Author Topic: Private Health Insurance for 32 yo F & newborn - FL  (Read 3774 times)

MrsCoolCat

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Private Health Insurance for 32 yo F & newborn - FL
« on: February 16, 2017, 07:22:59 AM »
Hi everyone. For anyone familiar with part of my story, in brief, I didn't qualify for FMLA bc I was with a company for less than a year... Yadda yadda... Since the company is in an at will state & a "sovereign nation" I was given the "opportunity" to come back to work after two weeks (considered) vacation when/after I delivered my baby & with a doctor's note. I saved extra time off which I profusely used the weeks before labor once I found out my grim situation. Anyways I made it back in two weeks but exhausted, missing my newborn, etc.

May I please have some details, suggestions, etc. on what private health insurance I can get for my newborn & I? My husband will go through his employer to get himaelf insurance. Not adding us bc it's an HMO & we're just better off getting private. I spoke to one agent yest about the timeframe. He said the beginning of next month bc my separation of employment would be a qualifying event. FYI Cobra is like $1,100 for the both of us... Any suggestions? Lastly, since we are worried about no coverage I will work until the end of this month before separating. Thank you always in advance.

P.S. I never thought I'd be in this situation & I always did wonder what the FIRE Mustachians did regarding their healthcare.
« Last Edit: February 16, 2017, 07:28:24 AM by MrsCoolCat »

Iplawyer

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Re: Private Health Insurance for 32 yo F & newborn - FL
« Reply #1 on: February 16, 2017, 08:33:21 AM »
You are going to have to explain why you are better off getting private insurance.

Johnny Aloha

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Re: Private Health Insurance for 32 yo F & newborn - FL
« Reply #2 on: February 16, 2017, 08:36:33 AM »
I get health insurance through my employer so I don't really have anything significant to offer, other than a recommendation to check with Costco and Obamacare...

MrsCoolCat

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Re: Private Health Insurance for 32 yo F & newborn - FL
« Reply #3 on: February 16, 2017, 08:58:03 AM »
You are going to have to explain why you are better off getting private insurance.

U mean as opposed to no insurance bc I'm separating from my employer to take care of my newborn or bc my husband has an HMO that's $700 to add us? Would private not be comparable or similar? I'm really just worried about my newborn. I'm pretty healthy imo. Obviously I still need/want insurance.

beltim

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Re: Private Health Insurance for 32 yo F & newborn - FL
« Reply #4 on: February 16, 2017, 09:44:05 AM »
May I please have some details, suggestions, etc. on what private health insurance I can get for my newborn & I?

You pretty much need to go to healthcare.gov and check out what plans are available.

SimpleCycle

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Re: Private Health Insurance for 32 yo F & newborn - FL
« Reply #5 on: February 16, 2017, 09:55:38 AM »
Don't eliminate any options until you've looked at them all.  Fire up healthcare.gov and see what your options are, and what is covered without a deductible for your newborn under each plan.  Then talk to a broker and see if they have any other options (in most states, they don't).  Analyze what is covered under the HMO and if there are any other options available through his employer that you'd be allowed to enroll in.  I am not 100% sure about the rules of when you can switch plans with a qualifying event as opposed to just adding people to your current plan, but it is worth asking about.

Make a spreadsheet and figure out what your spending would be with a year of "average" use, a year of "high" use, and a catastrophic year.  That should give you everything you need to make a decision.

FWIW, my daughter ended up with a $13k hospitalization (two nights!) at 7 months, so don't assume baby = low health care use.

historienne

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Re: Private Health Insurance for 32 yo F & newborn - FL
« Reply #6 on: February 16, 2017, 10:36:52 AM »
You are going to have to explain why you are better off getting private insurance.

U mean as opposed to no insurance bc I'm separating from my employer to take care of my newborn or bc my husband has an HMO that's $700 to add us? Would private not be comparable or similar? I'm really just worried about my newborn. I'm pretty healthy imo. Obviously I still need/want insurance.

