Selecting health insurance during pregnancy

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Hector
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Selecting health insurance during pregnancy

Post by Hector » Mon Mar 06, 2017 11:18 am

Wife is pregnant and we are looking for health insurance.
We are going to Kaiser right now and want to continue with Kaiser.

I compared all plans offered by Kaiser and thinking about going with the plan which has the lowest total expense (total premium for remaining 2017 + annual out of pocket maximum for an individual). Annual out of pocket maximum for an individual ranges from $4000 to $6800.

Comment/feedback?

david
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Re: Selecting health insurance during pregnancy

Post by david » Mon Mar 06, 2017 1:33 pm

I think it is a good idea to look at the maximum out of pocket costs for each plan (premium + OOP max). Then, I think it is worth checking to see what the costs would be for different potential coverage situations: 3k, 5k, 10k, 50k, 100k.

Remember, with pregnancy most preventative care is covered with no additional out of pocket cost and this includes all of the major prenatal visits and screenings. This does not change regardless of whether you have a bronze or platinum plan under the ACA. The only major expense you may see (i.e., is not fully covered) is the birth itself.

My wife went with a platinum plan and we never hit the OOP maximum on the plan because the deductible was 0 and the co-insurance was 10% to an OOP Max of 4000. Which, would have meant $40k of medical care before hitting the max. We ended up with a hospital bill that was about 25k, with a negotiated rate of 17%, which means the insurance company portion was less than 5k, and our portion being 10% of that. As such, we did not come close to reaching the OOP max. That said, none of this was with Kaiser, neither my wife nor child had any major complications. The billing dept. let me know that most of the other insurance companies had a negotiated rate of about 50%, which would have turned the 25k bill into a 12.5k bill. 10% of that still did not hit the OOP max. If we would have went with a bronze plan, we would not have hit the 6300 deductible and thus would have paid the 5k negotiated rate. If the negotiated rate was 50% of the rack rate, then it would have hit the deductible (along with the OOP max of 6800).

The premium difference between bronze and platinum plans was about $200 per month ($2xx vs $4xx), so about 2500 annual difference.

So, in my situation it made sense to go for the platinum plan (with 0 deductble and 4k OOP Max) but it may be different in different parts of the country and is certainly different with Kaiser which is its own healthcare silo.

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dm200
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Re: Selecting health insurance during pregnancy

Post by dm200 » Mon Mar 06, 2017 2:00 pm

Hector wrote:Wife is pregnant and we are looking for health insurance.
We are going to Kaiser right now and want to continue with Kaiser.
I compared all plans offered by Kaiser and thinking about going with the plan which has the lowest total expense (total premium for remaining 2017 + annual out of pocket maximum for an individual). Annual out of pocket maximum for an individual ranges from $4000 to $6800.
Comment/feedback?


If you have Kaiser now, and wish to continue - I don't understand why you are "looking for health insurance"?

My wife and I are with Kaiser now, and were with Kaiser off and on (only changed when employer insurance forced change) for 40 years. Never any experience with pregnancy/childbirth - but our then young son was on our Kaiser plans over the years.

We are (and have always been) very happy with Kaiser - both quality of care and costs.

Hector
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Re: Selecting health insurance during pregnancy

Post by Hector » Mon Mar 06, 2017 5:37 pm

dm200 wrote:
Hector wrote:Wife is pregnant and we are looking for health insurance.
We are going to Kaiser right now and want to continue with Kaiser.
I compared all plans offered by Kaiser and thinking about going with the plan which has the lowest total expense (total premium for remaining 2017 + annual out of pocket maximum for an individual). Annual out of pocket maximum for an individual ranges from $4000 to $6800.
Comment/feedback?


If you have Kaiser now, and wish to continue - I don't understand why you are "looking for health insurance"?

My wife and I are with Kaiser now, and were with Kaiser off and on (only changed when employer insurance forced change) for 40 years. Never any experience with pregnancy/childbirth - but our then young son was on our Kaiser plans over the years.

We are (and have always been) very happy with Kaiser - both quality of care and costs.


Job change.
Right now we have employer sponsored Kaiser. New employer does not provide Kaiser.
Difference in premium is not huge;
Monthly premium for adding family to employer sponsored plan considering pre-tax benefits for bronze HSA= 432.17
Monthly premium for getting Kaiser for spouse and kid for bronze HSA = 440.07
Monthly premium for getting Kaiser for spouse, kid and baby for bronze HSA = 591.2
Due date is in July and I do not care about saving (591.2-432.17)*6 = ~950 at a cost of changing doctor and hospital in mid pregnancy.

