New Kid and ACA

[lifeisshort123]

Have a new kid.

I have insurance through my job which is a good deal for me, not a great deal for my family, but does not meet the threshold of “unaffordable” in ACA.

My wife is self-employed and we buy her insurance through the marketplace.  She is not eligible for subsidies, but nevertheless we buy her better coverage for less money than my work plan would be.

Just had a baby very early.  Baby was delivered, but will be in NICU for a while.  Want to make sure we have insurance done correctly.  Our goal is to put her on a “marketplace plan”, but a different level of care than my wife’s current plan.

1. Mom’s insurance will cover delivery of baby
2. Fill out marketplace coverage for “special enrollment period”/qualifying life event should be done ASAP, but no later than 60 days of birth.
3. Select a plan for the baby (chose the plan with widest provider network and lowest out of pocket costs, given the stay in NICU for a long time is going to exceed any of those costs).
4. Pay premium for plan we select
5. Baby is now insured.

Am I missing something here? Just want to make sure I am not making a decision I will regret later. 

[economista]

I just want to make sure you know about the parent "birthday rule" when covering the baby for those first 30 days. You are required to have BOTH of your insurance plans cover the baby and whichever of your birthdays come first in the year must be the primary. Here are more details: https://www.npr.org/sections/health-shots/2021/01/27/961196647/birthday-rule-blindsides-first-time-parents-with-a-mammoth-medical-bill#:~:text=In%20most%20cases%2C%20they%20don,parent%27s%20insurance%20is%20considered%20secondary.

[lifeisshort123]

Yes, I ran into that.  Thankfully my wife (with the better plan) has the earlier birthday!  However, the one thing I find confusing about that - her plan is primary, my plan is secondary.  Do I just tell my insurance info to the hospital and they will handle the billing?

While our daughter is covered under our plans fro the first 30 days, that is included in our existing policy.  I am not required to purchase a second (or third) additional policy for her correct?

[economista]

I think you just give them your info as well. In my case my husband was on my insurance so we didn't have to deal with it. You are correct that for the first 30 days you do not need to add her to your policy, but it often takes time for them to process any plan changes so you probably want to get started on it asap. You will probably need to order a copy of the birth cert before she can be added.

We discovered that my work has a policy that any new babies must be added within 60 days of birth, and of course are covered automatically for the first 30 days. It left a 30 day window though where she wasn't technically covered. Our peds office usually sees newborns at 1wk, 2wk, 4wk and 8wk, so during that window we generally wouldn't have needed coverage. However, both of my kids were born with troubles that required specialist care during that window. I knew their insurance would be back-dated to cover the 30 day gap, but the providers all had to list us as self-pay anyway and made us sign consent forms to be self-pay. Thankfully it all worked out but it was a ton of added stress.

You mentioned your daughter is in the NICU. I'm not sure which state you are in but in CO if your child is in the NICU for 30 days they are automatically enrolled in CHIP, which is medicaid for children, regardless of income levels. Then they are covered under that for the first year. If you are in there that long you might end up in a similar situation.

[yachi]

I recently read that they made changes to the ACA affordability rules, and now it *also* looks at whether or not the plan is affordable for a couple and family.  It used to just look at affordability for the individual.  If they made those changes after you made the decision for marketplace without subsidies, it's worth a new look.