Author Topic: Mustachian pregnancy  (Read 1126 times)

put me in coach

  • 5 O'Clock Shadow
  • *
  • Posts: 21
Mustachian pregnancy
« on: September 10, 2018, 10:43:08 AM »
Hello,

My SO and i are looking to get pregnant soon. This will be our first child. We live in the Bay Area, CA. September=open enrollment for me. We're checking to see whether this (my open enrollment) counts as a qualifying event for my SO. Currently, we are both on the Kaiser plan from my work. Generally, we're in great health. We don't use our health insurance very often, but we have enjoyed Kaiser (seems like we're in the minority there) because it's all centralized and convenient and access is quick and easy. I know with pregnancy and expenses, there are so many variables (like High-risk pregnancy factors, like unplanned obstetrical surgery, epidurals, premature births, incubation or extended stays in the neonatal unit, NICU or maternity ward), and a lot of them may or may not happen/be necessary.

1. What are key medical expenses that we should be anticipating and comparing for the pregnancy, the birth, and soon after?

2. I've heard that if we're able to get SO on SO's insurance at work, and keep us both still on Kaiser (double coverage for her), it may work out that each plan would pay the out-of-pocket costs charged by the other, and the financial benefit of this might be more than the extra premiums you would pay for the double coverage. Anyone know of any DPs with trying this out? Key factors to consider when trying to calculate whether we should go for this (if we're able to)?

3. What are good ways to try to evaluate these prices among insurance offerings?

4. Other key strategies to keep in mind?

5. Most specifically, I work for a public agency and have access to the following health care options ($premium): Anthem Blue Cross Select ($1,662.88) Anthem Blue Cross Traditional ($2,222.26), Health Net SmartCare ($1,803.10), Kaiser Permanente ($1,536.50), PERS Choice Bay Area ($1,732.54), PERS Select ($1,086.38), PERSCare Bay Area ($2,263.36). If we decide to keep us both on my insurance, anybody have good/bad experiences with a pregnancy and child birth with these health plans?

From my understanding from brief research, the following is to be considered (please help me dispel anything untrue or identify anything controversial among the following):
a. Usually high prem, low deductible is favorable for pregnancy and child birth health care.
b. Ensure the following are provided in-network: Gyno, hospital of choice, anesthesiologist group, closest NICU unit (anything I'm missing?).
c. Among expenses to consider, include Prenatal services, health screenings, lab work, ultrasounds and birthing classes across all three trimesters (anything else I'm missing?).
d. Pediatric and/or routine and emergency care after baby is born, plus necessary immunizations, vaccinations and checkups in the early months and years of baby’s life, and common baby illnesses can all be covered by a completely different health care plan which i would pick within 30 days of child's birth and the coverage would be retroactively applied dating back to child birth.

Thanks for helping me weave through this complicated stuff!

onlykelsey

  • Handlebar Stache
  • *****
  • Posts: 1987
Re: Mustachian pregnancy
« Reply #1 on: September 10, 2018, 11:02:38 AM »
Hello,

My SO and i are looking to get pregnant soon. This will be our first child. We live in the Bay Area, CA. September=open enrollment for me. We're checking to see whether this (my open enrollment) counts as a qualifying event for my SO. Currently, we are both on the Kaiser plan from my work. Generally, we're in great health. We don't use our health insurance very often, but we have enjoyed Kaiser (seems like we're in the minority there) because it's all centralized and convenient and access is quick and easy. I know with pregnancy and expenses, there are so many variables (like High-risk pregnancy factors, like unplanned obstetrical surgery, epidurals, premature births, incubation or extended stays in the neonatal unit, NICU or maternity ward), and a lot of them may or may not happen/be necessary.

1. What are key medical expenses that we should be anticipating and comparing for the pregnancy, the birth, and soon after?

2. I've heard that if we're able to get SO on SO's insurance at work, and keep us both still on Kaiser (double coverage for her), it may work out that each plan would pay the out-of-pocket costs charged by the other, and the financial benefit of this might be more than the extra premiums you would pay for the double coverage. Anyone know of any DPs with trying this out? Key factors to consider when trying to calculate whether we should go for this (if we're able to)?

3. What are good ways to try to evaluate these prices among insurance offerings?

4. Other key strategies to keep in mind?

5. Most specifically, I work for a public agency and have access to the following health care options ($premium): Anthem Blue Cross Select ($1,662.88) Anthem Blue Cross Traditional ($2,222.26), Health Net SmartCare ($1,803.10), Kaiser Permanente ($1,536.50), PERS Choice Bay Area ($1,732.54), PERS Select ($1,086.38), PERSCare Bay Area ($2,263.36). If we decide to keep us both on my insurance, anybody have good/bad experiences with a pregnancy and child birth with these health plans?

