks
Posts: 675
Joined: Sun Apr 03, 2011 9:08 pm

Re: Having a baby -- [PPACA]

Post by boglerocks »

That puzzles me as well. I did check Kaiser individual coverage in Hawaii, and (from the web sites I looked at) that Kaiser does not cover maternity in Hawaii.
Yep, I confirmed it on the phone a couple years ago. That should change in 2014 though.
But if you get coverage after knowing about the pending claim, isn't that the opposite of how insurance is supposed to work?
Pre-Obamacare? Yes.
Get the health insurance for your wife, use some of that cash now, delaying because your waiting for some government policy to come into existence is foolish.
I don't understand what you're saying. What am I missing?
User avatar
dm200
Posts: 23214
Joined: Mon Feb 26, 2007 1:21 pm
Location: Washington DC area

Re: Having a baby -- [PPACA]

Post by dm200 »

While I have no first-hand experiences with this, I do think it is important to separate and evaluate the various costs and financial risks related to pregnancy and giving birth, as well as what is and is not covered by health insurance.

1. "Normal" pregnancy and delivery. While these costs are not trivial, they are probably very predictable, and unlikely to be "catastrophic". I know, for example, that many loan credit disability policies exclude disability due to normal pregnancy.

2. Pregnancy complications and other medical complications related to pregnancy. I suspect that many of the very expensive and risky conditions may be covered by health insurance. I know that many of these are covered by credit disability policies that do not cover normal pregnancy.

3. Medical costs for child. It is my understanding that the mother's coverage only covers the newborn for a very short period. Then, a policy for the child would kick in and (probably) cover whatever needs the child has. I suspect that coverage would need to be arranged ahead of the birth.

I thing these are some of the details that should be checked out for deciding what policy to get.
scubadiver
Posts: 1193
Joined: Sun May 04, 2008 9:48 pm

Re: Having a baby -- [PPACA]

Post by scubadiver »

scubadiver
Last edited by scubadiver on Sat Jul 11, 2020 11:17 am, edited 1 time in total.
livesoft
Posts: 85971
Joined: Thu Mar 01, 2007 7:00 pm

Re: Having a baby -- [PPACA]

Post by livesoft »

scubadiver wrote:
livesoft wrote:It can cost $20 co-pay to have a baby.
This is a bit misleading.
No kidding. But so are all estimates. I guess we've been lucky. Our insurance has been good. Our kids have been healthy. Our schools have been public. And our neighbors like our kids well enough that they sometimes feed and clothe them. The only hiccup has been that private elite university education. But that does not factor into the cost estimate mentioned earlier since that estimate stopped at age 18.
Wiki This signature message sponsored by sscritic: Learn to fish.
User avatar
Ted Valentine
Posts: 1561
Joined: Tue Jul 10, 2007 10:28 am
Location: Music City USA

Re: Having a baby -- [PPACA]

Post by Ted Valentine »

I googled "obamacare maternity coverage 2014" and the first link says that maternity will be covered by plans under the law.
The new ObamaCare health care law states that health plans offered in the individual and small group markets, both inside and outside of the Affordable Insurance Exchanges (Exchanges), offer "essential health benefits".

Starting January 1st of 2014 the following "benefits" must be included under all insurance plans:

• Emergency services
• Hospitalizations
• Laboratory services
• Maternity care
• Mental health and substance abuse treatment
• Outpatient, or ambulatory care
• Pediatric care
• Prescription drugs
• Preventive care
• Rehabilitative and habilitative (helping maintain daily functioning) services
• Vision and dental care for children
FYI, we had a baby with no maternity insurance in 2006. I notified all of the providers up front and they gave me a "no insurance" price with a steep discount for paying up front. I don't have the bills in front of me, but here is what I recall as the cost for a C-Section:

- OB/Gyn all inclusive prenatal, delivery, followup - $2200
- Hospital - $4500
- Anesthesia - $1000
- 24 week Ultrasound - $150
- Misc lab work - $120
- Pediatrician - covered $15 copay

We had another baby with maternity insurance in 2009 and the cost was within 20% of that without maternity insurance.

The only reason to get the insurance is in case something goes wrong. In our case both C-Sections were essentially problem free for mother and child.
Although our intellect always longs for clarity and certainty, our nature often finds uncertainty fascinating.
User avatar
zebrafish
Posts: 531
Joined: Sat Nov 24, 2012 9:28 pm
Location: Inside the tank

Re: Having a baby -- [PPACA]

Post by zebrafish »

dm200 wrote:That puzzles me as well. I did check Kaiser individual coverage in Hawaii, and (from the web sites I looked at) that Kaiser does not cover maternity in Hawaii.
I stand corrected
User avatar
dm200
Posts: 23214
Joined: Mon Feb 26, 2007 1:21 pm
Location: Washington DC area

Re: Having a baby -- [PPACA]

Post by dm200 »

zebrafish wrote:
dm200 wrote:That puzzles me as well. I did check Kaiser individual coverage in Hawaii, and (from the web sites I looked at) that Kaiser does not cover maternity in Hawaii.
I stand corrected
I am still very puzzled at the apparent total exclusion of maternity coverage by Kaiser in Hawaii. Of course, it makes absolutely zero difference to me, personally, since I am long, long past fathering a child anywhere, and have zero plans to ever move from the Est Coast of the US to Hawaii.
User avatar
semperlux
Posts: 439
Joined: Tue Jan 22, 2008 5:46 pm
Location: Ca

Re: Having a baby -- [PPACA]

Post by semperlux »

I'm going to check with my friend, but she's a Kaiser physician in Hawaii & had her child there. I believe she was under Kaiser insurance at the time since all employees are Kaiser insured.

