Author Topic: Help with health insurance with new baby  (Read 29825 times)

themagicman

  • Bristles
  • ***
  • Posts: 336
  • Age: 29
  • Location: Atlanta, GA
Help with health insurance with new baby
« on: April 25, 2016, 12:36:39 PM »
Our baby is due in a few months and we are trying to figure out what our best route for health insurance is. My wife is going to become a SAHM so we are looking for coverage for both of them. Unfortunately the employer based coverage is a terrible option ($1,600 a month for them with not great deductibles/out of pocket. Mine thankfully is paid by my employer) Also, my understanding is that since my employer offers them coverage (No matter if it is very overpriced) we are not eligible for any subsidies through the exchange. I have also found this medicare program for children (Peachcare for kids in GA) which looks great but I also think we would not be eligible since my employer offers coverage.

On the exchange I have found a catastrophic plan for both my wife and child and it would be $250 a month with about a $7k out of pocket/deductible. Does anyone have experience with these. Also, assuming our baby is of average health what do you think we should expect to pay out of pocket in the first couple of years (Assuming well baby is covered)

Any tips on what you all would do or any other ways I should be looking at this?

forummm

  • Walrus Stache
  • *******
  • Posts: 7396
  • Senior Mustachian
Re: Help with health insurance with new baby
« Reply #1 on: April 25, 2016, 12:59:15 PM »
You are correct that you can't get a tax credit for a Marketplace plan because your employer offers family coverage (unless the single-only premium [i.e. for just you the employee] is more than 9.5% of your income). You can buy a plan on the Marketplace and pay full price. However, if you apply to Peachcare and they say you qualify, then you get that for free (or almost free). It's unrelated to the ACA's tax credits. You have to have a pretty low income to qualify.

themagicman

  • Bristles
  • ***
  • Posts: 336
  • Age: 29
  • Location: Atlanta, GA
Re: Help with health insurance with new baby
« Reply #2 on: April 25, 2016, 01:06:03 PM »
However, if you apply to Peachcare and they say you qualify, then you get that for free (or almost free). It's unrelated to the ACA's tax credits. You have to have a pretty low income to qualify.

I believe we would be under the income limits (assuming that it is after 401k and IRA's are taken out). The limit is $49k for a family of 3. My concern with peachcare is if my daughter would be ineligible due to having coverage offered to her from my employer. There is a form that we need to fill out when applying that checks to see if she is offered coverage but I am not sure if they makes her ineligible or not.

NoStacheOhio

  • Handlebar Stache
  • *****
  • Posts: 2143
  • Location: Cleveland
Re: Help with health insurance with new baby
« Reply #3 on: April 25, 2016, 01:13:25 PM »
However, if you apply to Peachcare and they say you qualify, then you get that for free (or almost free). It's unrelated to the ACA's tax credits. You have to have a pretty low income to qualify.

I believe we would be under the income limits (assuming that it is after 401k and IRA's are taken out). The limit is $49k for a family of 3. My concern with peachcare is if my daughter would be ineligible due to having coverage offered to her from my employer. There is a form that we need to fill out when applying that checks to see if she is offered coverage but I am not sure if they makes her ineligible or not.

A lot of state programs like that look at gross (not AGI), but what's the worst that could happen? You apply and they say no? Worth doing IMO. $1600/mo is insanity. They're basically just giving all of their employees a big middle finger. I'm sorry you're in this position.

Also, consider a different employer (I wish I wasn't serious).

themagicman

  • Bristles
  • ***
  • Posts: 336
  • Age: 29
  • Location: Atlanta, GA
Re: Help with health insurance with new baby
« Reply #4 on: April 25, 2016, 01:26:39 PM »
However, if you apply to Peachcare and they say you qualify, then you get that for free (or almost free). It's unrelated to the ACA's tax credits. You have to have a pretty low income to qualify.

I believe we would be under the income limits (assuming that it is after 401k and IRA's are taken out). The limit is $49k for a family of 3. My concern with peachcare is if my daughter would be ineligible due to having coverage offered to her from my employer. There is a form that we need to fill out when applying that checks to see if she is offered coverage but I am not sure if they makes her ineligible or not.

A lot of state programs like that look at gross (not AGI), but what's the worst that could happen? You apply and they say no? Worth doing IMO. $1600/mo is insanity. They're basically just giving all of their employees a big middle finger. I'm sorry you're in this position.

Also, consider a different employer (I wish I wasn't serious).

Yeah I have seen them ask for Gross on the site but in a different part they asked for a list of deduction, so no telling what they want. I will just try to apply and see what they say.

Assuming that is am denied, do you all think the catastrophic plan would be a good choice. How much out of pocket do you think is average for an infant?

BeanCounter

  • Handlebar Stache
  • *****
  • Posts: 1406
Re: Help with health insurance with new baby
« Reply #5 on: April 25, 2016, 01:48:42 PM »
However, if you apply to Peachcare and they say you qualify, then you get that for free (or almost free). It's unrelated to the ACA's tax credits. You have to have a pretty low income to qualify.

I believe we would be under the income limits (assuming that it is after 401k and IRA's are taken out). The limit is $49k for a family of 3. My concern with peachcare is if my daughter would be ineligible due to having coverage offered to her from my employer. There is a form that we need to fill out when applying that checks to see if she is offered coverage but I am not sure if they makes her ineligible or not.

A lot of state programs like that look at gross (not AGI), but what's the worst that could happen? You apply and they say no? Worth doing IMO. $1600/mo is insanity. They're basically just giving all of their employees a big middle finger. I'm sorry you're in this position.

Also, consider a different employer (I wish I wasn't serious).

Yeah I have seen them ask for Gross on the site but in a different part they asked for a list of deduction, so no telling what they want. I will just try to apply and see what they say.

