Author Topic: Need help getting health insurance for my newborn  (Read 904 times)

Bikesy

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Need help getting health insurance for my newborn
« on: September 11, 2017, 06:50:00 AM »
So I will preface this post by saying I messed up and am now in a tough spot regarding health insurance for my new child.  I had 60 days to add newborn to my work policy and failed to.  I thought I had done it (company has record of me adding dependent but failing to hit submit button at the end.  I already appealed and was denied so cannot get coverage through my job).  The 60 day rule also applies for coverage through the exchange so I can't get coverage there.  That leaves me with 2 options:

1.  Self insure until open enrollment next year in April.
2. Contact insurers directly to get a policy for my newborn.

I have a couple questions and could use some help with what to do next.  Regarding potential penalties for not having coverage, our HHI is around 200k, NW is around 300k, planning to get a tax refund of approximately 6-8k this year.

- What would be the general feeling on self insuring a 3 mo old for 7 months? She is healthy and we would pay for some shots but thats about it.

- What would the potential penalties be for not having coverage for a child for part of the year?

- Any advice on what type of coverage and through which provider and potential monthly costs?


Thanks so much for the help!  If anyone needs more info please let me know.


milliemchi

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Re: Need help getting health insurance for my newborn
« Reply #1 on: September 11, 2017, 09:19:59 AM »
The potential penalty would be you discovering that your baby has one of the many conditions that can affect an infant and are potentially expensive to treat.

Also, babies get sick all the time. There may be a string of ear infections. There may be diaper rashes that need medical attention. There may be scary-looking eczema. There may be hip displasia. There may be reflux. There may be diarrhea that requires an ER visit.  Even a simple fever sufficiently high for sufficiently long will require an ER visit. These are just the run-of-the-mill conditions (that I've seen with my 2 kids), and there can always be bigger, more serious things. I have two friends whose babies had broken bones after a fall, and it happened to my brother too, when he was an infant.

Many states have programs that make sure kids and mothers (up to 1 year after birth) are covered. There is usually a sliding scale. Check into that.

cchrissyy

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Re: Need help getting health insurance for my newborn
« Reply #2 on: September 11, 2017, 10:41:17 AM »
hey, congrats on the baby!

find out what programs your state and county have for uninsured children. maybe there is a sliding scale and you're at the top of the scale but at least you'd get coverage.

if nothing comes of that, buy insurance on the open market, right away

I would never let a child be uninsured for 7 months. Days maybe but not months! it is entirely possible you could get wiped out by large medical bills for a contagious illness, a genetic condition, or accidents that happen at any age such as falls, car accidents, or burns.   I've had a child with medical bills well over $1m, he was age 7 at the time but it could have happened at any age (cancer), and during those hospital stays I saw babies in the oncology wing, the ER, and the ICU all the time. Remember the flu, RSV, or whooping cough is very serious for infants. And babies who seem to be born healthy can often have congenital conditions discovered later in their 1st year of life.

affordablehousing

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Re: Need help getting health insurance for my newborn
« Reply #3 on: September 11, 2017, 10:54:26 AM »
Does you company provide an FSA for you? I believe you can pay premiums with that. You probably do need to get insurance unless you have a host of pediatricians and pediatric specialists in your family with a private clinic. Otherwise, your HR department sounds like clowns. Maybe you could get another job? I would certainly threaten to quit over that treatment from them. See if they care to have your services.

Acastus

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Re: Need help getting health insurance for my newborn
« Reply #4 on: September 11, 2017, 11:21:39 AM »
I would not roll the dice on self insurance. Insurance for babies should be pretty cheap. You will probably need to call a couple insurance companies in your area. Use the ACA sign up page to make a list. Web searches get clogged with CHIP references, but you make too much money to qualify. Web sites assume an adult + family is signing up. You need a person to talk to.

April is a very odd time for company signup. Most companies refresh benefits in January.

Bikesy

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Re: Need help getting health insurance for my newborn
« Reply #5 on: September 11, 2017, 11:35:18 AM »
Thanks for the advice so far!  Neither me or my wife are keen on not having insurance.  I'll look into any programs in our state for children.  To answer a couple questions...We do have FSA plans available but I'm in the HSA plan.  Also someone suggested quitting, so far I've been really happy at the company I'm at.  Its a very large company and the people I talked to acted like the 60 day sign up window wasn't as much a company policy as a federal one.

We're in a great position financially, much in part to this forum.  We're lucky that this mistake which will probably cost a couple grand won't be a huge burden.   

Penelope Vandergast

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Re: Need help getting health insurance for my newborn
« Reply #6 on: September 11, 2017, 10:04:08 PM »
Look into Obamacare (the ACA) -- you have special circumstances that may allow you to get coverage outside the regular enrollment period. These include moving, losing your employer insurance, and other similar things. You have to apply by the 23rd of the month though to get coverage for the next month -- so do it by Sept 23 to get coverage for Oct 1. If you wait until Sept 24 you won't be able to get coverage until Nov 1. www.healthcare.gov

Bikesy

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Re: Need help getting health insurance for my newborn
« Reply #7 on: September 12, 2017, 10:42:39 AM »
I already tried to get coverage through the exchange and we're ineligible.  Talked to an Obamacare rep and he said our only option would be checking with providers directly to see if someone will enroll us outside open enrollment.

