Another insurance question (sorry long)

julieanne912 · November 2015

Open enrollment has begun at my work for the 2016 year, and my company made some changes to providers and rates, so now I'm trying to sift through it all to make the best decision. I've been a 1099 before the end of last year so figuring out employer paid insurance is a whole different world for me... so I'm hoping you MMers can help me

Some basics about us:

-I'm 33

-H is on his own insurance through his work, and 100% of his premiums are paid by his employer, but if I get added on his deductible goes way up. He receives very expensive medical treatments every 2 months so it makes no sense for me to be on his plan.

-I rarely get sick enough to go to a doctor, and am not currently on any prescriptions. I get my annual obgyn visit done yearly.

-Monthly cash flow is my biggest issue, and I currently pay $42.46 per check for an HDHP plan.

-The biggest: We are starting to TTC so there's a high likelihood I will be having a baby in 2016. Once baby is here, he/she will be on my plan as well, but the goal is to attempt to have the baby towards the end of the year but I'm just focusing on individual care right now.

-I don't see any reason we'd be in out of network coverage since we live in a major metro area and rarely travel to far off places

The plan options:

Aetna HDHP:

Per paycheck premium: $24.21

Deductible: $5,000

CoInsurance: 20%

CoPay for non-preventative doctor visits: $25

Out of Pocket Limit: $5,000

Preventative Care: Paid 100%

HSA: Option to pay in, no employer contribution

Aetna Choice:

Per paycheck premium: $79.09

Deductible: $2,500

CoInsurance: 20%

CoPay for non-preventative doctor visits: $25

Out of Pocket Limit: $5,000

Preventative Care: Paid 100%

HSA: None

This plan has an HRA Health Fund that employer contributes $750.00 to, and I can add to it if I want. The money rolls over to next year but has a $3,000 cap.

Kaiser (we live very close to a Kaiser facility including hospital, but would be limited to only Kaiser facilities):

Per paycheck premium: $102.67

Deductible: $500

Co-Insurance: 20% depending on what it's for

Co-Pay: $20, and for prenatal it's 80% covered after deductible is met

Out of Pocket Max: $2,000

Preventative Care: 100% covered

FSA available

The Kaiser plan is super tempting, at least for baby-having, but that premium is pretty hefty and frankly I'm not sure I can afford that to come out of every check, and still keep up with my savings goals.

The two Aetna plans are pretty similar other than the deductible. I figured that it would take a year and a half of paying the lower premium to make up the deductible difference. But then that gets offset a bit by the $750 my employer contributes to the HRA.

So I guess the question is... pay now or pay later?

GAH.... any insight here, maybe from people who know roughly the cost of having a baby, assuming nothing crazy or out of the ordinary happens with that?

jtmh2012 · November 2015

Just another set of numbers you may want to toss in there since you're planning for baby. If you and your husband were on the same plan, how would that work out with his treatments and the baby expenses? Depending on your numbers, it might be cheaper paying one set of deductibles than two.

You could then separate again the following year if that worked out.

julieanne912 · November 2015

jtmh2012 said:

Just another set of numbers you may want to toss in there since you're planning for baby. If you and your husband were on the same plan, how would that work out with his treatments and the baby expenses? Depending on your numbers, it might be cheaper paying one set of deductibles than two.
You could then separate again the following year if that worked out.

Yeah we looked at that... unfortunately his plan pretty much sucks for anybody being on it beyond him. His deductible goes from $2500 up to I think $10,000 if I get added. His treatments are about $7,000 a pop so while we'd hit the deductible pretty quick, the $7500 (plus whatever the premium is), is a huge difference since I'm only really considering a difference of $2500 in deductible money and $1400 in premium money per year.

brij2006 · November 2015

Will you be able to save up the $5,000 between now and say 9 months from now if/when you get pregnant, to be able to pay for the deductible/max OOP?

I would personally plan for meeting the max OOP on any of these plans, with the birth of a child.

My DD was born in February. Her birth was 100% natural, no meds, no epidural, no IV, and we didn't go to the hospital until 45 minutes before she was born. So there wasn't much monitoring. My individual deductible is $1,000, individual max OOP $3,000. Max family OOP is $5,000. DD was added to my policy when she was born.
Since she was born after January 1, but I was pregnant with her the majority of 2014, I had 2 deductibles and max OOP's to account for.

I paid $2,000 for my deductible (2014 and 2015), $1,000 for DD's deductible (2015), and another $3,000 to meet my max OOP for 2015, and I think I paid about $300 toward my max OOP for 2014 (was an 80/20 plan).

So in total we paid $5,300 for the birth of our daughter, and that was with the most basic labor and delivery.

Keep in mind that if you start TTC in January and it takes you a few months to get pregnant (it can take the average couple a year to get pregnant), then you may run into 2 deductibles and max OOP's. So the $5,000 max OOP plan may not be your best option.

I personally would take the low deductible, low max OOP, Kaiser plan for TTC purposes. Knowing very well that when you are fully done having children, you can switch back to a high deductible plan. But we also had fertility problems, so a plan that had a lot more coverage and lower deductibles would have been very helpful for us. Which is something you won't know ahead of time until you're actively TTC.