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dm200
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Re: Selecting health insurance during pregnancy

Post by dm200 » Mon Mar 06, 2017 6:17 pm

Hector wrote:
dm200 wrote:
Hector wrote:Wife is pregnant and we are looking for health insurance.
We are going to Kaiser right now and want to continue with Kaiser.
I compared all plans offered by Kaiser and thinking about going with the plan which has the lowest total expense (total premium for remaining 2017 + annual out of pocket maximum for an individual). Annual out of pocket maximum for an individual ranges from $4000 to $6800.
Comment/feedback?

If you have Kaiser now, and wish to continue - I don't understand why you are "looking for health insurance"?
My wife and I are with Kaiser now, and were with Kaiser off and on (only changed when employer insurance forced change) for 40 years. Never any experience with pregnancy/childbirth - but our then young son was on our Kaiser plans over the years.
We are (and have always been) very happy with Kaiser - both quality of care and costs.

Job change.
Right now we have employer sponsored Kaiser. New employer does not provide Kaiser.
Difference in premium is not huge;
Monthly premium for adding family to employer sponsored plan considering pre-tax benefits for bronze HSA= 432.17
Monthly premium for getting Kaiser for spouse and kid for bronze HSA = 440.07
Monthly premium for getting Kaiser for spouse, kid and baby for bronze HSA = 591.2
Due date is in July and I do not care about saving (591.2-432.17)*6 = ~950 at a cost of changing doctor and hospital in mid pregnancy.


OK, I see now.

Frankly, I am surprised how small the difference is from employer plan to your own on Kaiser.

If you stay with Kaiser, though, wouldn't you want to stay for the whole year? Maybe (not sure) you may not be able to switch family to employer plan mid-year?

Your situation and experience may be different, but our experience with Kaiser is that there are cost savings from having Kaiser beyond the apparent premiums, copays, etc. In several cases, for example, we do not need to see (and pay for) specialists as much because care is coordinated and separate followups are not needed as often. About half of what, outside Kaiser, would be office visits (and copays) can be done with no charge emails and telephone appointments. Kaiser has just started no charge "virtual" house calls (urgent care) and primary care appointments for some things.

Of course, I believe THE most important factor is what your wife wants to do! Marital "harmony" is worth a LOT! :happy :happy

Easy Rhino
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Re: Selecting health insurance during pregnancy

Post by Easy Rhino » Mon Mar 06, 2017 7:56 pm

So, you changing from employer Kaiser to marketplace Kaiser, is that it? When does the employer insurance end?

And of course, remember, that you won't have to put the baby on the insurance until it's born. I think it gets 30 days coverage under the mom's health insurance.

As mentioned, bear in mind that you may not even be hitting the out of pocket max if the co insurance is generous enough (or if your expenses just aren't that high).

Hector
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Re: Selecting health insurance during pregnancy

Post by Hector » Mon Mar 06, 2017 8:15 pm

dm200 wrote:
Hector wrote:
dm200 wrote:
Hector wrote:Wife is pregnant and we are looking for health insurance.
We are going to Kaiser right now and want to continue with Kaiser.
I compared all plans offered by Kaiser and thinking about going with the plan which has the lowest total expense (total premium for remaining 2017 + annual out of pocket maximum for an individual). Annual out of pocket maximum for an individual ranges from $4000 to $6800.
Comment/feedback?

If you have Kaiser now, and wish to continue - I don't understand why you are "looking for health insurance"?
My wife and I are with Kaiser now, and were with Kaiser off and on (only changed when employer insurance forced change) for 40 years. Never any experience with pregnancy/childbirth - but our then young son was on our Kaiser plans over the years.
We are (and have always been) very happy with Kaiser - both quality of care and costs.

Job change.
Right now we have employer sponsored Kaiser. New employer does not provide Kaiser.
Difference in premium is not huge;
Monthly premium for adding family to employer sponsored plan considering pre-tax benefits for bronze HSA= 432.17
Monthly premium for getting Kaiser for spouse and kid for bronze HSA = 440.07
Monthly premium for getting Kaiser for spouse, kid and baby for bronze HSA = 591.2
Due date is in July and I do not care about saving (591.2-432.17)*6 = ~950 at a cost of changing doctor and hospital in mid pregnancy.


OK, I see now.

Frankly, I am surprised how small the difference is from employer plan to your own on Kaiser.

