Navigating HDHP Insurance for childbirth

Navigating HDHP Insurance for childbirth
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Looking for some help here, I’ve gotten used to HDHP over the last few years for regular check ups, some diagnostics, etc. but nothing as big as this.

We had our first child on a really good Kaiser HMO plan, I never saw any bills for anything.

Obviously this time around it is going to be different. Our PPO network is very large, a full PPO network (Anthem, if that matters), not a skinny network.

  • Using Anthem’s “Castlight” site I’ve got a estimate of $3,000-$5,000 OOP for L&D. (Total cost $12k-$16k)

  • Max Out of Pocket on the plan is $6,500, Ded. is $1700. Wife is unsure about Epidural, let’s assume we go with one but I’m not sure if it is included in the above estimate.

  • We’re both a little spooked about the idea of someone out of network showing up on delivery day and billing us. Anything that can be done about this?

  • Are all Prenatal checks, ultrasounds, etc, still considered preventative care, even on HDHP?

I’m looking at the majority of bills being around L&D early next year (Feb). I’m looking into ways to minimize those bills if possible.

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I’m guessing you can’t switch back to Kaiser? :open_mouth:

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I can’t switch back to that Kaiser plan, it was with a previous employer. There’s talk at current employer they’re going to remove the current Kaiser options for 2019 entirely.

But your comment brings up an idea @scripta, the timing of due date (early Feb.) means that switching plans during open enrollment for a Jan 1 start is possible. I’d be on the hook for the difference in premiums for 2 months. Birth of the baby would be qualifying event and allow a switch back to old plan. Current Kaiser plan is $400 more per month for the family. There are also higher end PPO options with $4k max OOP, for around $300 more per month.

You should absolutely do this. The old open enrollment/childbirth/qualifying event switcharoo. Don’t let anyone let you feel bad about it either.

The medical/insurance system in the usa is a wreck. Take advantage of what you can.

I hope all goes well and everyone is healthy.

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From my experience with two different HDHP’s, here’s what you can expect:

  1. I don’t think Castlight is going to be very helpful here. There are just too many things going on. For us, we were billed for pre-natal OB, pre-natal labs/imaging, delivery room/doctor, baby’s hospital stay, anesthesiologist, pediatrician, and probably other things I’m forgetting.
  2. Personally, I would just budget on hitting OOP because it’s possible you will. Stuff happens, and even though your wife may not want an epidural, she might need one, or even a C-section. How likely you are to hit OOP depends on what your co-insurance is after deductible. Remember also you’ll likely have at least some pediatrician visits not covered by preventative care.
  3. This is something I’d talk to your OB/hospital about. Others may have better advice.
  4. It depends on insurance. Some consider pre-natal OB to be preventative, others not. I haven’t seen a plan that considers ultrasounds and labs to be preventative. For us, we were billed for labs/ultra-sounds at the time of service. OB + L&D were billed at time of delivery. Given the pregnancy is spanning two calendar years, you’ll have two limits/OOP to deal with.
  5. One thing to consider if you switch insurances to Kaiser is that your current OB (since I’m guessing you’ll have to switch) will bill you for most of their services. You’ll also have to transfer all records a month before delivery, which could become problematic (I’m sure doable, but extra stress).

Best of luck!

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Do you live in a state that has an exchange? If so, buy the best HMO coverage you can get and pay the full premium for your wife. You already know that will be way cheaper than any HDHP/CDHP plan.

As mentioned, you might have to wait for an open enrollment window, and they usually ask now if you need childbirth coverage.

Just to update a bit: There’s plenty in our HSA for OOP max x2 even, but why drain it?

@SpeedingLunatic I will lose zero sleep over switching and maximizing my options. Not that I’ll be sleeping much anyway :wink:

@rasheed We do have an exchange (CoveredCA). I’ll look into it as well. How does dual insurance work though? Or would I need to decline Wife’s insurance at work? I thought one of the questions for coverage on an exchange is “does your employer offer you coverage?” I’ll need to make sure the OB takes obamacare as well. Fortunately (or not) my employer does not offer coverage.

@physwa Thanks for all of those responses. I think switching to Kaiser that close would be tough as well. Kaiser also will probably ‘toss out’ some of the scans and stuff and want their own done. (duplicate effort, tough on a 7Mo pregnant wife).

Looks like I have some homework to do in November when both work and CoveredCA open enrollment hit.

If you are not going for any subsidy in CoveredCA, you can buy coverage even if your employer offers coverage during open enrollment. You just pay the full premium.