Also, I would look into what the max family OOP amounts are as well.

julieanne912 · November 2015

brij2006 said:

Will you be able to save up the $5,000 between now and say 9 months from now if/when you get pregnant, to be able to pay for the deductible/max OOP?

I would personally plan for meeting the max OOP on any of these plans, with the birth of a child.

My DD was born in February. Her birth was 100% natural, no meds, no epidural, no IV, and we didn't go to the hospital until 45 minutes before she was born. So there wasn't much monitoring. My individual deductible is $1,000, individual max OOP $3,000. Max family OOP is $5,000. DD was added to my policy when she was born.
Since she was born after January 1, but I was pregnant with her the majority of 2014, I had 2 deductibles and max OOP's to account for.
I paid $2,000 for my deductible (2014 and 2015), $1,000 for DD's deductible (2015), and another $3,000 to meet my max OOP for 2015, and I think I paid about $300 toward my max OOP for 2014 (was an 80/20 plan).
So in total we paid $5,300 for the birth of our daughter, and that was with the most basic labor and delivery.

Keep in mind that if you start TTC in January and it takes you a few months to get pregnant (it can take the average couple a year to get pregnant), then you may run into 2 deductibles and max OOP's. So the $5,000 max OOP plan may not be your best option.

I personally would take the low deductible, low max OOP, Kaiser plan for TTC purposes. Knowing very well that when you are fully done having children, you can switch back to a high deductible plan. But we also had fertility problems, so a plan that had a lot more coverage and lower deductibles would have been very helpful for us. Which is something you won't know ahead of time until you're actively TTC.

Also, I would look into what the max family OOP amounts are as well.

Thank you! This is good to know. We could come up with the cash if we needed, or at the very least, negotiate some interest free payments with the hospital if needed... they usually will do that in my experience.

On the side of infertility treatments... The HDHP plan covers 80% after deductible, Choice just says it varies depending on the treatment, Kaiser does not cover at all. So I guess that's something to keep in mind.

But yeah, we are probably going to start TTC here very quickly in the great hopes we can have this baby out in 2016, that would suck to have to pay 2 years of deductibles.

brij2006 · November 2015

That's a hard call then.

Me personally, I will tell anyone and everyone to not plan on making payments to the hospital for the deductible/max oop. You will have 9 months of warning that this expense is coming (more because you're choosing to TTC and know a baby would be in the future), and being a new parent is hard and stressful. The last thing anyone needs is to have to worry about additional financial strain on top of it all.

I personally would probably go with the HDHP plan and buckle down my budget greatly to start putting money aside for the deductible/max OOP. The odds of meeting the max OOP is pretty much guaranteed with the birth of a baby anymore, unfortunately. But I would definitely check to see what the family max OOP is first.

cupcait927 · November 2015

Is the OOP max on the Aetna HDHP plan really the same as the deductible? I'm confused as to why you'd have coinsurance on a plan that has an OOP max that matches the deductible.

julieanne912 · November 2015

brij2006 said:

That's a hard call then.
Me personally, I will tell anyone and everyone to not plan on making payments to the hospital for the deductible/max oop. You will have 9 months of warning that this expense is coming (more because you're choosing to TTC and know a baby would be in the future), and being a new parent is hard and stressful. The last thing anyone needs is to have to worry about additional financial strain on top of it all.

I personally would probably go with the HDHP plan and buckle down my budget greatly to start putting money aside for the deductible/max OOP. The odds of meeting the max OOP is pretty much guaranteed with the birth of a baby anymore, unfortunately. But I would definitely check to see what the family max OOP is first.

Family is $10,000

It's the same on the Choice plan as well. BUT, I'd consider switching to the Choice plan once we have a kid, because the employer contribution to the HRA increases to $1750.

julieanne912 · November 2015

cupcait927 said:

Is the OOP max on the Aetna HDHP plan really the same as the deductible? I'm confused as to why you'd have coinsurance on a plan that has an OOP max that matches the deductible.

Oh god, you're right! The deductible on the HDHP is also $2,500. I knew I would get something wrong when translating it over here.

So yeah, the HDHP plan is looking more and more attractive since I'm having a hard time seeing any benefit in the Choice plan other than the $750 employer contribution to the HRA.

It's interesting, these plans had bigger difference when I joined the company earlier this year... the HDHP premium was higher with higher deductible, and the Choice premium was lower, and had a lower OOP max. I think they're basically wanting everyone to switch to the HDHP to avoid that employer contribution to the HRA

cupcait927 · November 2015

I'm very pro-HDHP plans. I work in the insurance world and have seen that the majority of the time, employees are better off in an HDHP plan, even without an HSA contribution from the employer.

My suggestion - go with the Aetna HDHP plan and contribute at least the difference between that premium and the Aetna Choice plan to an HSA to get you started. It's pre-tax and if you're already willing to spend the money on premium, it's a better use of your dollars to put it into the HSA.

brij2006 · November 2015

Ooof, a $10k max family OOP. That would scare me a bit (my H's family max is $13k).