If you stay with Kaiser, though, wouldn't you want to stay for the whole year? Maybe (not sure) you may not be able to switch family to employer plan mid-year?

Your situation and experience may be different, but our experience with Kaiser is that there are cost savings from having Kaiser beyond the apparent premiums, copays, etc. In several cases, for example, we do not need to see (and pay for) specialists as much because care is coordinated and separate followups are not needed as often. About half of what, outside Kaiser, would be office visits (and copays) can be done with no charge emails and telephone appointments. Kaiser has just started no charge "virtual" house calls (urgent care) and primary care appointments for some things.

Of course, I believe THE most important factor is what your wife wants to do! Marital "harmony" is worth a LOT! :happy :happy


Yes. I was thinking that wife and kids would be stay with Kaiser for rest of the year. I do not think that I can change it before next open enrollment period. Birth is the life changing event, but I am not sure if I can add whole family to my employer then? If so, should I think about moving wife and kids to employer sponsored plan after birth?

Another question: annual out pf pocket maximum apply for calendar year and not 12 month period, correct?

Hector
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Re: Selecting health insurance during pregnancy

Post by Hector » Mon Mar 06, 2017 8:40 pm

Easy Rhino wrote:So, you changing from employer Kaiser to marketplace Kaiser, is that it? When does the employer insurance end?

And of course, remember, that you won't have to put the baby on the insurance until it's born. I think it gets 30 days coverage under the mom's health insurance.

As mentioned, bear in mind that you may not even be hitting the out of pocket max if the co insurance is generous enough (or if your expenses just aren't that high).


Yes. I am changing from employer Kaiser to marketplace Kaiser. My employer insurance ends on March 31st.

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Re: Selecting health insurance during pregnancy

Post by Hector » Mon Mar 06, 2017 8:42 pm

david wrote:I think it is a good idea to look at the maximum out of pocket costs for each plan (premium + OOP max). Then, I think it is worth checking to see what the costs would be for different potential coverage situations: 3k, 5k, 10k, 50k, 100k.

Remember, with pregnancy most preventative care is covered with no additional out of pocket cost and this includes all of the major prenatal visits and screenings. This does not change regardless of whether you have a bronze or platinum plan under the ACA. The only major expense you may see (i.e., is not fully covered) is the birth itself.

My wife went with a platinum plan and we never hit the OOP maximum on the plan because the deductible was 0 and the co-insurance was 10% to an OOP Max of 4000. Which, would have meant $40k of medical care before hitting the max. We ended up with a hospital bill that was about 25k, with a negotiated rate of 17%, which means the insurance company portion was less than 5k, and our portion being 10% of that. As such, we did not come close to reaching the OOP max. That said, none of this was with Kaiser, neither my wife nor child had any major complications. The billing dept. let me know that most of the other insurance companies had a negotiated rate of about 50%, which would have turned the 25k bill into a 12.5k bill. 10% of that still did not hit the OOP max. If we would have went with a bronze plan, we would not have hit the 6300 deductible and thus would have paid the 5k negotiated rate. If the negotiated rate was 50% of the rack rate, then it would have hit the deductible (along with the OOP max of 6800).

The premium difference between bronze and platinum plans was about $200 per month ($2xx vs $4xx), so about 2500 annual difference.

So, in my situation it made sense to go for the platinum plan (with 0 deductble and 4k OOP Max) but it may be different in different parts of the country and is certainly different with Kaiser which is its own healthcare silo.


Somehow I thought that we are likely to hit OOP maximum. Thanks for your feedback.

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Re: Selecting health insurance during pregnancy

Post by Hector » Tue Mar 07, 2017 12:53 am

After reading all responses and thinking over, I am thinking:
Get Kaiser Platinum plan from market place for wife from April to July. premium:513.69
Get Kaiser Bronze plan for kid and me from market place for April and May. premium:445.78
Get non-Kaiser Bronze plan from work for June and July; June is the earliest I can get insurance through work.premium:269.03 after considering pre-tax benefits
Get non-Kaiser Bronze plan for the entire family from work from August; birth event should qualify us to change insurance plan at that point. premium: 566.72 after considering pre-tax benefits

We might not hit annual out of pocket maximum for wife. Even if we do, we would still pay less than what we would pay if we go with insurance that I mentioned in my first post.

Our monthly premium would be.
April, May: 513.68 + 445.78 = 959.46 which is cheaper than COBRA that I will be eligible for after March 31st if I want to continue current health insurance.
June, July: 513.68 + 269.03 = 782.71
From August: 566.72

HIinvestor
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Re: Selecting health insurance during pregnancy

Post by HIinvestor » Tue Mar 07, 2017 3:08 am

I'm just curious about whether all these gyrations are necessary and whether it might be better to just gave one family plan for all of you including the baby until the next open season.