From my understanding from brief research, the following is to be considered (please help me dispel anything untrue or identify anything controversial among the following):
a. Usually high prem, low deductible is favorable for pregnancy and child birth health care.
b. Ensure the following are provided in-network: Gyno, hospital of choice, anesthesiologist group, closest NICU unit (anything I'm missing?).
c. Among expenses to consider, include Prenatal services, health screenings, lab work, ultrasounds and birthing classes across all three trimesters (anything else I'm missing?).
d. Pediatric and/or routine and emergency care after baby is born, plus necessary immunizations, vaccinations and checkups in the early months and years of baby’s life, and common baby illnesses can all be covered by a completely different health care plan which i would pick within 30 days of child's birth and the coverage would be retroactively applied dating back to child birth.

Thanks for helping me weave through this complicated stuff!

Some slightly OT advice that nonetheless would have been very helpful to me:
-take a child birth class.  I really think Bradley is the best for actually learning the biology of pregnancy and giving birth, which I was woefully behind on, frankly.  Mine was taught by a CNM/NP
-in the child birth class, ask the teacher what unexpected expenses/services students ended up using.

In particular, I think literally every woman could benefit from pelvic floor therapy during and after pregnancy.  I ended up with pretty severe trauma and separation of my pelvis at two joints, so need serious amounts in order to function afterward.  See what your insurance covers and who is in network (my insurance covered it but no one in my area really accepted insurance so I paid 400/hour!)

chaskavitch

  • Pencil Stache
  • ****
  • Posts: 502
  • Age: 32
  • Location: Fort Collins, CO
Re: Mustachian pregnancy
« Reply #2 on: September 10, 2018, 11:27:10 AM »
Hello,

My SO and i are looking to get pregnant soon. This will be our first child. We live in the Bay Area, CA. September=open enrollment for me. We're checking to see whether this (my open enrollment) counts as a qualifying event for my SO. Currently, we are both on the Kaiser plan from my work. Generally, we're in great health. We don't use our health insurance very often, but we have enjoyed Kaiser (seems like we're in the minority there) because it's all centralized and convenient and access is quick and easy. I know with pregnancy and expenses, there are so many variables (like High-risk pregnancy factors, like unplanned obstetrical surgery, epidurals, premature births, incubation or extended stays in the neonatal unit, NICU or maternity ward), and a lot of them may or may not happen/be necessary.

1. What are key medical expenses that we should be anticipating and comparing for the pregnancy, the birth, and soon after?

2. I've heard that if we're able to get SO on SO's insurance at work, and keep us both still on Kaiser (double coverage for her), it may work out that each plan would pay the out-of-pocket costs charged by the other, and the financial benefit of this might be more than the extra premiums you would pay for the double coverage. Anyone know of any DPs with trying this out? Key factors to consider when trying to calculate whether we should go for this (if we're able to)?

3. What are good ways to try to evaluate these prices among insurance offerings?

4. Other key strategies to keep in mind?

5. Most specifically, I work for a public agency and have access to the following health care options ($premium): Anthem Blue Cross Select ($1,662.88) Anthem Blue Cross Traditional ($2,222.26), Health Net SmartCare ($1,803.10), Kaiser Permanente ($1,536.50), PERS Choice Bay Area ($1,732.54), PERS Select ($1,086.38), PERSCare Bay Area ($2,263.36). If we decide to keep us both on my insurance, anybody have good/bad experiences with a pregnancy and child birth with these health plans?

From my understanding from brief research, the following is to be considered (please help me dispel anything untrue or identify anything controversial among the following):
a. Usually high prem, low deductible is favorable for pregnancy and child birth health care.
b. Ensure the following are provided in-network: Gyno, hospital of choice, anesthesiologist group, closest NICU unit (anything I'm missing?).
c. Among expenses to consider, include Prenatal services, health screenings, lab work, ultrasounds and birthing classes across all three trimesters (anything else I'm missing?).
d. Pediatric and/or routine and emergency care after baby is born, plus necessary immunizations, vaccinations and checkups in the early months and years of baby’s life, and common baby illnesses can all be covered by a completely different health care plan which i would pick within 30 days of child's birth and the coverage would be retroactively applied dating back to child birth.

Thanks for helping me weave through this complicated stuff!

Some slightly OT advice that nonetheless would have been very helpful to me:
-take a child birth class.  I really think Bradley is the best for actually learning the biology of pregnancy and giving birth, which I was woefully behind on, frankly.  Mine was taught by a CNM/NP
-in the child birth class, ask the teacher what unexpected expenses/services students ended up using.

In particular, I think literally every woman could benefit from pelvic floor therapy during and after pregnancy.  I ended up with pretty severe trauma and separation of my pelvis at two joints, so need serious amounts in order to function afterward.  See what your insurance covers and who is in network (my insurance covered it but no one in my area really accepted insurance so I paid 400/hour!)

Sorry to hijack, but what does separation of your pelvis feel like @onlykelsey ?  I had some severe pain after my son was born, but only after walking or standing for too long, and it felt like it was in my bones, not in a muscle or anything.  It went away eventually, but I'm worried it will happen again (I'm due in March), and I'd like more info so I can fix it more quickly.