Assuming that is am denied, do you all think the catastrophic plan would be a good choice. How much out of pocket do you think is average for an infant?
I think a catastrophic plan could be a good choice. If your baby is average health you should certainly come in under the employer cost of premium of $1,600 a month. I have two kids ages 7 and 3. In my 7 years of parenting we've never spent $19k in doctor/hospital visits. If that's really what coverage would cost from your employer for your spouse and baby I'm pretty sure you will come out ahead with a catastrophic plan. A couple things I would consider-
 -buy a plan with a good network and make sure that you ALWAYS use network providers
 -consider NOT using a pediatrician. We use a family practice because the out of pocket price for an office visit (which for a sick visit on a high deductible plan you will have to pay) is double for a pediatrician. We pay about $90 for sick visit to our family doc. Family practices have physicians who have plenty of knowledge in pediatrics and they will refer you out if they are stumped on an issue. For a visit like an ear infection or strep throat etc, the family doc knows what to do and can do it for half the cost.
-same thing for your wife, once the baby is born and she has her 6 week check up- stop seeing the OB-GYN. Go to the family doc. OB-GYN's like Ped's are specialists and can command a higher price per visit.
 -only make a visit to a Children's hospital if you absolutely have to. Children's hospitals while typically in network for a plan, do not have good discounts on services. So visits to their emergency room are outrageous. Same thing with seeing one of their specialists. Fine if it's necessary, but it will cost you.

Hope this helps a bit.

SKL-HOU

  • Pencil Stache
  • ****
  • Posts: 533
  • Location: Houston, TX
Re: Help with health insurance with new baby
« Reply #6 on: April 25, 2016, 01:53:06 PM »
I would get a good coverage for your baby. There is no telling how much infant healthcare can be. If you are unlucky like me, it could be 500k (preemie, luckily I had excellent coverage and only paid a little over 1250.)

BeanCounter

  • Handlebar Stache
  • *****
  • Posts: 1406
Re: Help with health insurance with new baby
« Reply #7 on: April 25, 2016, 01:57:13 PM »
I would get a good coverage for your baby. There is no telling how much infant healthcare can be. If you are unlucky like me, it could be 500k (preemie, luckily I had excellent coverage and only paid a little over 1250.)
Good point.
Will the baby and wife be covered under her plan until she quits after maternity leave? The timing of it all could be important. You may want to do employer coverage for the first 1-3 months to make sure baby and mom are not having any complications and THEN switch to catastrophic.

I'm a red panda

  • Walrus Stache
  • *******
  • Posts: 8011
  • Location: United States
Re: Help with health insurance with new baby
« Reply #8 on: April 25, 2016, 01:57:25 PM »
Just a question- what would it be to add your child to your insurance, but not your wife?

I worked somewhere that they paid my insurance, to add a spouse was astronomical, but just to add children wasn't so bad.

Then your wife would need to buy the separate insurance.

asiljoy

  • Bristles
  • ***
  • Posts: 406
Re: Help with health insurance with new baby
« Reply #9 on: April 25, 2016, 02:04:23 PM »
Just a question- what would it be to add your child to your insurance, but not your wife?

I worked somewhere that they paid my insurance, to add a spouse was astronomical, but just to add children wasn't so bad.

Then your wife would need to buy the separate insurance.

This is the case with my current employer. It was $30 a paycheck to add my son, $180 to add them both; but nowhere near what your'e looking at. Holy moly, that's insane.

themagicman

  • Bristles
  • ***
  • Posts: 336
  • Age: 29
  • Location: Atlanta, GA
Re: Help with health insurance with new baby
« Reply #10 on: April 25, 2016, 02:04:58 PM »
I would get a good coverage for your baby. There is no telling how much infant healthcare can be. If you are unlucky like me, it could be 500k (preemie, luckily I had excellent coverage and only paid a little over 1250.)
Good point.
Will the baby and wife be covered under her plan until she quits after maternity leave? The timing of it all could be important. You may want to do employer coverage for the first 1-3 months to make sure baby and mom are not having any complications and THEN switch to catastrophic.

Yes, thankful the baby will be on my wife's policy until she quits and her policy is great! (total cost for the babies birth is expected to be $150 and her deductible is $250) My wife and baby would have this coverage for the first few months so we would be able to see if any more expensive conditions come up for either during that time.

themagicman

  • Bristles
  • ***
  • Posts: 336
  • Age: 29
  • Location: Atlanta, GA
Re: Help with health insurance with new baby
« Reply #11 on: April 25, 2016, 02:05:57 PM »
Just a question- what would it be to add your child to your insurance, but not your wife?

I worked somewhere that they paid my insurance, to add a spouse was astronomical, but just to add children wasn't so bad.

Then your wife would need to buy the separate insurance.

$600 for just the baby. Better but still not worth it in my opinion ($2k deduct/$3k out of pocket)

BeanCounter

  • Handlebar Stache
  • *****
  • Posts: 1406
Re: Help with health insurance with new baby
« Reply #12 on: April 25, 2016, 02:13:50 PM »
Just a question- what would it be to add your child to your insurance, but not your wife?

I worked somewhere that they paid my insurance, to add a spouse was astronomical, but just to add children wasn't so bad.

Then your wife would need to buy the separate insurance.

$600 for just the baby. Better but still not worth it in my opinion ($2k deduct/$3k out of pocket)
So basically you're saving $4,200 in premiums but are at risk for $5,000 higher deductible? If I'm understanding correctly. I think it's a probably a safe risk. But to hedge my bets I'd save the difference in premiums in an HSA (need to buy a plan that allows that) so the money for the deductible is there. If you don't use it then great you can roll it over year after year.