Having a baby is a qualifying event, but I'm pretty sure it's only qualifying for the baby. Please be aware babies have been known to arrive early or late and may require extra care and possible prolonged hospitalization. Don't be penny-wise and pound-foolish in your choice of insurance coverages.

Your HR can give you the materials and info to carefully compare plans so you can make informed choices, including getting the full contract for the various plans and perhaps a chart comparing them.

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dm200
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Re: Selecting health insurance during pregnancy

Post by dm200 » Tue Mar 07, 2017 10:44 am

Yes. I am changing from employer Kaiser to marketplace Kaiser. My employer insurance ends on March 31st.


The nice thing about Kaiser coverage (at least our experience) is that there is excellent medical "continuity" when switching from one Kaiser plan to another. You keep the same medical record number, primary care and other physicians, access to records, etc.

Nate79
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Re: Selecting health insurance during pregnancy

Post by Nate79 » Tue Mar 07, 2017 11:57 am

Not sure if it applies in this case but switching plans often/usually resets deductibles.

Hector
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Re: Selecting health insurance during pregnancy

Post by Hector » Wed Mar 08, 2017 10:48 am

HIinvestor wrote:I'm just curious about whether all these gyrations are necessary and whether it might be better to just gave one family plan for all of you including the baby until the next open season.

Having a baby is a qualifying event, but I'm pretty sure it's only qualifying for the baby. Please be aware babies have been known to arrive early or late and may require extra care and possible prolonged hospitalization. Don't be penny-wise and pound-foolish in your choice of insurance coverages.

Your HR can give you the materials and info to carefully compare plans so you can make informed choices, including getting the full contract for the various plans and perhaps a chart comparing them.


I was looking at "California Code of Regulations" at https://govt.westlaw.com/calregs/Docume ... sc.Default) and it reads following:

"§ 6504. Special Enrollment Periods.
(a) A qualified individual may enroll in a QHP, or an enrollee may change from one QHP to another, during special enrollment periods only if one of the following triggering events occurs:

(1) some rules that is not relevant for this topic......

(2) A qualified individual gains a dependent or becomes a dependent through marriage or entry into domestic partnership, birth, adoption, placement for adoption, or placement in foster care, or through a child support order or other court order."


https://www.healthinsurance.org/ reads following:
"Becoming a dependent or gaining a dependent as a result or birth, adoption, or placement in foster care. Coverage is back-dated to the date of birth, adoption, or placement in foster care (new regulations also allow parents the option to select a later effective date). Because of the special rules regarding effective dates, it’s wise to use a special enrollment period in this case, even if the child is born or adopted during the general open enrollment period.The current regulation states that anyone who “gains a dependent or becomes a dependent” is eligible for a special open enrollment window, which obviously includes both the parents and the new baby or newly adopted or fostered child.But the Federally Facilitated Marketplace accepts applications for the entire family (including siblings) during the special open enrollment window. If you live in a state that is running its own exchange, check with your exchange to see how they have interpreted the regulation.

Source: https://www.healthinsurance.org/obamaca ... -coverage/"

Looks like mother(a qualified individual) can move from one health plan to another after giving birth. Am I reading it correctly?
Last edited by Hector on Wed Mar 08, 2017 11:11 am, edited 4 times in total.

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dm200
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Re: Selecting health insurance during pregnancy

Post by dm200 » Wed Mar 08, 2017 10:53 am

Nate79 wrote:Not sure if it applies in this case but switching plans often/usually resets deductibles.


as well as (probably) maximum "out of pocket" limits.

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Re: Selecting health insurance during pregnancy

Post by Hector » Wed Mar 08, 2017 10:55 am

dm200 wrote:
Nate79 wrote:Not sure if it applies in this case but switching plans often/usually resets deductibles.


as well as (probably) maximum "out of pocket" limits.


That is my understanding too.

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dm200
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Re: Selecting health insurance during pregnancy

Post by dm200 » Wed Mar 08, 2017 10:59 am

Hector wrote:
dm200 wrote:
Nate79 wrote:Not sure if it applies in this case but switching plans often/usually resets deductibles.

as well as (probably) maximum "out of pocket" limits.

That is my understanding too.