Another option to keep in mind, you can put your future child onto their own policy when they are born. We actually had the numbers ran both ways, then chose which way we went once our baby was born. Since everything was fine with her birth, it was better to add her to my policy. But had she had any time in the NICU or complications, we had a separate policy with a $1,000 max OOP quoted and ready to issue (you have 30 days after they're born to file the insurance) if we needed to since my family max OOP was pretty high.

simplyelise · November 2015

Each of the plans should have a summary page that details how much you would spend on regular medical services. Every insurance I've ever considered had a page specifically listing how much it would cost you to have a baby on that plan, both vaginal and cesarean birth. I'd look hard at those and then add each yearly premium total to the costs and see which worked out the best.

You can totally ignore this if you want because we're on the internet and I'm sticking my nose into your business. But I just strongly feel that because your husband makes six figures while you are struggling to cashflow your insurance premiums, he should be contributing to your health insurance costs if not covering them completely. Especially if you're going to TTC. The baby will be his responsibility too and he should be helping on covering that expense.

blondie42107 · November 2015

I have two kiddos, both were unplanned c-section. Both times, my start to finish all fell into the same calendar year so I only had one deductible to meet each time. My OOP max (family) was $5300.00 and we didn't meet it either time. However, we just planned knowing we could end up with a bill that big.

So I would find out how much adding a baby to your plan would cost. I always focus on the OOP max.

formerlyGDaisy09 · November 2015

insurance can be so confusing.

On your H's plan, do they have seperate individual and family deductibles? same thing for OOPmaxes?

if this is the case your care and your H's care go into seperate buckets...so once he meets his deductible/OOP max he's done, same for you. in which case it *might* make sense for you to be on the same plan.

However with TTC, this is harder, I think in many cases something like the Kaiser plan is going to be much cheaper, especially if your whole pregnancy falls into one calendar year (or mostly in one calendar year). most hospitals are now doing "global billing" for Obstetrical care, meaning that for all your prenatal and delivery care you'll get charged after you've delivered and been discharged from the hospital. things like labs and ultrasounds will get charged along the way. so if you get pregnant between now and March/early april that plan would work out well...if not, you'd be in for a year of high premiums only to have the majority of your pregnancy-related medical charges charged to your 2017 insurance (assuming a normal, healthy pregnancy).

Remember that having a baby is a life event that would allow you to change your insurance elections after the baby is born. I have a friend due at the end of January who is using this to her advantage, she selected the high-premium PPO plan offered by our employer, will use that to cover all her prenatal and delivery charges then will switch to the low-premium HDHP for the rest of 2016. Because of the ACA all preventative care is free, even on a HDHP, so things like well-child visits, vaccines, contraceptives, etc. should be covered at 100%.

julieanne912 · November 2015

simplyelise said:

Each of the plans should have a summary page that details how much you would spend on regular medical services. Every insurance I've ever considered had a page specifically listing how much it would cost you to have a baby on that plan, both vaginal and cesarean birth. I'd look hard at those and then add each yearly premium total to the costs and see which worked out the best.

You can totally ignore this if you want because we're on the internet and I'm sticking my nose into your business. But I just strongly feel that because your husband makes six figures while you are struggling to cashflow your insurance premiums, he should be contributing to your health insurance costs if not covering them completely. Especially if you're going to TTC. The baby will be his responsibility too and he should be helping on covering that expense.

Ha I put the business out there so stick away

He'll be helping to pay the bills for the baby and the huge daycare costs, no doubt. Also, he pays 100% of our mortgage and is solely paying down the debt incurred for our landscaping, driveway, and he will be paying for the backyard landscaping as well. So, while the kid is definitely a joint venture, it's not like he's just socking his money away and not helping me... it's just that his money goes to other things that benefit us both.

julieanne912 · November 2015

formerlyGDaisy09 said:

insurance can be so confusing.

On your H's plan, do they have seperate individual and family deductibles? same thing for OOPmaxes?
if this is the case your care and your H's care go into seperate buckets...so once he meets his deductible/OOP max he's done, same for you. in which case it *might* make sense for you to be on the same plan.

However with TTC, this is harder, I think in many cases something like the Kaiser plan is going to be much cheaper, especially if your whole pregnancy falls into one calendar year (or mostly in one calendar year). most hospitals are now doing "global billing" for Obstetrical care, meaning that for all your prenatal and delivery care you'll get charged after you've delivered and been discharged from the hospital. things like labs and ultrasounds will get charged along the way. so if you get pregnant between now and March/early april that plan would work out well...if not, you'd be in for a year of high premiums only to have the majority of your pregnancy-related medical charges charged to your 2017 insurance (assuming a normal, healthy pregnancy).

Remember that having a baby is a life event that would allow you to change your insurance elections after the baby is born. I have a friend due at the end of January who is using this to her advantage, she selected the high-premium PPO plan offered by our employer, will use that to cover all her prenatal and delivery charges then will switch to the low-premium HDHP for the rest of 2016. Because of the ACA all preventative care is free, even on a HDHP, so things like well-child visits, vaccines, contraceptives, etc. should be covered at 100%.