Lucky Recardito

  • Stubble
  • **
  • Posts: 208
  • Location: Major US City
Re: Mustachian pregnancy
« Reply #3 on: September 10, 2018, 11:54:10 AM »

Most specifically, I work for a public agency and have access to the following health care options ($premium): Anthem Blue Cross Select ($1,662.88) Anthem Blue Cross Traditional ($2,222.26), Health Net SmartCare ($1,803.10), Kaiser Permanente ($1,536.50), PERS Choice Bay Area ($1,732.54), PERS Select ($1,086.38), PERSCare Bay Area ($2,263.36). If we decide to keep us both on my insurance, anybody have good/bad experiences with a pregnancy and child birth with these health plans?

From my understanding from brief research, the following is to be considered (please help me dispel anything untrue or identify anything controversial among the following):
a. Usually high prem, low deductible is favorable for pregnancy and child birth health care.
b. Ensure the following are provided in-network: Gyno, hospital of choice, anesthesiologist group, closest NICU unit (anything I'm missing?).
c. Among expenses to consider, include Prenatal services, health screenings, lab work, ultrasounds and birthing classes across all three trimesters (anything else I'm missing?).
d. Pediatric and/or routine and emergency care after baby is born, plus necessary immunizations, vaccinations and checkups in the early months and years of baby’s life, and common baby illnesses can all be covered by a completely different health care plan which i would pick within 30 days of child's birth and the coverage would be retroactively applied dating back to child birth.

Thanks for helping me weave through this complicated stuff!

In the year that your partner gives birth, you will almost certainly meet the deductible for any plan with the birth alone, let alone ante/post-natal care. I believe the average cost for an uncomplicated vaginal delivery is $10-$20K presently, which should be above any deductible. (You can check averages in your area using Heath Care Bluebook.) 

I'm not sure what the costs you listed are (monthly premiums? yearly premiums?) -- but what I would suggest is that for each plan available to you, tally up the deductible + a full year of premiums, since that's probably a pretty good proxy for what you'll actually pay. If any of the plans include a co-insurance payment (or any shared cost) for in-network treatment after meeting the deductible, also add in an estimate there.

Made-up example #1: $5,000 deductible & out-of-pocket max; $1,000/mo premium = $17,000 total estimated cost

Made-up example #2: $2,500 deductible; $2,000/mo premium; 10% coinsurance on in-network care after deducible, to OOP max of $10,000 (estimate... maybe $15k in costs over deductible = $1,500) = $28,000 total estimated cost

If any plans include an HSA, HRA, or FSA into which your employer makes a contribution, subtract the value of that contribution from the total cost.

(NB: I'm ignoring the potential impact of tax treatment of these dollars here to keep the math really simple and back-of-the-napkin -- but you could gussy up these calculations by adjusting premium costs for your tax rate, since medical premiums are typically not taxable, and/or by assuming you'd max out any HSA/HRA/FSA available to you, which would lower your overall tax burden.)

Since some of the plans available to you are narrow networks (eg Kaiser), it's probably worth making sure you're happy with the choices available within those plans (of docs, of specialties, and of locations of clinics/hospitals), since going out-of-network tends to blow the budget no matter what plan you're on.

And another coverage to check: infertility treatments. It sounds like you're just at the beginning of your TTC journey, and I'm sure the future looks rosy -- but not everyone has an easy go of it. Consider checking whether any plans include coverage for infertility treatments, which can otherwise cost tens of thousands of dollars out-of-pocket.

chaskavitch

  • Pencil Stache
  • ****
  • Posts: 502
  • Age: 32
  • Location: Fort Collins, CO
Re: Mustachian pregnancy
« Reply #4 on: September 10, 2018, 12:01:27 PM »
For some on topic reply -

1) For a typical pregnancy with an uncomplicated delivery, I was billed for prenatal care, the hospital itself and associated costs (L&D room, recovery room, medication like ibuprofen, food), an anesthesiologist for an epidural, the medication for the epidural, and newborn costs (room, vitamin K, etc).  For just the hospital, the total bill was >$15,000, I think, plus $5000 for the prenatal care at a different facility.  We only paid our out of pocket max, fortunately, because everything was in-network. 

Prior to delivery, even though I was in a "plan" with my midwife clinic, all of the labs and ultrasounds were billed separately from the $5000 final bill.  I don't know if this is typical, but since they're often through outside services, maybe it is.  If you can keep your pregnancy inside a single calendar year it's helpful :)

2) I have zero idea about this.  I had Aflac hospital indemnity plan, which was nice, because they ended up paying us about $1700 for the hospital stay and epidural.  Totally separate from your actual insurance plan, though.

3), 4) Make sure everywhere you're considering is in-network. 

5) I have no comments on the specific insurance plans, but I'd do a comparison on your total out of pocket costs, probably assuming you're going to reach your out of pocket max.  Make sure to include your premiums, deductible, and co-insurance before you reach the max, as well as tax savings from maxing out a FSA vs a HSA.