SomedayStache

  • Pencil Stache
  • ****
  • Posts: 761
  • Live Long and Prosper
Re: Help with health insurance with new baby
« Reply #13 on: April 25, 2016, 02:14:15 PM »
I know two families where the parents choose to remain unmarried so that their children will qualify for my states equivalent of Peachcare.  These are families in long-term committed relationships that do live together-they are married in every sense of the word except that they are not married on paper.  I also know one couple that got divorced when one of them got cancer so that the cancer patient would qualify for state healthcare.   Obviously there are all sorts of potential issues with this, but hey, isn't this site about out of the box thinking?

themagicman

  • Bristles
  • ***
  • Posts: 336
  • Age: 29
  • Location: Atlanta, GA
Re: Help with health insurance with new baby
« Reply #14 on: April 25, 2016, 02:26:22 PM »
Just a question- what would it be to add your child to your insurance, but not your wife?

I worked somewhere that they paid my insurance, to add a spouse was astronomical, but just to add children wasn't so bad.

Then your wife would need to buy the separate insurance.

$600 for just the baby. Better but still not worth it in my opinion ($2k deduct/$3k out of pocket)
So basically you're saving $4,200 in premiums but are at risk for $5,000 higher deductible? If I'm understanding correctly. I think it's a probably a safe risk. But to hedge my bets I'd save the difference in premiums in an HSA (need to buy a plan that allows that) so the money for the deductible is there. If you don't use it then great you can roll it over year after year.

Yes, that is my thought process too. However, the catastrophic plans do not qualify for HSA (Not sure why this rule was put into place). To get a plan that is HSA eligible would cost at least $100 more a month which I do not think is worth the tax savings. I do not think cash flow for medical expenses will be an issue though.

seattlecyclone

  • Magnum Stache
  • ******
  • Posts: 4977
  • Age: 34
  • Location: Seattle, WA
    • My blog
Re: Help with health insurance with new baby
« Reply #15 on: April 25, 2016, 02:26:38 PM »
I'm pretty new at this parenting thing. The birth itself didn't seem to be particularly complex in any respect (no epidural, C section, NICU stay, etc.), yet we racked up approximately $15k of medical bills for two days in the hospital. Insurance ended up covering almost all of it. Having a good insurance plan through the first month or two after the birth therefore seems pretty essential. After that, if your baby seems healthy you probably won't be going too wrong by switching to a cheaper plan. Best of luck to you!

themagicman

  • Bristles
  • ***
  • Posts: 336
  • Age: 29
  • Location: Atlanta, GA
Re: Help with health insurance with new baby
« Reply #16 on: April 25, 2016, 02:29:06 PM »
I'm pretty new at this parenting thing. The birth itself didn't seem to be particularly complex in any respect (no epidural, C section, NICU stay, etc.), yet we racked up approximately $15k of medical bills for two days in the hospital. Insurance ended up covering almost all of it. Having a good insurance plan through the first month or two after the birth therefore seems pretty essential. After that, if your baby seems healthy you probably won't be going too wrong by switching to a cheaper plan. Best of luck to you!

Thanks for the insight! Yeah thankfully we will have great coverage during birth and the first couple of months (wife is a teacher)

themagicman

  • Bristles
  • ***
  • Posts: 336
  • Age: 29
  • Location: Atlanta, GA
Re: Help with health insurance with new baby
« Reply #17 on: April 25, 2016, 02:33:03 PM »
While thinking about the cost of coverage for my family I was thinking that mine is probably very expensive too. This is paid 100% by my employer but if the family cost is any inclination then it probably costs them at least $500 for my portion. Do you think that it is worth talking to my employer and trying asking for a raise in exchange for opting out of the health insurance. I could ask if I could opt out and out of the ~$6k savings for my boss receive a $5k raise (so its a win win) I could then purchase the same catastrophic plans as my wife and baby for about $150 more and use the savings to pay for potential health costs.

seattlecyclone

  • Magnum Stache
  • ******
  • Posts: 4977
  • Age: 34
  • Location: Seattle, WA
    • My blog
Re: Help with health insurance with new baby
« Reply #18 on: April 25, 2016, 02:42:54 PM »
While thinking about the cost of coverage for my family I was thinking that mine is probably very expensive too. This is paid 100% by my employer but if the family cost is any inclination then it probably costs them at least $500 for my portion. Do you think that it is worth talking to my employer and trying asking for a raise in exchange for opting out of the health insurance. I could ask if I could opt out and out of the ~$6k savings for my boss receive a $5k raise (so its a win win) I could then purchase the same catastrophic plans as my wife and baby for about $150 more and use the savings to pay for potential health costs.

Take a look at your W-2 for how much your insurance actually costs. Employers have been required to report that number for a few years now.

Proud Foot

  • Handlebar Stache
  • *****
  • Posts: 1041
Re: Help with health insurance with new baby
« Reply #19 on: April 25, 2016, 02:44:56 PM »
Something else to consider is what the cost of her current insurance would be if she were to stay on it with COBRA coverage.  Shouldn't be a problem getting the newborn on her plan before she quits, assuming she will "stay employed" until the end of her maternity leave.

themagicman

  • Bristles
  • ***
  • Posts: 336
  • Age: 29
  • Location: Atlanta, GA
Re: Help with health insurance with new baby
« Reply #20 on: April 25, 2016, 02:50:48 PM »
Something else to consider is what the cost of her current insurance would be if she were to stay on it with COBRA coverage.  Shouldn't be a problem getting the newborn on her plan before she quits, assuming she will "stay employed" until the end of her maternity leave.

Do you mean "stay employed" until the baby gets on her plan or stay employed the entire 12 weeks? The plan now is to tell them around 8 weeks that she is not coming back (If that is what we end up deciding for her not to go back)

Isn't COBRA coverage usually very, very expensive? Her plan is great and has practically not out of pocket costs we will have but I would imagine it would be over $2k a month since my plan without any employer subsidies (Which isn't nearly as good) is $1600

Proud Foot

  • Handlebar Stache
  • *****
  • Posts: 1041
Re: Help with health insurance with new baby
« Reply #21 on: April 25, 2016, 03:26:57 PM »
By "stay employed" I mean for her to not turn in her notice until the newborn is added to her policy.  Your plan to tell them around 8 weeks should be enough time to get it taken care of.