Regarding employer insurance plans, my recollection is that the "yearly" deductibles and out of pocket yearly limits may not be the "calendar" year, but the "insurance year" (as defined in the employer plan). I would check/verify how such a "year" is figured in any such plans.

ICMoney
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Re: Selecting health insurance during pregnancy

Post by ICMoney » Wed Mar 08, 2017 11:58 am

A couple thoughts for you:

Remember, with pregnancy most preventative care is covered with no additional out of pocket cost and this includes all of the major prenatal visits and screenings. This does not change regardless of whether you have a bronze or platinum plan under the ACA. The only major expense you may see (i.e., is not fully covered) is the birth itself.


One poster mentioned this, however in my experience this is often not the case. (i.e. that prenatal care = preventative care, in many plans it does not fall under preventative care so prenatal visits are not paid for by the plan at 100%) If you change providers or even insurers mid-pregnancy you may be on the hook for all of the OB office visits already incurred if your OB was planning to bill you under global billing. However, since you have Kaiser, I think you may be paying a copay for every visit anyway and not being billed under global billing, so this may not apply in your situation.

Also, yes, you may switch plans/add qualifying family members as of the date of the baby's birth due to it being a qualifying life event, however my experience is that all of your charges for birth will be dated as of the birthdate as well, so the new plan would technically be the one to pick them up IF your employer backdates the coverage change to be effective on the baby's birthdate. However, some plans are administered such changes due to qualifying life events as of the first of the following month following a qualifying life event - if that is the case with your plan, then you may be ok in getting Kaiser to pay for the birth in July if your spouse/kids wouldn't be moved onto your employer plan until August 1.

Best,
ICM

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Re: Selecting health insurance during pregnancy

Post by Hector » Wed Mar 08, 2017 12:55 pm

ICMoney wrote:A couple thoughts for you:

Remember, with pregnancy most preventative care is covered with no additional out of pocket cost and this includes all of the major prenatal visits and screenings. This does not change regardless of whether you have a bronze or platinum plan under the ACA. The only major expense you may see (i.e., is not fully covered) is the birth itself.


One poster mentioned this, however in my experience this is often not the case. (i.e. that prenatal care = preventative care, in many plans it does not fall under preventative care so prenatal visits are not paid for by the plan at 100%) If you change providers or even insurers mid-pregnancy you may be on the hook for all of the OB office visits already incurred if your OB was planning to bill you under global billing. However, since you have Kaiser, I think you may be paying a copay for every visit anyway and not being billed under global billing, so this may not apply in your situation.

Also, yes, you may switch plans/add qualifying family members as of the date of the baby's birth due to it being a qualifying life event, however my experience is that all of your charges for birth will be dated as of the birthdate as well, so the new plan would technically be the one to pick them up IF your employer backdates the coverage change to be effective on the baby's birthdate. However, some plans are administered such changes due to qualifying life events as of the first of the following month following a qualifying life event - if that is the case with your plan, then you may be ok in getting Kaiser to pay for the birth in July if your spouse/kids wouldn't be moved onto your employer plan until August 1.

Best,
ICM


Thanks. Looks like I may complicate things more and not save much by switching multiple times.
Seems like keeping my wife under market place Kaiser for rest of the year make more sense.

Current employer sponsored Kaiser for family ends on March 31s.
Get Kaiser via marketplace for wife from April 1st and stay there till end of the year.
Get Kaiser via marketplace for myself and kid from April 1st.
Get new employer sponsored plan for myself and kid from Jun 1st: first day when new employer sponsored plan kicks in.
Add baby to employer sponsored plan after the birth.

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Re: Selecting health insurance during pregnancy

Post by david » Wed Mar 08, 2017 2:11 pm

ICMoney wrote:A couple thoughts for you:

Remember, with pregnancy most preventative care is covered with no additional out of pocket cost and this includes all of the major prenatal visits and screenings. This does not change regardless of whether you have a bronze or platinum plan under the ACA. The only major expense you may see (i.e., is not fully covered) is the birth itself.


One poster mentioned this, however in my experience this is often not the case. (i.e. that prenatal care = preventative care, in many plans it does not fall under preventative care so prenatal visits are not paid for by the plan at 100%) If you change providers or even insurers mid-pregnancy you may be on the hook for all of the OB office visits already incurred if your OB was planning to bill you under global billing. However, since you have Kaiser, I think you may be paying a copay for every visit anyway and not being billed under global billing, so this may not apply in your situation.