I'll have to ask him to have him ask his employer how the deductibles work, but I believe it just shifts to a family if I get added on (instead of being two separate).

For the baby, I definitely was thinking Kaiser is the best way to go. That was actually my plan before the new premium rates came out... switch to Kaiser from the HDHP I'm currently on just for having the baby. But the Kaiser premiums jumped significantly (like $50 a paycheck) for 2016 compared to 2015, and the HDHP premiums went down $20ish per check, so I had to re-evaluate, especially since I could be paying those high premiums for awhile if we don't get pregnant right away.

And yes, all the preventative care on all the plans is 100% covered.

simplyelise · November 2015

julieanne912 said:

simplyelise said:

Each of the plans should have a summary page that details how much you would spend on regular medical services. Every insurance I've ever considered had a page specifically listing how much it would cost you to have a baby on that plan, both vaginal and cesarean birth. I'd look hard at those and then add each yearly premium total to the costs and see which worked out the best.

You can totally ignore this if you want because we're on the internet and I'm sticking my nose into your business. But I just strongly feel that because your husband makes six figures while you are struggling to cashflow your insurance premiums, he should be contributing to your health insurance costs if not covering them completely. Especially if you're going to TTC. The baby will be his responsibility too and he should be helping on covering that expense.

Ha I put the business out there so stick away He'll be helping to pay the bills for the baby and the huge daycare costs, no doubt. Also, he pays 100% of our mortgage and is solely paying down the debt incurred for our landscaping, driveway, and he will be paying for the backyard landscaping as well. So, while the kid is definitely a joint venture, it's not like he's just socking his money away and not helping me... it's just that his money goes to other things that benefit us both.

Isn't the mortgage and title in his name only? I just cannot wrap my head around your husband making $130k a year and you're talking about having to do interest free payments to the hospital for a birth with a possible $5k deductible.

julieanne912 · November 2015

simplyelise said:

julieanne912 said:

simplyelise said:

Each of the plans should have a summary page that details how much you would spend on regular medical services. Every insurance I've ever considered had a page specifically listing how much it would cost you to have a baby on that plan, both vaginal and cesarean birth. I'd look hard at those and then add each yearly premium total to the costs and see which worked out the best.

You can totally ignore this if you want because we're on the internet and I'm sticking my nose into your business. But I just strongly feel that because your husband makes six figures while you are struggling to cashflow your insurance premiums, he should be contributing to your health insurance costs if not covering them completely. Especially if you're going to TTC. The baby will be his responsibility too and he should be helping on covering that expense.

Ha I put the business out there so stick away He'll be helping to pay the bills for the baby and the huge daycare costs, no doubt. Also, he pays 100% of our mortgage and is solely paying down the debt incurred for our landscaping, driveway, and he will be paying for the backyard landscaping as well. So, while the kid is definitely a joint venture, it's not like he's just socking his money away and not helping me... it's just that his money goes to other things that benefit us both.

Isn't the mortgage and title in his name only? I just cannot wrap my head around your husband making $130k a year and you're talking about having to do interest free payments to the hospital for a birth with a possible $5k deductible.

Yes it is. It's in his name only because previously, I only had 1099 income and the BK from last year, so I was useless to be on the mortgage. And, the 130k is not his take-home, that's gross before anything is taken out.

Like I said before, we have the cash, but we are not debt averse whatsoever, so no reason to dip into our cash savings if the hospital let us do the interest free payments.

Also like I've mentioned, our finances are still separate. The idea that my husband should be paying my health insurance premiums (which I would have baby or no baby) just because he makes more sounds crazy to me, but I've been independent for a long time.

julieanne912 · November 2015

Also, I'm not concerned about paying either Aetna premium...those are easy to work into my current budget and still keep up with my savings goals. It was the Kaiser one that was a big jump from what I'm paying now that I am concerned with.

brij2006 · November 2015

julieanne912 said:

simplyelise said:

julieanne912 said:

simplyelise said:

Each of the plans should have a summary page that details how much you would spend on regular medical services. Every insurance I've ever considered had a page specifically listing how much it would cost you to have a baby on that plan, both vaginal and cesarean birth. I'd look hard at those and then add each yearly premium total to the costs and see which worked out the best.

You can totally ignore this if you want because we're on the internet and I'm sticking my nose into your business. But I just strongly feel that because your husband makes six figures while you are struggling to cashflow your insurance premiums, he should be contributing to your health insurance costs if not covering them completely. Especially if you're going to TTC. The baby will be his responsibility too and he should be helping on covering that expense.

Ha I put the business out there so stick away He'll be helping to pay the bills for the baby and the huge daycare costs, no doubt. Also, he pays 100% of our mortgage and is solely paying down the debt incurred for our landscaping, driveway, and he will be paying for the backyard landscaping as well. So, while the kid is definitely a joint venture, it's not like he's just socking his money away and not helping me... it's just that his money goes to other things that benefit us both.