COBRA can be very expense or not.  It all depends on what the plan is as it is the same plan only the employer is no longer subsidizing your premium, you are paying the full amount.  My wife has used COBRA twice since we have been married from changing jobs and having to wait until she was eligible for benefits at her new employer.  Both times her premiums have been around $600/month.  This was only coverage for herself though so adding a dependent would drive up the cost.

Nickels Dimes Quarters

  • Stubble
  • **
  • Posts: 152
  • Location: Near the Middle
    • Nickels, Dimes & Quarters ~ It All Adds Up
Re: Help with health insurance with new baby
« Reply #22 on: April 26, 2016, 05:41:39 AM »
Congrats on the new little one!

NDQ

NoStacheOhio

  • Handlebar Stache
  • *****
  • Posts: 2143
  • Location: Cleveland
Re: Help with health insurance with new baby
« Reply #23 on: April 26, 2016, 05:50:50 AM »
Maybe try talking to your HR/healthcare plan people and see if they'll drop family coverage all together. Right now they're just making everyone's life more difficult, and increasing overhead for administration.

mm1970

  • Walrus Stache
  • *******
  • Posts: 6847
Re: Help with health insurance with new baby
« Reply #24 on: April 26, 2016, 11:33:23 AM »
I'm pretty new at this parenting thing. The birth itself didn't seem to be particularly complex in any respect (no epidural, C section, NICU stay, etc.), yet we racked up approximately $15k of medical bills for two days in the hospital. Insurance ended up covering almost all of it. Having a good insurance plan through the first month or two after the birth therefore seems pretty essential. After that, if your baby seems healthy you probably won't be going too wrong by switching to a cheaper plan. Best of luck to you!
My most recent childbirth was 2012, $14k, no epidural, one night in the hospital

asiljoy

  • Bristles
  • ***
  • Posts: 406
Re: Help with health insurance with new baby
« Reply #25 on: April 26, 2016, 11:51:52 AM »
I'm pretty new at this parenting thing. The birth itself didn't seem to be particularly complex in any respect (no epidural, C section, NICU stay, etc.), yet we racked up approximately $15k of medical bills for two days in the hospital. Insurance ended up covering almost all of it. Having a good insurance plan through the first month or two after the birth therefore seems pretty essential. After that, if your baby seems healthy you probably won't be going too wrong by switching to a cheaper plan. Best of luck to you!
My most recent childbirth was 2012, $14k, no epidural, one night in the hospital
I thought our previous insurance was OK; covered all prenatal, and then we paid out of pocket around 4,500 for delivery and follow up. Our current insurance sucks donkey and we need to make sure that all pregnancy costs land in the same calendar year; that means we're looking at 9,500 out of pocket, otherwise if it crosses years, we'll be looking at 19,000 out of pocket because almost nothing is covered this time around. Percentage co-pays for literally everything. We're coming up on the deadline for this year and trying to figure out if it's worth it to wait another year, or just suck it up if it happens.

susanna

  • 5 O'Clock Shadow
  • *
  • Posts: 25
Re: Help with health insurance with new baby
« Reply #26 on: April 26, 2016, 01:00:29 PM »
I don't have kids, but my employer has the same unaffordable dependent premiums as yours. This is a known problem with the ACA called the "family glitch". I'm sorry to hear of this, but hope you find a good solution. All the best to your family!

Axecleaver

  • Magnum Stache
  • ******
  • Posts: 3384
  • Location: New York
Re: Help with health insurance with new baby
« Reply #27 on: April 26, 2016, 02:17:56 PM »
Quote
I know two families where the parents choose to remain unmarried so that their children will qualify for my states equivalent of Peachcare. 
No judgment, but this is also known as "Medicaid fraud." Medicaid uses the household's income when determining eligibility. If the unmarried parent lives in the same household, they are likely retaining eligibility by under reporting household income. This is a fairly widespread problem.

OP, at 49k household income, you are at 243% of the 2016 FPL for a family of three. You would not be eligible for Medicaid or CHIP at this salary. (See: https://chipmedicaid.org/sites/chipmedicaid.org/files/documents/Income_Guidelines_ENG.pdf) Because of the "family glitch" mentioned above - which is a very questionable interpretation of the ACA by the IRS, to a component of the law that was clearly intended to protect people in exactly your situation - you wouldn't qualify for subsidies, either. The family glitch compares the cost of just the wage earner's health insurance to the 9.5% affordability measure, not the family cost.

Your best bet is to explore the COBRA option (you will pay 100% of the NEGOTIATED cost, which means if her employer did a better job, you could still get affordable insurance), or the catastrophic coverage at 100% for the girls. Third option is to find a job that doesn't offer health insurance, at which point you'll be eligible for heavy subsidies through the Exchange.

SomedayStache

  • Pencil Stache
  • ****
  • Posts: 761
  • Live Long and Prosper
Re: Help with health insurance with new baby
« Reply #28 on: April 27, 2016, 07:48:48 AM »
Quote
I know two families where the parents choose to remain unmarried so that their children will qualify for my states equivalent of Peachcare. 
No judgment, but this is also known as "Medicaid fraud." Medicaid uses the household's income when determining eligibility. If the unmarried parent lives in the same household, they are likely retaining eligibility by under reporting household income. This is a fairly widespread problem.