Looking at the insurance plans I have available currently, we come out ahead by ~ $50 with a high deductible plan, but that's solely because my employer contributes to my HSA.  Otherwise the traditional plan would be far and away the better choice.

d) A birth counts as a qualifying event, and generally you have 30 days from the birth to add your new child to your current health insurance plan.  The plan itself won't change, just the number of people on it, and yes it should retroactively include everything from birth forward.  Most health plans will cover all vaccines and well-baby and well-child visits for years.  Anything else like pinkeye or crazy "my baby won't stop crying oh God what's wrong?!?" visits will be just like a regular visit that goes toward your deductible.

Like onlykelsey said, take some classes, especially birth and breastfeeding classes.  You really have no idea how some of this stuff works, and it's pretty crazy.  I took a pain management class, which was moderately helpful?  You might want to check out the Fertility, Baby, and Pregnancy journal here on the forums - there is a nice list of books/resources for pregnancy/birth, trying to conceive, child rearing, etc, you could look at. 

seattlecyclone

  • Magnum Stache
  • ******
  • Posts: 4407
  • Age: 33
  • Location: Seattle, WA
Re: Mustachian pregnancy
« Reply #5 on: September 10, 2018, 12:09:21 PM »
Here's a copy-and-paste from my recent reply to another thread, in which I shared how double high-deductible coverage worked out for us.

If you and your spouse both have workplace health plans available, look into covering the birth mom and/or baby on both health plans, effective on the date of birth. The birth is a qualifying event for change of coverage, so you don't need to be locked into paying double premiums for the whole year.

For both of our kids, what we did was had my wife on her plan alone for the entire year. As a single person on her employer's plan she had a lower deductible and out-of-pocket max than if she was on a family plan with me, or with the kid added to hers. Then we added both her and the baby to my plan effective on the delivery date. Both plans are HDHPs.

How do the payments work with double coverage?
* Each person on two plans has one plan as "primary" and one as "secondary." Adults on their own employer's plan always have that plan as primary for them, while the other is secondary. If a dependent is on two parents' plans, whichever parent has a birthday falling earlier in the year is primary and the other is secondary.
* Each plan looks at each claim, and computes how much it would pay as if there isn't another plan in the picture. The primary will pay the amount they normally would, while the secondary will pay the amount they normally would unless that would add up to more than the total bill, in which case they only pay the remainder.

Here's a real-life example from when our second kid was born earlier this year.
My wife's plan (for a single person) has a $2,000 deductible, $3,000 out-of-pocket max, and 20% coinsurance after the deductible.
My plan (for a family) has a $3,000 deductible, $6,000 out-of-pocket max, and 10% coinsurance after the deductible.

She paid about $500 this calendar year prior to the delivery date for various prenatal stuff, leaving $1,500 left in the deductible.
The hospital charged her about $7,500 for hospital room and board. With her plan she had $1,500 left on the deductible, plus 20% of the next $5,000 brings her to the out-of-pocket max. Her insurance paid $5,000, leaving $2,500 remaining. We would have had to pay that out of our own pockets if she was only on one insurance plan.

However because we signed her up on my plan too, let's look at how much they paid. The expense was $7,500. Subtract the $3,000 deductible and $450 coinsurance (10% of the remaining $4,500), and my plan is willing to pay $4,050. That's more than the $2,500 that we still owed after my wife's insurance paid their part, so my insurance pays $2,500 and we owe nothing out of pocket. This also satisfies the deductible on my plan, meaning we only pay the coinsurance for any of my son's bills.

His hospital bill was $4,000. The fact that my wife's bill used up the deductible meant we only owed $400 for him rather than $3,100 ($3,000 deductible plus 10% of the remaining $1,000).

Just for those two expenses, double-covering my wife meant that our out-of-pocket costs went down by $5,200. That's a lot more than the extra premiums we're paying to add my wife to my plan for half the year.

Note however that when you have double coverage, the amount you pay can depend on the order in which claims are received by the insurance company. If my son's bill had gone in first, we would have owed the full $3,100 on that one because the deductible had not been satisfied at that point. My wife's bill would still have ended up being fully covered between the two plans. That's a $2,700 difference just based on which bill goes in first!

For that reason we were proactive about getting the hospital to bill the secondary insurance for my wife's expenses right away. We called their billing department the day we got back from the hospital. Where our son was concerned, we played it a bit coy and said we had not made a final decision about which plan to cover him under, as we have 30 days from the birth to make that choice. They assumed we'd probably cover him under my wife's plan and we didn't disabuse them of that notion until after we saw the claim go in for my wife's bill.

As to expenses prior to the birth, each pregnancy we had a couple of ultrasounds (full price: a few hundred each) and a few lab tests (on the order of $10-100 each) prior to the delivery. In both cases we ended up paying the full cost because we had not yet met my wife's deductible for the year, and she was only covered under one plan until the delivery date.