Isn't the mortgage and title in his name only? I just cannot wrap my head around your husband making $130k a year and you're talking about having to do interest free payments to the hospital for a birth with a possible $5k deductible.

Yes it is. It's in his name only because previously, I only had 1099 income and the BK from last year, so I was useless to be on the mortgage. And, the 130k is not his take-home, that's gross before anything is taken out.

Like I said before, we have the cash, but we are not debt averse whatsoever, so no reason to dip into our cash savings if the hospital let us do the interest free payments.

Also like I've mentioned, our finances are still separate. The idea that my husband should be paying my health insurance premiums (which I would have baby or no baby) just because he makes more sounds crazy to me, but I've been independent for a long time.

Just so you are aware, 95% of hospitals give you a discount for paying cash for the balance in full. We received 15% off, but they did also offer 12 months 0% interest payments. Um yeah, our bill was $5,300. A 15% discount brought that down to $4,505. I happily wrote a check from our savings to take advantage of that. Even though they did offer 0%.

Oh, but I had to call and as what the discount was. They did not put it on our bill.

julieanne912 · November 2015

brij2006 said:

julieanne912 said:

simplyelise said:

julieanne912 said:

simplyelise said:

Each of the plans should have a summary page that details how much you would spend on regular medical services. Every insurance I've ever considered had a page specifically listing how much it would cost you to have a baby on that plan, both vaginal and cesarean birth. I'd look hard at those and then add each yearly premium total to the costs and see which worked out the best.

You can totally ignore this if you want because we're on the internet and I'm sticking my nose into your business. But I just strongly feel that because your husband makes six figures while you are struggling to cashflow your insurance premiums, he should be contributing to your health insurance costs if not covering them completely. Especially if you're going to TTC. The baby will be his responsibility too and he should be helping on covering that expense.

Ha I put the business out there so stick away He'll be helping to pay the bills for the baby and the huge daycare costs, no doubt. Also, he pays 100% of our mortgage and is solely paying down the debt incurred for our landscaping, driveway, and he will be paying for the backyard landscaping as well. So, while the kid is definitely a joint venture, it's not like he's just socking his money away and not helping me... it's just that his money goes to other things that benefit us both.

Isn't the mortgage and title in his name only? I just cannot wrap my head around your husband making $130k a year and you're talking about having to do interest free payments to the hospital for a birth with a possible $5k deductible.

Yes it is. It's in his name only because previously, I only had 1099 income and the BK from last year, so I was useless to be on the mortgage. And, the 130k is not his take-home, that's gross before anything is taken out.

Like I said before, we have the cash, but we are not debt averse whatsoever, so no reason to dip into our cash savings if the hospital let us do the interest free payments.

Also like I've mentioned, our finances are still separate. The idea that my husband should be paying my health insurance premiums (which I would have baby or no baby) just because he makes more sounds crazy to me, but I've been independent for a long time.

Just so you are aware, 95% of hospitals give you a discount for paying cash for the balance in full. We received 15% off, but they did also offer 12 months 0% interest payments. Um yeah, our bill was $5,300. A 15% discount brought that down to $4,505. I happily wrote a check from our savings to take advantage of that. Even though they did offer 0%.

Oh, but I had to call and as what the discount was. They did not put it on our bill.

Oh sweet, I didn't know that. We would do that if it meant saving hundreds of dollars.

dragonstarjk · November 2015

brij2006 said:

julieanne912 said:

simplyelise said:

julieanne912 said:

simplyelise said:

Each of the plans should have a summary page that details how much you would spend on regular medical services. Every insurance I've ever considered had a page specifically listing how much it would cost you to have a baby on that plan, both vaginal and cesarean birth. I'd look hard at those and then add each yearly premium total to the costs and see which worked out the best.

You can totally ignore this if you want because we're on the internet and I'm sticking my nose into your business. But I just strongly feel that because your husband makes six figures while you are struggling to cashflow your insurance premiums, he should be contributing to your health insurance costs if not covering them completely. Especially if you're going to TTC. The baby will be his responsibility too and he should be helping on covering that expense.

Ha I put the business out there so stick away He'll be helping to pay the bills for the baby and the huge daycare costs, no doubt. Also, he pays 100% of our mortgage and is solely paying down the debt incurred for our landscaping, driveway, and he will be paying for the backyard landscaping as well. So, while the kid is definitely a joint venture, it's not like he's just socking his money away and not helping me... it's just that his money goes to other things that benefit us both.

Isn't the mortgage and title in his name only? I just cannot wrap my head around your husband making $130k a year and you're talking about having to do interest free payments to the hospital for a birth with a possible $5k deductible.

Yes it is. It's in his name only because previously, I only had 1099 income and the BK from last year, so I was useless to be on the mortgage. And, the 130k is not his take-home, that's gross before anything is taken out.

Like I said before, we have the cash, but we are not debt averse whatsoever, so no reason to dip into our cash savings if the hospital let us do the interest free payments.

Also like I've mentioned, our finances are still separate. The idea that my husband should be paying my health insurance premiums (which I would have baby or no baby) just because he makes more sounds crazy to me, but I've been independent for a long time.