I've been wondering if this was the case.  But how can they get away with this?  I don't get it.  Since only one of them is working is the stay-at-home spouse reporting zero income?  Shouldn't this raise red flags?  Don't want to derail this post, but this isn't exactly something I can ask my friends about without appearing extremely nosy.

forummm

  • Walrus Stache
  • *******
  • Posts: 7396
  • Senior Mustachian
Re: Help with health insurance with new baby
« Reply #29 on: April 27, 2016, 09:12:03 AM »
Only 4 months in, but other than the cost of his birth, ForuMMM Jr has cost me $0 in medical care. The well child visits (1 week, 2 weeks, 1 month, 2 months, 4 months, etc) are free because of the ACA. Vaccines are free too. If he gets sick in a way that needs a doctor visit, then I'd have to pay something. So far that hasn't happened. And there isn't a lot they can do if your kid gets a virus at day care other than tell you to do the basic stuff (fluids, etc). And if something really expensive happened, you'd only be out a few grand.

themagicman

  • Bristles
  • ***
  • Posts: 336
  • Age: 29
  • Location: Atlanta, GA
Re: Help with health insurance with new baby
« Reply #30 on: April 27, 2016, 01:34:06 PM »
Only 4 months in, but other than the cost of his birth, ForuMMM Jr has cost me $0 in medical care. The well child visits (1 week, 2 weeks, 1 month, 2 months, 4 months, etc) are free because of the ACA. Vaccines are free too. If he gets sick in a way that needs a doctor visit, then I'd have to pay something. So far that hasn't happened. And there isn't a lot they can do if your kid gets a virus at day care other than tell you to do the basic stuff (fluids, etc). And if something really expensive happened, you'd only be out a few grand.

That is relieving to hear! It seems like the catastrophic seems like a decent deal then

AlwaysLearningToSave

  • Bristles
  • ***
  • Posts: 437
Re: Help with health insurance with new baby
« Reply #31 on: April 27, 2016, 02:13:10 PM »
While thinking about the cost of coverage for my family I was thinking that mine is probably very expensive too. This is paid 100% by my employer but if the family cost is any inclination then it probably costs them at least $500 for my portion. Do you think that it is worth talking to my employer and trying asking for a raise in exchange for opting out of the health insurance. I could ask if I could opt out and out of the ~$6k savings for my boss receive a $5k raise (so its a win win) I could then purchase the same catastrophic plans as my wife and baby for about $150 more and use the savings to pay for potential health costs.

Just found this thread for the first time.  I am quite familiar with your predicament as I went through the same process trying to find affordable coverage for my wife and daughter since my employer does not contribute toward family healthcare premiums on its group plan.

My employer's family healthcare plan premiums are a level per-employee cost, regardless of the number of kids or age of the employee or spouse.  Works well for employers who pay family premiums (it helps avoid discrimination claims based on the cost to insure certain employees), but for my small, young, health family of three, that means comparatively exorbitant health insurance costs.

I inquired about opting out of the group health insurance plan and found out that the employer would give me a small amount of money in a flex spending account if I did so, but it was not nearly enough to justify opting out completely.  I put together a spreadsheet of numbers showing the problem and potential savings to my employer if they could give me more $$$.  They looked into it and told me that if they did so, they would have to offer the same benefit to everyone-- which would greatly increase the employer's total cost of providing health benefits. 

Then I asked about a raise in lieu of the flex spending account contribution.  Again, they looked into it and said no because giving me a raise would increase the employer's payroll tax obligation-- giving me enough money to make it worthwhile to opt out of the employer plan would result in an overall increase in the cost of compensating me.  Plus there would be the whole "I-have-a-higher-salary-than-employees-more-senior-than-me" problem.

I truly don't begrudge my employer.  I understand where they are coming from and how over time they came to be in the position they are in.  But it sucks to be forced to pay so much out of pocket post tax for health insurance coverage.  I just view it as the one downside of what is otherwise a pretty good gig for me. 

Only 4 months in, but other than the cost of his birth, ForuMMM Jr has cost me $0 in medical care. The well child visits (1 week, 2 weeks, 1 month, 2 months, 4 months, etc) are free because of the ACA. Vaccines are free too. If he gets sick in a way that needs a doctor visit, then I'd have to pay something. So far that hasn't happened. And there isn't a lot they can do if your kid gets a virus at day care other than tell you to do the basic stuff (fluids, etc). And if something really expensive happened, you'd only be out a few grand.

This is a big benefit of the ACA.  You almost get back dollar-for-dollar what you pay in premiums for the baby on the immunizations and well baby checks that are 100% covered. 

Gin1984

  • Magnum Stache
  • ******
  • Posts: 4751
Re: Help with health insurance with new baby
« Reply #32 on: April 27, 2016, 02:24:56 PM »
However, if you apply to Peachcare and they say you qualify, then you get that for free (or almost free). It's unrelated to the ACA's tax credits. You have to have a pretty low income to qualify.

I believe we would be under the income limits (assuming that it is after 401k and IRA's are taken out). The limit is $49k for a family of 3. My concern with peachcare is if my daughter would be ineligible due to having coverage offered to her from my employer. There is a form that we need to fill out when applying that checks to see if she is offered coverage but I am not sure if they makes her ineligible or not.

A lot of state programs like that look at gross (not AGI), but what's the worst that could happen? You apply and they say no? Worth doing IMO. $1600/mo is insanity. They're basically just giving all of their employees a big middle finger. I'm sorry you're in this position.

Also, consider a different employer (I wish I wasn't serious).

Yeah I have seen them ask for Gross on the site but in a different part they asked for a list of deduction, so no telling what they want. I will just try to apply and see what they say.

Assuming that is am denied, do you all think the catastrophic plan would be a good choice. How much out of pocket do you think is average for an infant?
I think a catastrophic plan could be a good choice. If your baby is average health you should certainly come in under the employer cost of premium of $1,600 a month. I have two kids ages 7 and 3. In my 7 years of parenting we've never spent $19k in doctor/hospital visits. If that's really what coverage would cost from your employer for your spouse and baby I'm pretty sure you will come out ahead with a catastrophic plan. A couple things I would consider-
 -buy a plan with a good network and make sure that you ALWAYS use network providers
 -consider NOT using a pediatrician. We use a family practice because the out of pocket price for an office visit (which for a sick visit on a high deductible plan you will have to pay) is double for a pediatrician. We pay about $90 for sick visit to our family doc. Family practices have physicians who have plenty of knowledge in pediatrics and they will refer you out if they are stumped on an issue. For a visit like an ear infection or strep throat etc, the family doc knows what to do and can do it for half the cost.
-same thing for your wife, once the baby is born and she has her 6 week check up- stop seeing the OB-GYN. Go to the family doc. OB-GYN's like Ped's are specialists and can command a higher price per visit.
 -only make a visit to a Children's hospital if you absolutely have to. Children's hospitals while typically in network for a plan, do not have good discounts on services. So visits to their emergency room are outrageous. Same thing with seeing one of their specialists. Fine if it's necessary, but it will cost you.