We took a childbirth preparation class. Highly recommended. I don't think our insurance covers this at all, but my employer kicked in a portion under their education reimbursement program. Worth looking into.

The obstetric practice we used has a policy of rolling their physician charges for prenatal visits, the birthing, and one postnatal visit all into one bill. Not sure how common that is. For our double coverage scenario this practice worked in our favor, by eliminating a bunch of bills for prenatal visits that would have otherwise been charged to my wife's individual deductible before the birth, but instead should be fully covered by the two insurance plans.
« Last Edit: September 10, 2018, 12:11:58 PM by seattlecyclone »

seattlecyclone

  • Magnum Stache
  • ******
  • Posts: 4407
  • Age: 33
  • Location: Seattle, WA
Re: Mustachian pregnancy
« Reply #6 on: September 10, 2018, 12:14:33 PM »
d) A birth counts as a qualifying event, and generally you have 30 days from the birth to add your new child to your current health insurance plan.  The plan itself won't change, just the number of people on it, and yes it should retroactively include everything from birth forward.  Most health plans will cover all vaccines and well-baby and well-child visits for years.  Anything else like pinkeye or crazy "my baby won't stop crying oh God what's wrong?!?" visits will be just like a regular visit that goes toward your deductible.

For a high-deductible plan the bolded bit is not necessarily correct. When you add a second person to a health plan (especially a high-deductible one) the deductible and out-of-pocket max often increase since you switched from an individual plan to a family plan. This may turn out to be a better deal than adding a kid to the dad's account and then paying two deductibles, but something to be aware of.

chaskavitch

  • Pencil Stache
  • ****
  • Posts: 502
  • Age: 32
  • Location: Fort Collins, CO
Re: Mustachian pregnancy
« Reply #7 on: September 10, 2018, 12:21:56 PM »
d) A birth counts as a qualifying event, and generally you have 30 days from the birth to add your new child to your current health insurance plan.  The plan itself won't change, just the number of people on it, and yes it should retroactively include everything from birth forward.  Most health plans will cover all vaccines and well-baby and well-child visits for years.  Anything else like pinkeye or crazy "my baby won't stop crying oh God what's wrong?!?" visits will be just like a regular visit that goes toward your deductible.

For a high-deductible plan the bolded bit is not necessarily correct. When you add a second person to a health plan (especially a high-deductible one) the deductible and out-of-pocket max often increase since you switched from an individual plan to a family plan. This may turn out to be a better deal than adding a kid to the dad's account and then paying two deductibles, but something to be aware of.

Sorry, good point.  I was running with the assumption that they would end up with both parents remaining on the same health plan, like they are now.  What I was trying to say was that you don't get to change anything about your health plan (switch from a traditional to a HDHP, jump between PPO plans, etc) just because it's a qualifying event.  You'll remain on the same health plan, with another person added, which may or may not change your premiums, deductible, or OOP max. 

put me in coach

  • 5 O'Clock Shadow
  • *
  • Posts: 21
Re: Mustachian pregnancy
« Reply #8 on: September 10, 2018, 06:02:06 PM »
Wow thanks, everyone! This gives me a lot to go on, and a very concrete start to calculations.

I don't have any FSA options at work, and the HSA option has no employer-contribution. I'll have to look further into it if this option would be worth our while.

(And no worries on hijacking the post!)

CindyBS

  • Bristles
  • ***
  • Posts: 325
Re: Mustachian pregnancy
« Reply #9 on: September 10, 2018, 07:49:53 PM »
I don't have pregnancy specific advice, but we do max out our health insurance deductible every year.

Some tips - set up the HSA if at all possible.  They will probably issue a debit card - don't use it.

Instead, use a credit card for all medical expenses that gives the rewards of your choice.  You know you will be hit with the majority of the bills around the birth (if you haven't maxed out on prenatal care).  This the a good time to open a new card with a nice sign up bonus that has a minimum spend of several thousand dollars. 

Then reimburse yourself from the HSA.

So the discounts are:  reward from card, sign up bonus for card, then whatever you would have paid in taxes on the amount from the HSA since that is tax free money.

Less than 1 hour of work that can save you hundreds of $$$.

KS

  • Stubble
  • **
  • Posts: 207
Re: Mustachian pregnancy
« Reply #10 on: September 10, 2018, 10:31:48 PM »
I was/am very, very lucky to have a somewhat unique insurance option available through my husband's job, that resulted in my total out of pocket cost for prenatal care and delivery/hospital stay being something ridiculous like $150-200. (No I'm not missing any zeros there.) But for a little Bay Area cost perspective I remember reviewing the summary of charges for my very uncomplicated very fast delivery and 2 day stay at big name local hospital and with no insurance would have been billed approximately $50k for that part. Not sure if I ever looked into what the prenatal would have cost. Another top choice hospital in the area is maybe a little less than that, but I don't have direct comparison since my closest friend who delivered there ended up needing C-section so obviously her billing would be totally different. Also maybe helpful info from her, anesthesiologist billed her epidural by 15 minute increments. Don't know if that's the same everywhere, I didn't see that part itemized on the summary I looked at for mine.

