Out of Pocket Max for Mom + Baby

[scottd]

I just discovered that if you add your newborn to your insurance, your out of pocket max increases.

After doing some insurance math, my husband and I (living in Los Angeles) decided to get:

Me - Platinum Plan @ 937/mo, $0 deductible, $4,500 individual out of pocket max (double this for family)

Husband - Bronze Plan @ $460/mo, $6,300 deductible, $9,100 out of pocket max (double this for family)

I am due in March. What I'm trying to understand is, for when I give birth and pay for the full delivery hospital stay, will my out of pocket expense be $4,500? Or will it increase to $9,000 if I add the newborn to my plan?

If the latter, does it make sense to add the newborn to my plan or my husband's plan? Feeling incredibly confused and frustrated at the obscene US health care costs.

 

[vladimirsurguy]

@scottd It depends on whether the deductible is “embedded” or “aggregate.” Embedded means that you would only have to meet your individual deductible before your expenses are paid. Aggregate means the whole family has to meet it first.

 

[samuelc]

@vladimirsurguy Before baby is born, you're an individual. After baby is born, you have a period of time (I believe it's 30 days) to add baby to your policy, which makes it a family policy and family deductible/OOPM would apply. Please remember that sometimes hospitals will bill the mom's plan as a "courtesy" in the first 30 days of the baby's life (for any hospital services provided to the baby). But unless you ACTIVELY add the baby to your insurance, at the end of that period of time all claims will be reversed. Vice versa, if you choose to add baby to the other parent's insurance, you'll have to notify the hospital to bill that plan for baby's expenses.

 

[lilith_eve]

@samuelc Can you choose which insurance u want to add baby to? And all claims (retroactively) go to that one?