Hope this helps a bit.
OMG, read this post blew my mind.  I can't believe you are serious.  So a woman should not have a pap smear by someone trained to do so (and OB/gyn or a nurse practitioner trained in that)?  Do you know how many times medical issues are caught by a pap?  Second, some family doctors have enough info on peds, many don't and things can be missed.  The reason they are specialists is because they have training that the general MD does not.  Pinching a few pennies to potentially miss a huge issue seems a horrid idea. 
That said, I have spent more than the BeanCounter, my daughter picked up croup at daycare and in the middle of the night woke up gasping for breath.  If we had not gotten her treated at the ER she could have died.  It was a simple treatment (well two of them), but the consequences for not treating are deadly to infants. 
Please don't pinch pennies on your child's health.  One of the great things about making decent money and being frugal is I can make decisions that are best for my family, not based on money. 

forummm

  • Walrus Stache
  • *******
  • Posts: 7396
  • Senior Mustachian
Re: Help with health insurance with new baby
« Reply #33 on: April 27, 2016, 05:29:43 PM »
OMG, read this post blew my mind.  I can't believe you are serious.  So a woman should not have a pap smear by someone trained to do so (and OB/gyn or a nurse practitioner trained in that)?  Do you know how many times medical issues are caught by a pap? 

GPs are trained to do Paps too. They aren't complicated. And you only need one every 3 years, only after 21, and can go as long as 5 years after 30 with an HPV DNA test. And if you get the HPV vaccine (prior to HPV exposure), you'll prevent the main problems a Pap will find.

seattlecyclone

  • Magnum Stache
  • ******
  • Posts: 4977
  • Age: 34
  • Location: Seattle, WA
    • My blog
Re: Help with health insurance with new baby
« Reply #34 on: April 27, 2016, 05:52:33 PM »
If you have a high-deductible plan you can do well to try and be a good consumer about things. If you have something you've never seen before, going to a specialist can be the best move even when it costs more. But if your kid has already had five ear infections and you're sure they just got a sixth one, might as well go to the cheap storefront doctor to get yourself a prescription for antibiotics.

BeanCounter

  • Handlebar Stache
  • *****
  • Posts: 1406
Re: Help with health insurance with new baby
« Reply #35 on: April 27, 2016, 06:09:21 PM »
OMG, read this post blew my mind.  I can't believe you are serious.  So a woman should not have a pap smear by someone trained to do so (and OB/gyn or a nurse practitioner trained in that)?  Do you know how many times medical issues are caught by a pap? 

GPs are trained to do Paps too. They aren't complicated. And you only need one every 3 years, only after 21, and can go as long as 5 years after 30 with an HPV DNA test. And if you get the HPV vaccine (prior to HPV exposure), you'll prevent the main problems a Pap will find.
Correct, and they have to do pediatric training too. They are not specialists, but for darn near everything a specialist is not needed. A good family doc will tell you when they aren't sure and refer you to the necessary specialist. We've had to do this 3 times for things that our family doc wanted another opinion on.
It is cheaper to do it this way and it is NOT risky. I would never put my child at risk or deny them healthcare to save a buck. But I sure as hell am not going to pay someone $180 dollars to look in my kids ears or do a strep test when I can pay my family doc $90- who quite frankly has more time for me and a better relationship with us.
This past winter for example my 3 year old had a chest infection. I got him right in to our family doc. She took a look at him and felt uncomfortable so she wrote me orders for a chest x-Ray at Children's and then called us back personally after she put her own kids in bed to go over the results the same night. My cost- $90 office visit and $100 for the x-Ray. Had I gone to children's on my own, it's $900 to walk through the damn door.

abhe8

  • Bristles
  • ***
  • Posts: 486
Re: Help with health insurance with new baby
« Reply #36 on: April 27, 2016, 06:26:54 PM »
I agree with the rec for a family practicr doctor. Ours spend way more time with the kids then like previous ped and is very thorough. FP s can do paps...heck even med students do paps :) it's not rocket science. We have very healthy children, no chronic conditions and very rare acute infections. If my child had a rare disease, sure I'd go to the ped. But in no way am I neglecting or abusing then by using a board certified family Dr. Sheesh. The "only a specialist" attitude is part of why health care costs si much in this country.

Eta: and I agree it's way less expensive. We have a hdhp with a hsa. Well checks are free. Sick visits about 90. Sometimes I just use the clinic with a nurse practitioner in the pharmacy at our grocery store, if I'm worried about an ear infection or strep.

One of the biggest inc to medical costs will be daycare... Those kids just get sick a lot more.
« Last Edit: April 27, 2016, 06:30:57 PM by abhe8 »

forummm

  • Walrus Stache
  • *******
  • Posts: 7396
  • Senior Mustachian
Re: Help with health insurance with new baby
« Reply #37 on: April 27, 2016, 06:33:16 PM »
If you have a high-deductible plan you can do well to try and be a good consumer about things. If you have something you've never seen before, going to a specialist can be the best move even when it costs more. But if your kid has already had five ear infections and you're sure they just got a sixth one, might as well go to the cheap storefront doctor to get yourself a prescription for antibiotics.