Agree with other poster about making sure you're happy with the hospital/medical team for whatever option you are considering! I knew the insurance we chose would be amazing in that it included everything and out of pocket would be low (though how low actually caught me by surprise, I expected a little more) but I did a TON of research into who I'd go with before we signed up, because it was important to me to feel 100% comfortable with my care and I was willing to spend more if needed to get that. My insurance was similar to Kaiser in that as long as you stay in network, all the costs for typical stuff is just included and seamless, and there's a lot to be said for the peace of mind that brings not getting a thousand random bills you have to figure out, so if you feel good about your local options for that it could be a great way to go. My two cents!

chaskavitch

  • Pencil Stache
  • ****
  • Posts: 502
  • Age: 32
  • Location: Fort Collins, CO
Re: Mustachian pregnancy
« Reply #11 on: September 11, 2018, 06:17:55 AM »
I don't have pregnancy specific advice, but we do max out our health insurance deductible every year.

Some tips - set up the HSA if at all possible.  They will probably issue a debit card - don't use it.

Instead, use a credit card for all medical expenses that gives the rewards of your choice.  You know you will be hit with the majority of the bills around the birth (if you haven't maxed out on prenatal care).  This the a good time to open a new card with a nice sign up bonus that has a minimum spend of several thousand dollars. 

Then reimburse yourself from the HSA.

So the discounts are:  reward from card, sign up bonus for card, then whatever you would have paid in taxes on the amount from the HSA since that is tax free money.

Less than 1 hour of work that can save you hundreds of $$$.

This is a genius idea.  I'm very glad you mentioned this, thank you.

The_Pretender

  • 5 O'Clock Shadow
  • *
  • Posts: 20
  • Location: Midwest
Re: Mustachian pregnancy
« Reply #12 on: September 11, 2018, 10:26:26 AM »
Just recently went through this.  There were a few bills from prenatal visits leading up to the big day.  These mostly were billed as incurred.  My DW took the time to research the hospitals near us.  Our approach was to look for a minimum level 3 NICU with access to Level 4.  She also took time to get people's opinions from the area combined with proximity to home and work.

1.) Plan on hitting your Max OOP, unless you have an insane Max. so simple math:  Max OOP for family (include the baby headcount) + Premiums.  We have had HSA for a few years so we had more than enough of our Max OOP covered in savings there... but my Max went up $500 since my plan changed from a Me+1 to a Me+2.  Example:  $4,300 + $1,000 premiums

2.) Plan on a few lab blood and glucose tests (Make sure you know what lab is covered).  The lab we were covered under was just a short walk to another building.

3.) There are visits I believe starting at 8 weeks and is every 4 weeks until 32 weeks then every 2 until 36 then weekly visits until 40.  Not sure, as your hospital may be different, but we received bills for these visits leading up to the delivery.

4.) Maybe consider your HSA...  You can contribute to this before taxes and FiCA.  You will also be able to contribute up to 6,900 into your HSA... check your Max OOP in your plan.  Some plans I've heard of have Max OOP of 10,000+ which is greater than what you can contribute tax free and would probably be less advantageous compared to other plans.  Research HSA in more depth, but the benefit comes when you invest.  Our HSA investments had strong enough returns the past few years to cover our pregnancy (tax free).

5.)  Someone mentioned already.  Plan on looking at getting a CC card with sign up bonus.  You will hit those bonus hurdles and can further use this to offset the pregnancy or go on a nice trip once the baby is born.

@chaskavitch my DW had similar pains and had damage to her pelvic floor.  The pain was so bad she had troubles walking up and down our stairs and was afraid of falling while carrying the baby.  She is getting physical therapy to try and get it to heal back properly.  Supposedly this is very common, but gets un-diagnosed as many women may not even report it and write off as "just part of the healing".  My DW did this for a couple weeks but at her 6 week post-partum appointment she brought it up.  I guess if you receive an epidural it increases these odds as you can not feel how much pressure you're applying.  Also happens when your partner/nurse pulls your leg too high during pushing.

Good luck and congrats on the this. It sure does change your life and perspective.  In our case it has helped us become better at cooking in home and getting closer to mustachianism.

put me in coach

  • 5 O'Clock Shadow
  • *
  • Posts: 21
Re: Mustachian pregnancy
« Reply #13 on: September 12, 2018, 12:29:57 PM »
Just recently went through this.  There were a few bills from prenatal visits leading up to the big day.  These mostly were billed as incurred.  My DW took the time to research the hospitals near us.  Our approach was to look for a minimum level 3 NICU with access to Level 4.  She also took time to get people's opinions from the area combined with proximity to home and work.