Acastus

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Re: Need help getting health insurance for my newborn
« Reply #8 on: September 12, 2017, 11:24:09 AM »
Regular ACA enrollment starts November 1 - December 15. You may be able to sign up then.

Pass it on. Advertising has been cut by the current administration.

SimpleCycle

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Re: Need help getting health insurance for my newborn
« Reply #9 on: September 12, 2017, 11:33:53 AM »
If you can buy insurance, I certainly would do that.  But I suspect it's unlikely there are private insurers who enroll outside open enrollment, although some may with medical underwriting.  If you can't get private insurance, I would cross my fingers and enroll in ACA insurance in November (starting January 1st) until your company's open enrollment.

Sibley

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Re: Need help getting health insurance for my newborn
« Reply #10 on: September 12, 2017, 12:09:13 PM »
You should be able to buy an off-exchange insurance product (individual policy) at any time. Talk to your local insurance companies - Aetna, BlueCross, etc.

Righty

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Re: Need help getting health insurance for my newborn
« Reply #11 on: September 12, 2017, 12:09:42 PM »
Any way to trigger other "life events" that open up a new 60-day window for you?

SimpleCycle

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Re: Need help getting health insurance for my newborn
« Reply #12 on: September 12, 2017, 01:10:33 PM »
I think "problem with health insurance enrollment" counts as qualifying you for a Special Enrollment Period for Marketplace plans.  I would get in touch with your state's marketplace to find out.


SimpleCycle

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Re: Need help getting health insurance for my newborn
« Reply #13 on: September 12, 2017, 01:15:53 PM »
You should be able to buy an off-exchange insurance product (individual policy) at any time. Talk to your local insurance companies - Aetna, BlueCross, etc.

Underwritten individual policies do not really exist in the post-Obamacare world, and don't count as qualifying coverage for the purpose of avoiding the penalties.  At least in my state, the major insurers only offer exchange compliant products and only enroll during open enrollment or special enrollment periods.

Sibley

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Re: Need help getting health insurance for my newborn
« Reply #14 on: September 12, 2017, 01:27:30 PM »
You should be able to buy an off-exchange insurance product (individual policy) at any time. Talk to your local insurance companies - Aetna, BlueCross, etc.

Underwritten individual policies do not really exist in the post-Obamacare world, and don't count as qualifying coverage for the purpose of avoiding the penalties.  At least in my state, the major insurers only offer exchange compliant products and only enroll during open enrollment or special enrollment periods.

Um, I work for one of them, we still have off-exchange policies. They may look like exchange policies on the surface though, I don't actually do much with that section, but they're not. The system is freaking hard to navigate though. Regardless, it can't hurt to call and talk to the insurance companies.

SimpleCycle

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Re: Need help getting health insurance for my newborn
« Reply #15 on: September 12, 2017, 01:30:36 PM »
You should be able to buy an off-exchange insurance product (individual policy) at any time. Talk to your local insurance companies - Aetna, BlueCross, etc.

Underwritten individual policies do not really exist in the post-Obamacare world, and don't count as qualifying coverage for the purpose of avoiding the penalties.  At least in my state, the major insurers only offer exchange compliant products and only enroll during open enrollment or special enrollment periods.

Um, I work for one of them, we still have off-exchange policies. They may look like exchange policies on the surface though, I don't actually do much with that section, but they're not. The system is freaking hard to navigate though. Regardless, it can't hurt to call and talk to the insurance companies.

Yeah, my understanding is they are off-exchange but still function the same way as exchange policies?  I tried to buy one once and it was very, very confusing.  But I agree, it doesn't hurt to get in touch with them.

SimpleCycle

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Re: Need help getting health insurance for my newborn
« Reply #16 on: September 12, 2017, 01:38:02 PM »
You should be able to buy an off-exchange insurance product (individual policy) at any time. Talk to your local insurance companies - Aetna, BlueCross, etc.

Underwritten individual policies do not really exist in the post-Obamacare world, and don't count as qualifying coverage for the purpose of avoiding the penalties.  At least in my state, the major insurers only offer exchange compliant products and only enroll during open enrollment or special enrollment periods.

Um, I work for one of them, we still have off-exchange policies. They may look like exchange policies on the surface though, I don't actually do much with that section, but they're not. The system is freaking hard to navigate though. Regardless, it can't hurt to call and talk to the insurance companies.