And according to this web site, looks like maternity care IS covered in Hawaii (scroll down):

http://www.flexab.com/handbook/HealthCa ... overs.html
Jack
Posts: 3254
Joined: Tue Feb 27, 2007 1:24 am

Re: Having a baby -- [PPACA]

Post by Jack »

boglerocks wrote:My wife and I are California residents but we would like to have a baby in Hawaii. We're both 32 with no health insurance. I'm self-employed and my wife works for me. We've lived in Hawaii before and I remember Blue Cross Blue Shield and Kaiser are the only choices. BCBS requires waiting 12 months after signing up before maternity is covered and Kaiser doesn't cover maternity there at all. Doesn't [the PPACA] make maternity coverage mandatory in 2014? If so, is that the 1st of the year?
Yes, the ACA requires maternity coverage for all individual and small group plans as part of "essential benefits" starting in 2014. This requirement does not extend to large group plans for big companies but if they offer maternity coverage, they cannot treat it as a pre-existing condition.

You would be eligible to buy either two individual plans or a small group plan for your business on the Hawaii exchange. You should be able to start shopping for a plan on the Hawaii exchange October 1 for a plan that is effective January 1, 2014. Plans on the exchange are open to all, regardless of current health status and cannot exclude pre-existing conditions.

Added: Here is where you go for Hawaii information -- http://www.hawaiihealthconnector.com/
Last edited by Jack on Sat Jul 06, 2013 7:06 pm, edited 1 time in total.
Topic Author
boglerocks
Posts: 675
Joined: Sun Apr 03, 2011 9:08 pm

Re: Having a baby -- [PPACA]

Post by boglerocks »

And according to this web site, looks like maternity care IS covered in Hawaii (scroll down):

http://www.flexab.com/handbook/HealthCa ... overs.html
Wow, maybe things have changed since 2011. It sounds like it won't matter after 01/01/2014.

Thanks for that info Jack.

[Removed response to prior post (no longer in this thread) --admin LadyGeek]
User avatar
White Coat Investor
Posts: 17338
Joined: Fri Mar 02, 2007 8:11 pm
Location: Greatest Snow On Earth

Re: Having a baby -- [PPACA]

Post by White Coat Investor »

I can't buy a policy on the open market in Utah that covers routine maternity either. It's usually provided by employer provided policies though. The open market policies don't cover routine maternity costs (or have a $7500 exclusion even if your regular deductible is only $3K), but do cover catastrophic costs. So if you end up with a C-section or a kid in the ICU, it'll pay.

My first kid cost $10 (entire pregnancy) due to some nice insurance I had as a resident provided by the hospital, and my second and third were completely free (thanks to the military.)

That's my suggestion. You want your kids free? Join the military!

You should also look into AFLAC.

http://www.pregnancyhealthinsurance.net ... rance.html
1) Invest you must 2) Time is your friend 3) Impulse is your enemy | 4) Basic arithmetic works 5) Stick to simplicity 6) Stay the course
fisher_man89
Posts: 31
Joined: Sun Jan 22, 2012 3:54 pm

Re: Having a baby -- [PPACA]

Post by fisher_man89 »

Insurance is not magic. The reason why some states (like Texas) do not have maternity health insurance is fairly intuitive.

Insurance works by paying the premiums out in benefits, minus administrative expenses and profits.
Only where there are many more insureds paying premiums than insureds receiving benefits, does insurance work well.

But who wants to pay for an open market maternity policy?
Males? Women over 45 or under 14? Women who don't want children?
Only people expecting to collect benefits, so most do collect on private policies.
Therefore the cost of insurance would be close to the cost of a normal birth, except for group policies, where the employer is paying for this benefit for all.
It can only be cheaper under insurance when people are paying for it, but don't use it.

Many regular policies will cover complications from birth, which is the necessary insurance.
So depending on the location you might pay $3-10,000 cash for a vaginal birth.
Paying that much in premiums would not be any smarter for a maternity policy.
This for private health insurance---not the new regulations.

I've found this information on average cost per birth per state informative:
http://transform.childbirthconnection.o ... techarges/

It seems where your have a baby changes the cost dramatically, though Hawaii doesn't look out of line with the mainland.
User avatar
LadyGeek
Site Admin
Posts: 95466
Joined: Sat Dec 20, 2008 4:34 pm
Location: Philadelphia
Contact:

Re: Having a baby -- [PPACA]

Post by LadyGeek »

I removed a few posts with political content. See: Forum Policy
In order to avoid the inevitable frictions that arise from these topics, political or religious posts and comments are prohibited.
Wiki To some, the glass is half full. To others, the glass is half empty. To an engineer, it's twice the size it needs to be.
Post Reply