Just so you are aware, 95% of hospitals give you a discount for paying cash for the balance in full. We received 15% off, but they did also offer 12 months 0% interest payments. Um yeah, our bill was $5,300. A 15% discount brought that down to $4,505. I happily wrote a check from our savings to take advantage of that. Even though they did offer 0%.

Oh, but I had to call and as what the discount was. They did not put it on our bill.

True. I've never had a baby, BUT every time we've had a bill through our hospital for something, I've called and asked if they offer a paid in full discount. Ours does 25%. Almost every medical bill I've gotten and asked for a paid in full discount, I have gotten one, but I've had to ask for it.

AprilZ81 · November 2015

formerlyGDaisy09 said:

However with TTC, this is harder, I think in many cases something like the Kaiser plan is going to be much cheaper, especially if your whole pregnancy falls into one calendar year (or mostly in one calendar year). most hospitals are now doing "global billing" for Obstetrical care, meaning that for all your prenatal and delivery care you'll get charged after you've delivered and been discharged from the hospital. things like labs and ultrasounds will get charged along the way. so if you get pregnant between now and March/early april that plan would work out well...if not, you'd be in for a year of high premiums only to have the majority of your pregnancy-related medical charges charged to your 2017 insurance (assuming a normal, healthy pregnancy).

Yes, check with your doctor and hospital to see if they do global billing. This will minimize the likelihood of you needing to meet the deductible/out of pocket max in two calendar years with a pregnancy.

Also, you will have a lot of different bills.

1) Your prenatal care & delivery fees from your OBGYN

2) Actual hospital bill for your room & board and every tissue you use

3) Any specialist (anathethisiologist or however that is spelled) doctor who sees you in the hospital

4) Once the baby is born he/she will have their own billing for testing, room & board, circumcision, etc.

Global billing is your friend for pregnancy.

I know cash flow is important to you, but I would actually add up your premiums, expected childbirth expenses, subtract any HRA/HSA contributions and see which is the better bottom line.

kmurphy2131 · November 2015

julieanne912 said:

formerlyGDaisy09 said:

insurance can be so confusing.

On your H's plan, do they have seperate individual and family deductibles? same thing for OOPmaxes?
if this is the case your care and your H's care go into seperate buckets...so once he meets his deductible/OOP max he's done, same for you. in which case it *might* make sense for you to be on the same plan.

However with TTC, this is harder, I think in many cases something like the Kaiser plan is going to be much cheaper, especially if your whole pregnancy falls into one calendar year (or mostly in one calendar year). most hospitals are now doing "global billing" for Obstetrical care, meaning that for all your prenatal and delivery care you'll get charged after you've delivered and been discharged from the hospital. things like labs and ultrasounds will get charged along the way. so if you get pregnant between now and March/early april that plan would work out well...if not, you'd be in for a year of high premiums only to have the majority of your pregnancy-related medical charges charged to your 2017 insurance (assuming a normal, healthy pregnancy).

Remember that having a baby is a life event that would allow you to change your insurance elections after the baby is born. I have a friend due at the end of January who is using this to her advantage, she selected the high-premium PPO plan offered by our employer, will use that to cover all her prenatal and delivery charges then will switch to the low-premium HDHP for the rest of 2016. Because of the ACA all preventative care is free, even on a HDHP, so things like well-child visits, vaccines, contraceptives, etc. should be covered at 100%.

I'll have to ask him to have him ask his employer how the deductibles work, but I believe it just shifts to a family if I get added on (instead of being two separate).

For the baby, I definitely was thinking Kaiser is the best way to go. That was actually my plan before the new premium rates came out... switch to Kaiser from the HDHP I'm currently on just for having the baby. But the Kaiser premiums jumped significantly (like $50 a paycheck) for 2016 compared to 2015, and the HDHP premiums went down $20ish per check, so I had to re-evaluate, especially since I could be paying those high premiums for awhile if we don't get pregnant right away.

And yes, all the preventative care on all the plans is 100% covered.

Any family plan I have ever seen has it laid out like this:

deductible $2500 max per person/$10000 max per family

Obviously I just made up those numbers, but it could be that his plan is $2500/person and $10,000/family. Meaning that no one individual can have a deductible of greater than $2500, and the entire family won't pay more than $10,000. So if two of you are on it and everyone uses their deductible it would be $5000 max per year, if you add a baby it would be $7500 total (in this example). I think is what @formerlyGdaisy09 meant.

But maybe his company increases the individual deductible too. I just thought it was worth mentioning since I think that could make a big difference potentially.

kmurphy2131 · November 2015

Also I meant to add, I am hesitant to ever get an insurance plan that limits me to a hospital group/facility for multiple reasons.

First off, I live just outside of Boston (less than 30min) so we have access to a lot of awesome hospitals. My mom (and I) are part of a hospital network that has a very good reputation and is it just outside of Boston, but when my mom has had some medical stuff happen recently she moved to a different hospital network in Boston (we basically have lahey, partners, and north shore medical center as our options). She has had an amazing exeperience and even with choosing a great hospital initially things would have gone poorly and it would have sucked if she was stuck to the one hospital.

