Need advice on insurance (delivery of baby)

[theodorealexander]

Good morning everyone,

My wife’s employment recently ended and she will be without insurance starting on the first. She is also eight months pregnant and we’re looking to get her signed under a new plan. I don’t really understand the options we were presented with and I need some help in choosing the best one for birthing/delivery.

We were presented with three plans and I feel the first plan can safely be ruled out, but the second two plans I’m unsure of what to make of them. The second plan “seems” better, but being a cheaper option I feel like I’m missing something. The below two options are both in-network and I’ve excluded out of network as the hospital is in network.

Plan 2 deductible is: Deductible:

N/A Drug Deductible: N/A
Combined Medical and Drug Deductible: Individual: $7,400 / Family: $7400 per person | $14800 per group

Annual out of pocket is:

Medical Benefits: N/A
Drug Benefits: N/A Medical and Drug Benefits Total: Individual: $9,100 / Family: $9,100 per person | $18,200 per group

Labor/delivery - hospital stay:

$400 Copay after deductible
In-Network Only: Copay is applied per Stay.

Plan 3 (more expensive option):

Deductible:

Deductible: Individual: $0 / Family: $0 per person | $0 per group
Combined Medical and Drug Deductible: N/A

Annual out of pocket maximum:

Medical Benefits: N/A
Drug Benefits: N/A Medical and Drug Benefits Total: Individual: $9,100 / Family: $9,100 per person | $18,200 per group

Labor/delivery - hospital stay:

$3,000
In-Network Only: The cost share is applied for a max of 2 days per admission.

Any guidance would be greatly appreciated.

 

[jriz]

@theodorealexander Oh man. In this situation I would be on cobra so fast it would make your head spin.

Continuity of care and having already done five months of the year under this deductible are huge. You are going to blow through that out of pocket immediately upon giving birth and then some.

I would do cobra through the end of the year and then decide during open enrollment. Don't forget to add baby to the plan within 30 days! You also get a special enrollment in the exchanges with baby arriving, and if you really cannot afford it, pregnant women and their newborn babies are automatically eligible for Medicaid as a class.

Those are horror show out of pocket costs. How much of those have you satisfied already on the employer plan. Consider that before you choose one of these and give up that employer plan on cobra.

 

[theodorealexander]

@jriz This is probably a dumb question but I’ve literally never heard of cobra. What is that?

 

[plamp]

@theodorealexander You should receive cobra notice in mail within 30 days after employment ends. Do check with your employer if they pay for cobra for a few extended months. Some employers do pay up to 1-3 months after termination.

 

[theodorealexander]

@plamp Is this something your employer opts for? She was told that her benefits wouldn’t be extended. Works for a public school.

 

[jriz]

@theodorealexander Was she rifed? Is she under contract or non-continuing? Usually benefits are for the year if continuing and will go through the summer because of the contract year. If not continuing, they would end at the end of the last paid month.

Still look at the cost of cobra against these and max out of pocket. She and the baby will most certainly hit it.

 

[theodorealexander]

@jriz She was planning to resign anyway, but they are letting her go at the end of the year regardless. Her position is no longer needed.

 

[jriz]

@theodorealexander Para or cert? And is it WA? And was she in a continuing contract? Not trying to dox. Conditions.are super specific in WA right now and budget cuts are causing a lot of what you are sharing.

 

[theodorealexander]

@jriz Nah, not in WA and she’s a full time employee, but not salary.

 

[jriz]

@theodorealexander Ah. Ok. Well, good luck.

 

[theodorealexander]

@jriz Thanks, we’ll see!

 

[plamp]

@theodorealexander Seems like it. My employer wrote that clause down in the document of separation.

Something like pay cobra until when.

 

[plamp]

@theodorealexander The biggest cost is on delivery. I paid 500 on my insurance. So all you need to compare is the exact cost on that day among the plans.

 

[theodorealexander]

@plamp Where as if I’m understanding, she’ll pay $3000 with plan 3.

 

[jriz]

@theodorealexander The right to continue the employer plan at full out of pocket cost for up to 18 months. Why did your wife's employment end? Did she resign because she was unable to continue working? Because that is a prime use of FMLA which is protected and she would still have her insurance that way.

 

[elliminator11]

@theodorealexander Is there a co-Insurance? If not Plan 2: your plan starts paying after pay $7,400 first.

 

[theodorealexander]

@elliminator11 Which given the circumstances would effectively make it as though we had no insurance. We would have to pay for the entire delivery out of pocket before the plan started paying most likely.

 

[elliminator11]

@theodorealexander Otherwise people will get insurance and cancel it once their treatment / situation is over.

Do you have Medical insurance from your job? if yes, you should be able to cover your spouse as losing job is a life event.

 

[ifitry]

@theodorealexander easier if you just post a link or screenshot to the sob's for each plan

 

[theodorealexander]

@ifitry Here we go!

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