1.) Plan on hitting your Max OOP, unless you have an insane Max. so simple math:  Max OOP for family (include the baby headcount) + Premiums.  We have had HSA for a few years so we had more than enough of our Max OOP covered in savings there... but my Max went up $500 since my plan changed from a Me+1 to a Me+2.  Example:  $4,300 + $1,000 premiums

2.) Plan on a few lab blood and glucose tests (Make sure you know what lab is covered).  The lab we were covered under was just a short walk to another building.

3.) There are visits I believe starting at 8 weeks and is every 4 weeks until 32 weeks then every 2 until 36 then weekly visits until 40.  Not sure, as your hospital may be different, but we received bills for these visits leading up to the delivery.

4.) Maybe consider your HSA...  You can contribute to this before taxes and FiCA.  You will also be able to contribute up to 6,900 into your HSA... check your Max OOP in your plan.  Some plans I've heard of have Max OOP of 10,000+ which is greater than what you can contribute tax free and would probably be less advantageous compared to other plans.  Research HSA in more depth, but the benefit comes when you invest.  Our HSA investments had strong enough returns the past few years to cover our pregnancy (tax free).

5.)  Someone mentioned already.  Plan on looking at getting a CC card with sign up bonus.  You will hit those bonus hurdles and can further use this to offset the pregnancy or go on a nice trip once the baby is born.

@chaskavitch my DW had similar pains and had damage to her pelvic floor.  The pain was so bad she had troubles walking up and down our stairs and was afraid of falling while carrying the baby.  She is getting physical therapy to try and get it to heal back properly.  Supposedly this is very common, but gets un-diagnosed as many women may not even report it and write off as "just part of the healing".  My DW did this for a couple weeks but at her 6 week post-partum appointment she brought it up.  I guess if you receive an epidural it increases these odds as you can not feel how much pressure you're applying.  Also happens when your partner/nurse pulls your leg too high during pushing.

Good luck and congrats on the this. It sure does change your life and perspective.  In our case it has helped us become better at cooking in home and getting closer to mustachianism.

This is awesome. Thanks for all this.


onlykelsey

  • Handlebar Stache
  • *****
  • Posts: 1987
Re: Mustachian pregnancy
« Reply #14 on: September 12, 2018, 12:45:24 PM »
One more vague comment!  If you're low-risk and comfortable with it, consider making your pregnancy as low-info as possible.  We do WAY MORE prenatal testing than is standard in most countries.  Obviously I am not suggesting you obtain no prenatal care, but if you're unsure what the point of a certain test or scan is, ask.  Ask what happens if you don't get it, as well.  This is awful advice if you have a high risk pregnancy, obviously.

I find CNMs to be the best pregnancy service providers (again, obviously not true if you're having triplets or a C-section or something), and I would definitely look at them if you haven't already.

put me in coach

  • 5 O'Clock Shadow
  • *
  • Posts: 21
Re: Mustachian pregnancy
« Reply #15 on: September 14, 2018, 11:19:42 AM »
One more vague comment!  If you're low-risk and comfortable with it, consider making your pregnancy as low-info as possible.  We do WAY MORE prenatal testing than is standard in most countries.  Obviously I am not suggesting you obtain no prenatal care, but if you're unsure what the point of a certain test or scan is, ask.  Ask what happens if you don't get it, as well.  This is awful advice if you have a high risk pregnancy, obviously.

I find CNMs to be the best pregnancy service providers (again, obviously not true if you're having triplets or a C-section or something), and I would definitely look at them if you haven't already.

This is standard me with doctor visits; however, we went to Mexico in August (Zika) and are in our mid-30s. I'll still ask to try to weed out a couple unnecessary expenses though. Or at least ask how my SO would feel about that. Thanks.

FLBiker

  • Pencil Stache
  • ****
  • Posts: 876
  • Age: 42
Re: Mustachian pregnancy
« Reply #16 on: September 14, 2018, 11:35:33 AM »
We did an HMO (which we both have from work) and I believe paid $250 for everything, including pre-natal.  We had a $100 visit to the ER as well.  In other words, based on my limited experience, and HMO plan works great.

One thing that was important to us was to try to go as natural as possible (which still having the option of intervention available, if needed).  We were lucky to find a birthing group that kept DW with a CNM, up until things got dicey, then they had an ob/gyn w/ a NICU team on standby.  And we did this in a hospital.  Everything worked out great.

Another tip I've heard (that we couldn't do) is that some supplemental insurance (ie disability) can be used for pregnancy / delivery.  Ours couldn't, though, so we didn't sign up.  Good luck!

kimmarg

  • Pencil Stache
  • ****
  • Posts: 665
  • Location: Northern New England
Re: Mustachian pregnancy
« Reply #17 on: September 14, 2018, 11:44:26 AM »
Just a counter point. I would put a fair bit of weight on what providers are easy and what insurance companies are easy. I was on a slightly cheaper plan for a while with horrible customer service that required me to go to very specific locations. I went to the higher priced plan for pregnancy and it was wonderful to just have a $175 hospital copay and not worry about anything else. New babies are stressful enough.