Second of all (and I am biased based on my work) that means that you can't be treated at a private practice. Maybe not a big deal for routine medical stuff, but what about physical therapy, chiropractic, etc if you have to do that you may want to go somewhere closer to work or home or the place where your good friends had a great experience. I actually work in private practice and have seen issues where people can't see us despite starting treatment because their hospital specific insurance plan won't cover us at the regular rate and they have a huge deductible.

Not trying to start any kind of debate here (at least not on purpose) but I am very uncomfortable with any kind of medical care, insurance etc that limits providers based on a hospital. Thats just all about $$$ not quality care.

Xstatic3333 · November 2015

Oh hi near neighbor! I'm in RI, and lived in the Boston area for many years. Your additional information seals the deal that I'd go with one of the Aetna plans. I completely agree that being limited is especially frustrating in the Boston area. I had a brief dalliance with a Fallon plan (is that what Kaiser is now?) early in my career and it was super annoying. I've always ended up at Partners facilities and been really happy there, and if heaven forbid anything serious ever happens to you health-wise they include MGH and I'm pretty sure Children's.

abrewer5 · November 2015

julieanne912 said:

simplyelise said:

julieanne912 said:

simplyelise said:

Each of the plans should have a summary page that details how much you would spend on regular medical services. Every insurance I've ever considered had a page specifically listing how much it would cost you to have a baby on that plan, both vaginal and cesarean birth. I'd look hard at those and then add each yearly premium total to the costs and see which worked out the best.

You can totally ignore this if you want because we're on the internet and I'm sticking my nose into your business. But I just strongly feel that because your husband makes six figures while you are struggling to cashflow your insurance premiums, he should be contributing to your health insurance costs if not covering them completely. Especially if you're going to TTC. The baby will be his responsibility too and he should be helping on covering that expense.

Ha I put the business out there so stick away He'll be helping to pay the bills for the baby and the huge daycare costs, no doubt. Also, he pays 100% of our mortgage and is solely paying down the debt incurred for our landscaping, driveway, and he will be paying for the backyard landscaping as well. So, while the kid is definitely a joint venture, it's not like he's just socking his money away and not helping me... it's just that his money goes to other things that benefit us both.

Isn't the mortgage and title in his name only? I just cannot wrap my head around your husband making $130k a year and you're talking about having to do interest free payments to the hospital for a birth with a possible $5k deductible.

Yes it is. It's in his name only because previously, I only had 1099 income and the BK from last year, so I was useless to be on the mortgage. And, the 130k is not his take-home, that's gross before anything is taken out.

Like I said before, we have the cash, but we are not debt averse whatsoever, so no reason to dip into our cash savings if the hospital let us do the interest free payments.

Also like I've mentioned, our finances are still separate. The idea that my husband should be paying my health insurance premiums (which I would have baby or no baby) just because he makes more sounds crazy to me, but I've been independent for a long time.

I 100% agree with you on this (and I know I'm also the minority not the majority on this board when it comes to separate finances). H's health insurance plan is significantly cheaper and better than the plans I'm offered thru work, but if I get put on it his bi-weekly insurance payment will double, so I'm hesitant to do it. If we go that route, which makes the most sense, I'm planning to set up an auto-pay to his account to cover my portion of the insurance.

I also agree fully with @kmurphy2131 I would not want to be limited to one hospital/provider. If there's a true emergency what happens if that's not the closest hospital to you? Or if another hospital is better equipped to handle to your case? Then you're stuck with a huge bill after the fact to deal with.

jtmh2012 · November 2015

julieanne912 said:

But yeah, we are probably going to start TTC here very quickly in the great hopes we can have this baby out in 2016, that would suck to have to pay 2 years of deductibles.

Something else you might want to ask. Our doctor charges a "ob fee" for the entire pregnancy (excluding labs and ultrasounds). Since we were on a HDHP, they billed the whole thing at the end meaning had we needed to cross plan years that we would have only hit one deductible. It's worth asking about to minimize the damage.

formerlyGDaisy09 · November 2015

julieanne912 said:

formerlyGDaisy09 said:

insurance can be so confusing.

On your H's plan, do they have seperate individual and family deductibles? same thing for OOPmaxes?
if this is the case your care and your H's care go into seperate buckets...so once he meets his deductible/OOP max he's done, same for you. in which case it *might* make sense for you to be on the same plan.

However with TTC, this is harder, I think in many cases something like the Kaiser plan is going to be much cheaper, especially if your whole pregnancy falls into one calendar year (or mostly in one calendar year). most hospitals are now doing "global billing" for Obstetrical care, meaning that for all your prenatal and delivery care you'll get charged after you've delivered and been discharged from the hospital. things like labs and ultrasounds will get charged along the way. so if you get pregnant between now and March/early april that plan would work out well...if not, you'd be in for a year of high premiums only to have the majority of your pregnancy-related medical charges charged to your 2017 insurance (assuming a normal, healthy pregnancy).