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I did not know that. Another possible moving piece. :slight_smile: Thanks again

She probably needs regular checkups and ultrasound anyway, so the effort should not be duplicate. On my employer’s KP plan all prenatal visits are free (no co-pays/deductibles). They have classes for expecting parents as well, some free, some for a nominal fee.

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Our prenatal care was bundled into the “global” fee for the OB/GYN. They charged a single fee (say $3,000 or so) for their time from the first prenatal visit (after our first visit to get the pregnancy confirmed which was a regular copay/office visit) through delivery. Although we didn’t get billed for all of that care until after the birth, the OB office made us make partial payments toward our expected contribution after they talked with the insurance company.

We had our first kid on an HMO plan, the second on PPO and it was crazy the difference. Same hospital, same doctor 3 years apart and a $2,500 difference. HMO cost us $200ish and the PPO was $2,700ish. Would not want to see how much it would be on our current HDHP.

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I’ve been on a HDHP since I’ve been at my current employer. My wife had her own insurance when she had our first child. She is now staying home and I have the full family covered on my HDHP. I have always planned on switching from the HDHP to the more expensive traditional POS plan my employer offers during open enrollment, either when my wife gets pregnant again or we plan on her getting pregnant again. When I consider the likelihood of the pregnancy spanning two coverage years, I feel like that makes the decision a no-brainer.

I appreciate all the info here from everyone. I’m definitely going to switch. The question now becomes:

  • ACA Platinum Plan (would cost around $1k in premiums) I would keep HDHP plan in place and have dual insurance.

  • Employer HMO plan (unfortunately I don’t get to see this plan until Nov., it could be Kaiser, could be someone else).

  • Highest end PPO plan from wife’s employer ($4k OOP Max, $1k deductable), probably an additional $600 in premiums.

I’m probably not looking at Kaiser (unless my wife says she wants to go back). She’s up for a lot, but I don’t think she would want to switch that close to delivery. Have to respect that because I’m not the one doing the hard work.

In theory yes, but Kaiser won’t want to talk to you until you’re on their plan and then they’ll need to schedule appointments, transfer records, etc… I’m not saying it can’t get done, but there’s a high likelihood of something getting lost somewhere. Personally, I wouldn’t want to take that risk or that stress. Especially if the pregnancy has any complications (which you might not know about until just before the switch).

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Make sure you read all the rules about secondary insurance and figure out which plan will be primary and how secondary will pay. It’s rarely a good deal from what I’ve read.

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Agreed. If possible, don’t keep the employer coverage for wife if you go to exchange (Plat plan).

Rasheed

Update:

Open enrollment arrived. Switched to the highest PPO plan offered. $420 extra per month (Jan & Feb).

Knocks OOP max down from 6500 to $4,000

Knocks Ded. from $1700 to $1,100.

Figure my $850 in additional premium is saving me $2500.

It doesn’t help me with the issue of an out of network provider showing up on game day.

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I’ve got 24 hours to decide if this is what I want to do as well. Up until today, I was leaning toward changing to my employers best PPO plan, but now I’m leaning the other way. Here’s my situation:

HDHP costs $6,252/yr
PPO costs $8,220/yr
Employer contributes $2,800 to my HSA if I choose the HDHP.
So the difference in price is actually $8,220-($6,252-$2,800)=$4,768.

So what do I get for $4,768 more per year?..
The per-person deductible goes from $2,800 to $750. The pre- and post-natal care is $200 total per pregnancy with a disclaimer that it doesn’t include inpatient stays; and ultrasounds are $50 a pop. I don’t know if that disclaimer means that the inpatient stay is covered completely or covered at 80% or something else. When my wife was on her previous employer’s insurance with similar coverage, we ended up paying 20% of a nearly $10,000 delivery bill and another 20% of the anesthesiologist’s bill (can’t remember how much that was, but it cost us at least another $200).

If the HDHP actually covers everything for my wife once we spend $2,800, I can’t see why It would make sense to switch. Even if the delivery was FREE (which I assume it isn’t), we are still losing $4,768 to save $2,800. Unless our baby had complications that resulted in his/her own hospital stay and another $2,800 deductible, wouldn’t the HDHP definitely be cheaper in my case? And even in that worst case scenario, the HDHP will only be $832 more, right?

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Sorry I’m not following. The Deductible and OOP max are not the same amount, correct? You could also have this issue on HDHP as well–get the initial bill and baby needs to return (say Jaundice) after 1-2 days, you’d be on the hook for a portion of that 2nd stay up to your OOP max.

Also why aren’t you considering switching back after the baby is born? No need to pay the entire year at the higher amount unless your wife is due in the later part of the year.