robartsd

  • Handlebar Stache
  • *****
  • Posts: 1741
  • Location: Northern California
Re: Mustachian pregnancy
« Reply #18 on: September 14, 2018, 12:17:40 PM »
5. Most specifically, I work for a public agency and have access to the following health care options ($premium): Anthem Blue Cross Select ($1,662.88) Anthem Blue Cross Traditional ($2,222.26), Health Net SmartCare ($1,803.10), Kaiser Permanente ($1,536.50), PERS Choice Bay Area ($1,732.54), PERS Select ($1,086.38), PERSCare Bay Area ($2,263.36). If we decide to keep us both on my insurance, anybody have good/bad experiences with a pregnancy and child birth with these health plans?
The only plan with lower premium is PERS Select (a limited network PPO) - I'm pretty sure you want an HMO for a pregnancy. Most of the CalPERS offered HMOs have pretty close to the same copay structure. Kaiser does have a $15 copay for outpatient surgery where the others are $0 and Kaiser your only option for ongoing medication (supply >30 days) is to use the mail order pharmacy (which is the cheapest option anyway). Your pregnancy related visits should have $0 copay with Kaiser (not sure about other CalPERS HMO plans - not on the summary comparisons). https://www.calpers.ca.gov/docs/2018-kaiser-basic-summary-benefits-coverage.pdf

erutio

  • Stubble
  • **
  • Posts: 209
Re: Mustachian pregnancy
« Reply #19 on: September 14, 2018, 12:53:40 PM »
My brother's wife just delivered their first baby at Kaiser 2 weeks ago.   They had a great experience through the whole process, despite some of Kaiser's reputation.  The pregnancy was great but she did have a complicated delivery.  I will ask him for any insights, and post back later.

catccc

  • Handlebar Stache
  • *****
  • Posts: 1609
  • Location: SE PA
Re: Mustachian pregnancy
« Reply #20 on: September 14, 2018, 01:01:43 PM »
I happened to have great insurance when I had my kids under two different plans.  The first one required a $50 copay (yup, for everything), and the second required a $100-$150 copay.   I can't exactly remember but it really wasn't much at all.  I think that copay would have been the same whether I opted for an OB assisted hospital birth, or if I opted for the midwife attended Birth Center choice that I ultimately selected.  But ordering interventions like epidurals and c-sections (which would have required transfer to the hospital across the street) occur so infrequently in birth centers, so perhaps if there is an additional cost to those options, a birth center could save you money?  Also, there are other great benefits to natural birth for both mom and baby.  Just a thought.  I know a lot of people are too scared about the "what ifs" to go the birth center or home birth route, but some people don't even know it is an option.  Just an FYI.

FWIW, choosing the birth center was the best call ever for us.  Natural childbirth isn't all that difficult, and having such a non-medical approach to birth makes sense for most moms and babies.  I got to labor how I wanted without constantly being checked for progress or being hooked up to monitoring stuff.  The pre-natal care I got was top notch, I am certain I would not have had the face time with an OB that I had with my team of midwives.  They watched out for me at every step and I couldn't have asked for better support.  Also, you get to eat during labor at the birth center, something they don't let you do at the hospital (in case you need a c-section).  So instead of being fed ice chips for the duration of my labor, I could actually fuel my body to do the work of having a baby.   Labor started on a Sunday night and I didn't have her until Tuesday morning, so I would have been super hangry if eating was not an option...

formerlydivorcedmom

  • Pencil Stache
  • ****
  • Posts: 568
  • Location: Texas
Re: Mustachian pregnancy
« Reply #21 on: September 14, 2018, 02:36:53 PM »
d. Pediatric and/or routine and emergency care after baby is born, plus necessary immunizations, vaccinations and checkups in the early months and years of baby’s life, and common baby illnesses can all be covered by a completely different health care plan which i would pick within 30 days of child's birth and the coverage would be retroactively applied dating back to child birth.


Note that this can be a PITA.  When my oldest was born, my H and I each had insurance through our employers.  Mine had a TERRIFIC deal on childbirth ($25 co-pay period).  His was better at regular stuff.  When I pre-registered at the hospital, I listed H's insurance for the baby and mine for me.

Baby was a preemie and had to stay in the hospital for 3 weeks.  The hospital charged it all to my insurance, as they assume that baby is on mom's, even though I had specifically told them that wasn't the case.  It took a freak-ton of paperwork and phone calls to get all the charges straightened out....at a time when I did not have the physical or emotional energy to take care of all that (I'd rather spend my time with my newborn, or, you know, SLEEPING).

If your future baby is a normal delivery and healthy, then you shouldn't have much issue putting him/her on a different insurance, but if there are complications and resulting hospital charges, ugh.

As for whether open enrollment is a qualifying event - only if one or both of you gain or lose coverage.  So, during my open enrollment I did not sign up for insurance.  The day my insurance coverage ended, I could sign up on H's insurance as my loss of insurance was a qualifying event.  (Same if I had suddenly gained it - that was a qualifying event to get off of his.)