Careful about antibiotics for ear infections. A lot of times kids don't actually need them and you're just depleting their microbiome. A lot of doctors will just give them to you, but they are often not needed.

bonjourliz

  • 5 O'Clock Shadow
  • *
  • Posts: 93
Re: Help with health insurance with new baby
« Reply #38 on: April 27, 2016, 06:55:18 PM »
If the baby (or your wife) is really sick, like needing surgery or hospitalization, you will hit your deductible and then some on virtually any plan.  Odds are that they won't be, and a catastrophic plan would be sufficient. 

Peachcare for kids -- I have heard great things about it, but I don't know the particular rules.  If is definitely far easier to qualify for than Medicare. (Or is it Medicaid. I mix them up.)

Agree with the recs to look outside the usual suspects when you are doctor-shopping.  Family practices can be great (though personally we prefer our ped to the family practice we were using. But it's all based on the individual doctor/practice). And I have (adult) friends whose regular doctor is at an urgent care facility.  They see the same doc every time and it's basically the same as a GP except it has urgent care in the name.  Or maybe she loves her OB or MW and wants to see them for annuals.  Their self pay rates are usually very reasonable -- just ask. For labs, consider a "DIY" place like Any Lab Test, etc.  I found an online lab that saved me 50% vs what I would have paid otherwise.  And guess what, they sent me to labcorp for the test -- same as my doctor would have.


Sent from my HTC first using Tapatalk


BeanCounter

  • Handlebar Stache
  • *****
  • Posts: 1406
Re: Help with health insurance with new baby
« Reply #39 on: April 27, 2016, 07:33:53 PM »
However, if you apply to Peachcare and they say you qualify, then you get that for free (or almost free). It's unrelated to the ACA's tax credits. You have to have a pretty low income to qualify.

I believe we would be under the income limits (assuming that it is after 401k and IRA's are taken out). The limit is $49k for a family of 3. My concern with peachcare is if my daughter would be ineligible due to having coverage offered to her from my employer. There is a form that we need to fill out when applying that checks to see if she is offered coverage but I am not sure if they makes her ineligible or not.

A lot of state programs like that look at gross (not AGI), but what's the worst that could happen? You apply and they say no? Worth doing IMO. $1600/mo is insanity. They're basically just giving all of their employees a big middle finger. I'm sorry you're in this position.

Also, consider a different employer (I wish I wasn't serious).

Yeah I have seen them ask for Gross on the site but in a different part they asked for a list of deduction, so no telling what they want. I will just try to apply and see what they say.

Assuming that is am denied, do you all think the catastrophic plan would be a good choice. How much out of pocket do you think is average for an infant?
I think a catastrophic plan could be a good choice. If your baby is average health you should certainly come in under the employer cost of premium of $1,600 a month. I have two kids ages 7 and 3. In my 7 years of parenting we've never spent $19k in doctor/hospital visits. If that's really what coverage would cost from your employer for your spouse and baby I'm pretty sure you will come out ahead with a catastrophic plan. A couple things I would consider-
 -buy a plan with a good network and make sure that you ALWAYS use network providers
 -consider NOT using a pediatrician. We use a family practice because the out of pocket price for an office visit (which for a sick visit on a high deductible plan you will have to pay) is double for a pediatrician. We pay about $90 for sick visit to our family doc. Family practices have physicians who have plenty of knowledge in pediatrics and they will refer you out if they are stumped on an issue. For a visit like an ear infection or strep throat etc, the family doc knows what to do and can do it for half the cost.
-same thing for your wife, once the baby is born and she has her 6 week check up- stop seeing the OB-GYN. Go to the family doc. OB-GYN's like Ped's are specialists and can command a higher price per visit.
 -only make a visit to a Children's hospital if you absolutely have to. Children's hospitals while typically in network for a plan, do not have good discounts on services. So visits to their emergency room are outrageous. Same thing with seeing one of their specialists. Fine if it's necessary, but it will cost you.

Hope this helps a bit.
OMG, read this post blew my mind.  I can't believe you are serious.  So a woman should not have a pap smear by someone trained to do so (and OB/gyn or a nurse practitioner trained in that)?  Do you know how many times medical issues are caught by a pap?  Second, some family doctors have enough info on peds, many don't and things can be missed.  The reason they are specialists is because they have training that the general MD does not.  Pinching a few pennies to potentially miss a huge issue seems a horrid idea. 
That said, I have spent more than the BeanCounter, my daughter picked up croup at daycare and in the middle of the night woke up gasping for breath.  If we had not gotten her treated at the ER she could have died.  It was a simple treatment (well two of them), but the consequences for not treating are deadly to infants. 
Please don't pinch pennies on your child's health.  One of the great things about making decent money and being frugal is I can make decisions that are best for my family, not based on money.
I'm not a physician, but I work with plenty of them. My understanding is that the biggest difference between OB/GYN and your GP is that the OB/GYN is trained in surgery.
I don't need a surgeon to swab my hoo-ha and read the lab results.

There is a real movement to push patients into the GP for majority of their care. So don't be surprised in the future when you no longer have the choice.

Gin1984

  • Magnum Stache
  • ******
  • Posts: 4751
Re: Help with health insurance with new baby
« Reply #40 on: April 27, 2016, 08:42:19 PM »
However, if you apply to Peachcare and they say you qualify, then you get that for free (or almost free). It's unrelated to the ACA's tax credits. You have to have a pretty low income to qualify.

I believe we would be under the income limits (assuming that it is after 401k and IRA's are taken out). The limit is $49k for a family of 3. My concern with peachcare is if my daughter would be ineligible due to having coverage offered to her from my employer. There is a form that we need to fill out when applying that checks to see if she is offered coverage but I am not sure if they makes her ineligible or not.

A lot of state programs like that look at gross (not AGI), but what's the worst that could happen? You apply and they say no? Worth doing IMO. $1600/mo is insanity. They're basically just giving all of their employees a big middle finger. I'm sorry you're in this position.

Also, consider a different employer (I wish I wasn't serious).