Also, yes, you may switch plans/add qualifying family members as of the date of the baby's birth due to it being a qualifying life event, however my experience is that all of your charges for birth will be dated as of the birthdate as well, so the new plan would technically be the one to pick them up IF your employer backdates the coverage change to be effective on the baby's birthdate. However, some plans are administered such changes due to qualifying life events as of the first of the following month following a qualifying life event - if that is the case with your plan, then you may be ok in getting Kaiser to pay for the birth in July if your spouse/kids wouldn't be moved onto your employer plan until August 1.

Best,
ICM


My experience with my Wife's pregnancy last year was that we did not see an out of pocket expense for any of the prenatal screenings/visits/labs either under the bronze plan with a first provider network (in the first half of the pregnancy) and the platinum plan with the second provider network (from the second half of the pregnancy through the birth), though, the same doctors/labs were used throughout.

I believe there would have been out of pocket expenses if, for example, my wife developed a pregnancy related condition that required treatment (e.g., gestational diabetes treatment as opposed to the screening which is fully covered) , if there was a problem with the fetus that doctors had to intervene, etc. Assuming both mother and child remain relatively healthy throughout, however, I don't believe there would be out of pocket costs. Please correct me if I am wrong.

To the OP-
Remember deductibles and OOP maxes reset when you change insurance plans and so if you actually access healthcare, it may make sense to remain on a plan. Also, I would reevaluate in the period after the birth as there may be complications or issues that arise or become known then. If all goes well and everyone is perfectly healthy, your plan to hop around makes some sense. Problems that I can foresee is a lot of added complexity (i.e., you receive EOBs from different insurance companies after you no longer have them as a provider), getting insurance cards/minutia of setting up the plan to see doctors etc before your time on the plan ends.

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Re: Selecting health insurance during pregnancy

Post by ICMoney » Wed Mar 08, 2017 3:12 pm

My experience with my Wife's pregnancy last year was that we did not see an out of pocket expense for any of the prenatal screenings/visits/labs either under the bronze plan with a first provider network (in the first half of the pregnancy) and the platinum plan with the second provider network (from the second half of the pregnancy through the birth), though, the same doctors/labs were used throughout.

I believe there would have been out of pocket expenses if, for example, my wife developed a pregnancy related condition that required treatment (e.g., gestational diabetes treatment as opposed to the screening which is fully covered) , if there was a problem with the fetus that doctors had to intervene, etc. Assuming both mother and child remain relatively healthy throughout, however, I don't believe there would be out of pocket costs. Please correct me if I am wrong.


Hi david, I know this can be different plan-by-plan which is why I wanted to mention that your experience is not universally applicable in case anyone might take action based on your pregnancy billing experience. It sounds like your health plan is generous in that it covers prenatal care at 100% with no cost sharing, but my guess is that you may be in the minority with how it is being handled by your plan.

For multiple health plans that our family has been covered under in the recent past for pregnancies, prenatal care was NOT considered preventative and thus not covered at 100%. However, we didn't get charged for each visit individually since many OBs will global-bill. This basically means the OB will charge a lump amount as of the date of baby's delivery, but this lump amount covers the OB's cost of providing all prenatal care/appointments and birth assistance. Ultrasounds and labs are not a part of the global bill and will likely be applied to the deductible (i.e. those are not considered preventative care on some health plans). The global-bill means that while the OB's office may not generate a charge statement itemizing a charge for each visit, if for example a pregnant woman switches to another OB during pregnancy, the woman would still be charged by their first OB for any office visits incurred at the standard office visit rate, reduced by any coinsurance/U&C limitations.

Best,
ICM

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Re: Selecting health insurance during pregnancy

Post by Hector » Thu Mar 23, 2017 12:02 pm

In the process of applying for health insurance through market place I learned that there is no discount in premium when getting one insurance policy for multiple family members VS getting separate insurance policies for multiple family members.

Here is the summary:
Family size: me, pregnant wife and kid.
Due to job change we are loosing our employer sponsored Kaiser plan.
New employer does not provide Kaiser and we do not want to change doctor and hospital in mid pregnancy.
I am thinking about getting my insurance through employer and other family members' via Kaiser.

Premium is the same if I apply for 1)wife and kid's insurance in same application OR 2) separate insurance for wife and kid.
Thinking about getting platinum plan for wife as she is pregnant. Will get platinum plan for baby after the birth.
Difference in the premium is ~$120/month if we get platinum vs bronze for kid. This would be for rest of the year starting from April 1st. Difference of ~$1000.

Does it makes sense to get platinum plan for wife and bronze for kid? Are there any downside in doing so?

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