Remember that having a baby is a life event that would allow you to change your insurance elections after the baby is born. I have a friend due at the end of January who is using this to her advantage, she selected the high-premium PPO plan offered by our employer, will use that to cover all her prenatal and delivery charges then will switch to the low-premium HDHP for the rest of 2016. Because of the ACA all preventative care is free, even on a HDHP, so things like well-child visits, vaccines, contraceptives, etc. should be covered at 100%.

I'll have to ask him to have him ask his employer how the deductibles work, but I believe it just shifts to a family if I get added on (instead of being two separate).

For the baby, I definitely was thinking Kaiser is the best way to go. That was actually my plan before the new premium rates came out... switch to Kaiser from the HDHP I'm currently on just for having the baby. But the Kaiser premiums jumped significantly (like $50 a paycheck) for 2016 compared to 2015, and the HDHP premiums went down $20ish per check, so I had to re-evaluate, especially since I could be paying those high premiums for awhile if we don't get pregnant right away.

And yes, all the preventative care on all the plans is 100% covered.

Yes, there is some federal law that stipulates a minimum deductible for individual deductibles to be seperate buckets on a family plan. the deductibles on my company's HDHP jumped from $2500 to $2600 because at $2600 individuals contribute to their own buckets (our family deductible is $5200)...so for example once I meet my $2600 deductible all my care is under the 10% co-insurance until I meet the $4000 individual MaxOOP. H and/or baby have their own $2600 deductibles to meet after that (though co-insurance kicks in once our total cost hits $5200. I Believe $2600 is the cut-off, so if your H's deductible is $2500, then you may all be contributing to one "family bucket". That sucks

I might try to sit down with someone in benefits at your H's company and get the real scoop on what happens if you and children are on his plan. Especially since you know that your H will be on that expensive prescription.

hoffse · November 2015

abrewer5 said:

julieanne912 said:

simplyelise said:

julieanne912 said:
Also like I've mentioned, our finances are still separate. The idea that my husband should be paying my health insurance premiums (which I would have baby or no baby) just because he makes more sounds crazy to me, but I've been independent for a long time.

I 100% agree with you on this (and I know I'm also the minority not the majority on this board when it comes to separate finances). H's health insurance plan is significantly cheaper and better than the plans I'm offered thru work, but if I get put on it his bi-weekly insurance payment will double, so I'm hesitant to do it. If we go that route, which makes the most sense, I'm planning to set up an auto-pay to his account to cover my portion of the insurance.
I also agree fully with @kmurphy2131 I would not want to be limited to one hospital/provider. If there's a true emergency what happens if that's not the closest hospital to you? Or if another hospital is better equipped to handle to your case? Then you're stuck with a huge bill after the fact to deal with.

I would honestly look at his options too and pick the plan between the both of you that has the lowest OOP max. If you feel the need to pay him back for your share, that's fine. It might also make sense to look at switching him over to yours in the year you give birth. I'm just saying run all the numbers as a household and figure out what would cost you guys the least amount of money in the aggregate. You guys can always make each other square after the fact. You may find it's cheapest to insure baby on his/her own, but that rarely happens. I wouldn't assume that keeping your H on his own single plan while paying for a family plan to cover baby makes sense.

Others have mentioned this, but with your H's treatments you need to understand what the individual buckets within the family plan options are. It may not cost that much more for his treatments since he's the only one receiving them - a $10k OOP max on a family plan is for the ENTIRE family, not necessarily just him. His share may be $2500 or $5000. Who knows - it's worth finding out, because that's the only way you'll be able to compare apples to apples.

If you guys switched him to yours (or vice versa), his employer may also give him an insurance stipend. A lot of companies do that for employees who are not being insured under the company's plan because it saves them a crapton of money. Plenty of employers are willing to split that savings with employees.

Finally, when doing this math I think with little kids you need to assume you will go through baby's share of the deductible for the first couple of years of life. We have many friends having babies right now, and it seems like every couple of months one of the kids gets a stomach virus they can't get under control and has to go to children's. Or another kid develops a food allergy and is now going through testing. Or another one takes a bad fall and breaks something. Little kids go to the doctor a lot. If your kid is incredibly healthy and never gets sick even as a baby, then you can adjust your plan later if needed. I just wouldn't pick a plan based on that assumption because I get the sense it's pretty rare.

Obviously the limited choices in providers is another issue, and it would be worth paying more to have options.

brij2006 · November 2015

Everyone is pointing out the global billing part. While it is great and wonderful, I will point out that not everything falls under that. My doctor offered it and that's what we went with, knowing everything would be billed in February when baby was born and I would only have to worry about deductible and max OOP for 2014.

However, I had blood work done right after a positive test that was not part of the global, then 2 extra ultrasounds because of a placenta and cervix issue, and then in November she decided to give us a scare and not move for 3 days straight. So to the hospital we went to be hooked up to monitors.

Those items alone, while are considered a routine/precautionary visit, were not part of the global billing. Hence why I met my deductible in 2014, even with taking advantage of global billing.

And for what it's worth, my pregnancy was considered low risk and I received the okay to labor at home as long as possible because of it.

Another insurance question (sorry long)

Re: Another insurance question (sorry long)

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