Yeah I have seen them ask for Gross on the site but in a different part they asked for a list of deduction, so no telling what they want. I will just try to apply and see what they say.

Assuming that is am denied, do you all think the catastrophic plan would be a good choice. How much out of pocket do you think is average for an infant?
I think a catastrophic plan could be a good choice. If your baby is average health you should certainly come in under the employer cost of premium of $1,600 a month. I have two kids ages 7 and 3. In my 7 years of parenting we've never spent $19k in doctor/hospital visits. If that's really what coverage would cost from your employer for your spouse and baby I'm pretty sure you will come out ahead with a catastrophic plan. A couple things I would consider-
 -buy a plan with a good network and make sure that you ALWAYS use network providers
 -consider NOT using a pediatrician. We use a family practice because the out of pocket price for an office visit (which for a sick visit on a high deductible plan you will have to pay) is double for a pediatrician. We pay about $90 for sick visit to our family doc. Family practices have physicians who have plenty of knowledge in pediatrics and they will refer you out if they are stumped on an issue. For a visit like an ear infection or strep throat etc, the family doc knows what to do and can do it for half the cost.
-same thing for your wife, once the baby is born and she has her 6 week check up- stop seeing the OB-GYN. Go to the family doc. OB-GYN's like Ped's are specialists and can command a higher price per visit.
 -only make a visit to a Children's hospital if you absolutely have to. Children's hospitals while typically in network for a plan, do not have good discounts on services. So visits to their emergency room are outrageous. Same thing with seeing one of their specialists. Fine if it's necessary, but it will cost you.

Hope this helps a bit.
OMG, read this post blew my mind.  I can't believe you are serious.  So a woman should not have a pap smear by someone trained to do so (and OB/gyn or a nurse practitioner trained in that)?  Do you know how many times medical issues are caught by a pap?  Second, some family doctors have enough info on peds, many don't and things can be missed.  The reason they are specialists is because they have training that the general MD does not.  Pinching a few pennies to potentially miss a huge issue seems a horrid idea. 
That said, I have spent more than the BeanCounter, my daughter picked up croup at daycare and in the middle of the night woke up gasping for breath.  If we had not gotten her treated at the ER she could have died.  It was a simple treatment (well two of them), but the consequences for not treating are deadly to infants. 
Please don't pinch pennies on your child's health.  One of the great things about making decent money and being frugal is I can make decisions that are best for my family, not based on money.
I'm not a physician, but I work with plenty of them. My understanding is that the biggest difference between OB/GYN and your GP is that the OB/GYN is trained in surgery.
I don't need a surgeon to swab my hoo-ha and read the lab results.

There is a real movement to push patients into the GP for majority of their care. So don't be surprised in the future when you no longer have the choice.
That is very much not the biggest difference, the biggest difference is the training and knowledge base/focus of their residency.  A OB is more likely to catch problems, including ones stemming from giving birth than a GP.  I find your statement unlikely given the law now to treat annual women exams as preventive care.  Having a GP who also is a board certified OB doing your exams is one thing.  Expecting a GP with a much lower skill/knowledge, in that area, to treat is just foolish if you have another choice.  If you had a heart concern you might start at your primary but you would not except a GP to have the knowledge base of a cardiologist, why are you assuming that with these specialities?  The training is different.

seattlecyclone

  • Magnum Stache
  • ******
  • Posts: 4977
  • Age: 34
  • Location: Seattle, WA
    • My blog
Re: Help with health insurance with new baby
« Reply #41 on: April 27, 2016, 09:18:21 PM »
If you had a heart concern you might start at your primary but you would not except a GP to have the knowledge base of a cardiologist, why are you assuming that with these specialities?  The training is different.

Going with the heart analogy, I wouldn't go straight to a cardiologist every year to check my heart just to see if anything is wrong, because there probably isn't anything wrong. I would instead go to a GP, trusting them to know enough to tell if anything seems amiss with my heart (or any other part of my body), and would refer me to a specialist to get a concrete diagnosis if something does look abnormal.

forummm

  • Walrus Stache
  • *******
  • Posts: 7396
  • Senior Mustachian
Re: Help with health insurance with new baby
« Reply #42 on: April 29, 2016, 07:48:46 AM »
I'm not a physician, but I work with plenty of them. My understanding is that the biggest difference between OB/GYN and your GP is that the OB/GYN is trained in surgery.
I don't need a surgeon to swab my hoo-ha and read the lab results.

There is a real movement to push patients into the GP for majority of their care. So don't be surprised in the future when you no longer have the choice.
That is very much not the biggest difference, the biggest difference is the training and knowledge base/focus of their residency.  A OB is more likely to catch problems, including ones stemming from giving birth than a GP.  I find your statement unlikely given the law now to treat annual women exams as preventive care.  Having a GP who also is a board certified OB doing your exams is one thing.  Expecting a GP with a much lower skill/knowledge, in that area, to treat is just foolish if you have another choice.  If you had a heart concern you might start at your primary but you would not except a GP to have the knowledge base of a cardiologist, why are you assuming that with these specialities?  The training is different.

Sorry, but you are understating the skills of a GP. GPs should be just fine for Pap tests. An OB will have more familiarity with births, sure. And if you have a particular problem it might be better handled by an OB, but likely would also be handled well by a GP depending on what it is. But you definitely don't need to go to an OB for well woman visits. Going to a GP for your well woman visit is also included in the ACA's preventive services coverage requirement. GPs are trained and routinely handle all the recommended preventive services for women of all ages and pregnancy status.

NoStacheOhio

  • Handlebar Stache
  • *****
  • Posts: 2143
  • Location: Cleveland
Re: Help with health insurance with new baby
« Reply #43 on: April 29, 2016, 09:44:57 AM »
Alternately, consider a Certified Nurse Midwife (it's advanced practice nursing) for primary OBGYN care. Depending on your insurance and the particular provider, it may be less expensive than either flavor of MD.