Also, the off-exchange plans are not underwritten policies, they must accept all comers and cover essential health benefits, which is why they have limited enrollment periods.

iowajes

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Re: Need help getting health insurance for my newborn
« Reply #17 on: September 12, 2017, 01:42:42 PM »
Any way to trigger other "life events" that open up a new 60-day window for you?

Seriously- might be worth moving to a new apartment for the rest of the year.  A huge cost, but I wouldn't risk no insurance.

Divorce? Remarry next year? 

Bikesy

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Re: Need help getting health insurance for my newborn
« Reply #18 on: September 12, 2017, 06:19:18 PM »
Regarding the life changes for special enrollment periods, I asked the rep what qualified and its pretty specific.  There are numerous events that qualify but that event essentially has to be the reason for losing coverage.  I had asked about buying a house and was told that wouldn't qualify my daughter for coverage. 

I did contact a close family friend who sells insurance for a living, explained the situation and he said he was going to reach out and see what he could find.  I guess obamacare open enrollment would be the last resort and we'd just cross our fingers and pray for no major events in the next 3 months.

The crazy thing to me is I feel like I can't be the first person this has happened to.  The fact that its this hard to get insurance after making a "one click" mistake is insane.  We're on this forum together contemplating me divorcing and remarrying my wife just to get my 3 month old coverage ( I wouldn't entertain this option but the fact we're talking about is almost unbelievable).

I'll update when I hear back from our insurance friend.  Thank you all so much for the help so far!

Bikesy

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Re: Need help getting health insurance for my newborn
« Reply #19 on: September 12, 2017, 06:24:29 PM »
One more question...If I can't get my daughter health insurance until open enrollment will I face any penalties and if so how much?

Thanks!

milliemchi

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Re: Need help getting health insurance for my newborn
« Reply #20 on: September 12, 2017, 07:40:46 PM »
I'm looking at the flyer my son brought home from school. At the bottom, it says:
"Note: All children in the state of <state> are eligible for Low Cost/Free Health Insurance"
It doesn't give contact info, but I'm sure it would be possible to find.  Check with your state/county/city social services office.  A lot of states offer coverage for kids because it's not in anybody's interest to have uninsured kids.

Bikesy

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Re: Need help getting health insurance for my newborn
« Reply #21 on: September 13, 2017, 07:06:07 AM »
I'm looking at the flyer my son brought home from school. At the bottom, it says:
"Note: All children in the state of <state> are eligible for Low Cost/Free Health Insurance"
It doesn't give contact info, but I'm sure it would be possible to find.  Check with your state/county/city social services office.  A lot of states offer coverage for kids because it's not in anybody's interest to have uninsured kids.

I'm in FL and all I was able to find was medicaid and CHIP.  Both seem to have income requirements which make us ineligible.

iowajes

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Re: Need help getting health insurance for my newborn
« Reply #22 on: September 13, 2017, 08:24:03 AM »
I wasn't totally joking about divorce... I think I'd do that rather than keep my newborn without insurance. 
It is a serious flaw in the system that a on click mistake puts you in this position. And that your HR wouldn't reach out to be "you have to enroll by tomorrow". I mean, new parents are seriously sleep deprived!  (We had issues because the birth certificate took so long to get here and we couldn't enroll until we had it. I was so worried about the deadline.)

Is emergency insurance still a thing? When I got married I purchased a short term emergency health insurance policy from USAA that covered me for only a month. (Enough time to go skiing for my honeymoon, which I would not do uninsured, but marriage triggered me being dropped from my parent's policy and I wouldn't have time to yet get on my husband's.)   You could buy 1-month blocks until you can hit open enrollment. Edit: It looks like these are still a thing. They are quite expensive and you'd still get hit with an ACA penalty.

What about the Christian share policies that exempt you from ACA provisions?
« Last Edit: September 14, 2017, 07:14:25 AM by iowajes »

AK

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Re: Need help getting health insurance for my newborn
« Reply #23 on: September 13, 2017, 07:30:17 PM »
Call the Florida Child Health Plus Office at 1-888-540-KIDS (5437) to see if you can enroll. From what I can tell, you can apply at any time.

In my state, I thought I was ineligible for Child Health Plus (CHP) due to income being too high BUT that's not true. It simply means I have to pay the full premium and don't get any subsidy. If it's anything like my state, they make the determination at the end of the phone call. Being self-employed, we have the kids on CHP and my spouse and I are on a high-deductible, HSA eligible plan. I always thought the entire household has to be on the same health insurance plan but that's not true. It can be done any which way.

https://www.healthykids.org/kidcare/eligibility/Florida_KidCare_Income_Guidelines.pdf seems to imply you're still eligible but have to pay the full premium.
https://www.healthykids.org/kidcare/how/ for more info on applying.

Also, make sure you call no later than the 15th because the 15th of each month may be a cutoff point. In my state, if you apply from the 1st - 15th then coverage begins the first of the next month. Applying the 16th through the end of the month means coverage begins on the 1st of the following month. For example, applying on 9/16 means coverage would begin on 11/1.