Health Insurance! Ugh!

MorningStar · #1 (**permalink**) 08-13-2008, 01:38 PM

So our baby is due in 5 weeks and my husband's company just decided that they are changing health insurance companies effective Sept. 1st. The good news is, the premium is lower. The bad news is, our new deductible will be $3000. We fulfilled my individual deductible with our current company, which is $350 ($1050 for family), but the new plan doesn't do individual deductibles within the family plan. So we're looking at possibly getting a whopping bill for $2650. After the deductible, we pay 20%. I think my husband is going to have a stroke. Our prescriptions go towards the deductible too, so that's going to be difficult too.

We could handle the deductible a lot better if it were little by little, but we don't know how we're going to manage paying it all at once. After the deductible is met, we would have to pay 20% for the hospital bill and we still have to pay 10% for all of my maternity visits with our current plan, which they bill you for at the end.

This is what I'm hoping for - that the baby will be ready to be born in August. A week from Sunday, I am allowed to go into labor, but I'm not due until Sept. 14th. My doctor won't induce for financial reasons (well, I wouldn't either), but I'm hoping she'll just be ready.

With this new plan we are getting an HSA account. Anyone familiar with those? It sounds cool, but I had no idea how much we could really afford to contribute to it each month. The company is going to pay over $100 into it.

browneyes · #2 (**permalink**) 08-13-2008, 01:56 PM

What state do you live in?I know that here in the state of IL that we offer free baby care for the mommy and baby both before and after the baby is born. They usally bill your insurance first then pay the dec or what ever portion that you are left to pay with.

MorningStar · #3 (**permalink**) 08-13-2008, 02:12 PM

We live in Washington State but I don't know of anything like that. Sounds nice!

We have something called "Basic Health", but we don't qualify financially. It's reduced insurance. We used to be on it and all maternity care was free.

bytor2112 · #4 (**permalink**) 08-13-2008, 02:36 PM

Quote:

Originally Posted by MorningStar

So our baby is due in 5 weeks and my husband's company just decided that they are changing health insurance companies effective Sept. 1st. The good news is, the premium is lower. The bad news is, our new deductible will be $3000. We fulfilled my individual deductible with our current company, which is $350 ($1050 for family), but the new plan doesn't do individual deductibles within the family plan. So we're looking at possibly getting a whopping bill for $2650. After the deductible, we pay 20%. I think my husband is going to have a stroke. Our prescriptions go towards the deductible too, so that's going to be difficult too.

We could handle the deductible a lot better if it were little by little, but we don't know how we're going to manage paying it all at once. After the deductible is met, we would have to pay 20% for the hospital bill and we still have to pay 10% for all of my maternity visits with our current plan, which they bill you for at the end.

This is what I'm hoping for - that the baby will be ready to be born in August. A week from Sunday, I am allowed to go into labor, but I'm not due until Sept. 14th. My doctor won't induce for financial reasons (well, I wouldn't either), but I'm hoping she'll just be ready.

With this new plan we are getting an HSA account. Anyone familiar with those? It sounds cool, but I had no idea how much we could really afford to contribute to it each month. The company is going to pay over $100 into it.

A Health Savings Account allows you to set aside money for future use if you are in a high deductible health insurance plan. As a family you can contribute up to $5650.00 per year. If your husband company offers a salary reduction plan...then it would be pre-tax dollars.

If not salary reduction, then you can contribute and it is considered an "above the line tax deduction." In other words, if you earn $100,000 per year and you contribute $5650.00, your taxable income is reduced by that amount.

funkymonkey · #5 (**permalink**) 08-13-2008, 02:42 PM

Health savings accounts are pretax as well. So $100 in your savings account, is the same as $80 on your paycheck.

However, the recent laws with health savings accounts makes it a little more high maintenance. You have to keep all our receipts and they won't pay on prescriptions from drug stores initally...only after you mail in the receipt.
But if you're willing to pay the extra attention to it, it's worth the money.

Bookmeister · #6 (**permalink**) 08-13-2008, 04:24 PM

Just make absolutely certain that the new insurance carrier doesn't class your pregnancy as a "pre-existing condition" that they won't cover. It often happens that a new carrier will have a 30 to 90 day exclusion for pre-existing conditions. During this period, the new carrier will not cover any of the costs of treatment for a pre-existing condition.

Just some free legal advice...

pam · #7 (**permalink**) 08-13-2008, 05:27 PM

Would they not allow a "grandfather clause" for those that were already in treatment? Like tail end of a pregnancy? I was a medical claims adjustor for 6 years and there were many plans that allowed this when there was a change mid stream.

pam · #8 (**permalink**) 08-13-2008, 05:28 PM

Quote:

Originally Posted by Bookmeister

Just make absolutely certain that the new insurance carrier doesn't class your pregnancy as a "pre-existing condition" that they won't cover. It often happens that a new carrier will have a 30 to 90 exclusion for pre-existing conditions. During this period, the new carrier will not cover any of the costs of treatment for a pre-existing condition.

Just some free legal advice...

It is illegal to have a pregnancy listed as a prexisting condition.

Pregnancy is not considered a pre-existing condition. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was signed into law by President Bill Clinton. With this act came the provision that no group health insurance plan can exclude pregnancy as a pre-existing condition. In addition, these plans cannot exclude newborns or adopted children under age 18 as long as you have enrolled the child within 30 days of the birth or adoption.

Palerider · #9 (**permalink**) 08-13-2008, 09:31 PM

Quote:

Originally Posted by MorningStar

So our baby is due in 5 weeks and my husband's company just decided that they are changing health insurance companies effective Sept. 1st. The good news is, the premium is lower. The bad news is, our new deductible will be $3000. We fulfilled my individual deductible with our current company, which is $350 ($1050 for family), but the new plan doesn't do individual deductibles within the family plan. So we're looking at possibly getting a whopping bill for $2650. After the deductible, we pay 20%. I think my husband is going to have a stroke. Our prescriptions go towards the deductible too, so that's going to be difficult too.

We could handle the deductible a lot better if it were little by little, but we don't know how we're going to manage paying it all at once. After the deductible is met, we would have to pay 20% for the hospital bill and we still have to pay 10% for all of my maternity visits with our current plan, which they bill you for at the end.

This is what I'm hoping for - that the baby will be ready to be born in August. A week from Sunday, I am allowed to go into labor, but I'm not due until Sept. 14th. My doctor won't induce for financial reasons (well, I wouldn't either), but I'm hoping she'll just be ready.

With this new plan we are getting an HSA account. Anyone familiar with those? It sounds cool, but I had no idea how much we could really afford to contribute to it each month. The company is going to pay over $100 into it.

this plan is very similar to the we have where I work. One guy hurt his back and the Doc told him he needed to purchase a certain kind of mattress. He asked the Doc to write that on a prescription and he turned it in to the insurance. If I understand it right because of this move he met the deductible for the year.

Palerider · #10 (**permalink**) 08-13-2008, 09:32 PM

Quote:

Originally Posted by funkymonkey

Health savings accounts are pretax as well. So $100 in your savings account, is the same as $80 on your paycheck.

However, the recent laws with health savings accounts makes it a little more high maintenance. You have to keep all our receipts and they won't pay on prescriptions from drug stores initally...only after you mail in the receipt.
But if you're willing to pay the extra attention to it, it's worth the money.

several of the people I work with love this program...