Get on the exchanges and check.  Depending on how much money your husband makes, $700 might be competitive, especially if the HMO has a reasonable deductible.  I like having a low deductible for the first year of my kids' lives, because 1) you don't have much history to predict how healthy they will be, and 2) little things can require big interventions for newborns.  My 8 week old had a fever, and ended up spending 3 days in the hospital as a precaution until they ruled out bacterial meningitis. If he'd been over a year, I wouldn't even have taken him to the doctor for that fever.

Edit: Remember that the $700 is (presumably) pre-tax.  Premiums for private plans are post-tax. Depending on your marginal tax rate, this could be important to your calculations.
« Last Edit: February 16, 2017, 10:38:29 AM by historienne »

Iplawyer

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Re: Private Health Insurance for 32 yo F & newborn - FL
« Reply #7 on: February 16, 2017, 11:40:29 AM »
You are going to have to explain why you are better off getting private insurance.

U mean as opposed to no insurance bc I'm separating from my employer to take care of my newborn or bc my husband has an HMO that's $700 to add us? Would private not be comparable or similar? I'm really just worried about my newborn. I'm pretty healthy imo. Obviously I still need/want insurance.


Get on the exchanges and check.  Depending on how much money your husband makes, $700 might be competitive, especially if the HMO has a reasonable deductible.  I like having a low deductible for the first year of my kids' lives, because 1) you don't have much history to predict how healthy they will be, and 2) little things can require big interventions for newborns.  My 8 week old had a fever, and ended up spending 3 days in the hospital as a precaution until they ruled out bacterial meningitis. If he'd been over a year, I wouldn't even have taken him to the doctor for that fever.

Edit: Remember that the $700 is (presumably) pre-tax.  Premiums for private plans are post-tax. Depending on your marginal tax rate, this could be important to your calculations.

I think you are wrong about tax treatment:

http://www.healthedeals.com/articles/are-health-insurance-premiums-deductible

SimpleCycle

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Re: Private Health Insurance for 32 yo F & newborn - FL
« Reply #8 on: February 16, 2017, 11:48:29 AM »
You are going to have to explain why you are better off getting private insurance.

U mean as opposed to no insurance bc I'm separating from my employer to take care of my newborn or bc my husband has an HMO that's $700 to add us? Would private not be comparable or similar? I'm really just worried about my newborn. I'm pretty healthy imo. Obviously I still need/want insurance.


Get on the exchanges and check.  Depending on how much money your husband makes, $700 might be competitive, especially if the HMO has a reasonable deductible.  I like having a low deductible for the first year of my kids' lives, because 1) you don't have much history to predict how healthy they will be, and 2) little things can require big interventions for newborns.  My 8 week old had a fever, and ended up spending 3 days in the hospital as a precaution until they ruled out bacterial meningitis. If he'd been over a year, I wouldn't even have taken him to the doctor for that fever.

Edit: Remember that the $700 is (presumably) pre-tax.  Premiums for private plans are post-tax. Depending on your marginal tax rate, this could be important to your calculations.

I think you are wrong about tax treatment:

http://www.healthedeals.com/articles/are-health-insurance-premiums-deductible

They are deductible as medical expenses, so only the portion above 10% of AGI is deductible.

historienne

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Re: Private Health Insurance for 32 yo F & newborn - FL
« Reply #9 on: February 16, 2017, 11:57:27 AM »
You are going to have to explain why you are better off getting private insurance.

U mean as opposed to no insurance bc I'm separating from my employer to take care of my newborn or bc my husband has an HMO that's $700 to add us? Would private not be comparable or similar? I'm really just worried about my newborn. I'm pretty healthy imo. Obviously I still need/want insurance.


Get on the exchanges and check.  Depending on how much money your husband makes, $700 might be competitive, especially if the HMO has a reasonable deductible.  I like having a low deductible for the first year of my kids' lives, because 1) you don't have much history to predict how healthy they will be, and 2) little things can require big interventions for newborns.  My 8 week old had a fever, and ended up spending 3 days in the hospital as a precaution until they ruled out bacterial meningitis. If he'd been over a year, I wouldn't even have taken him to the doctor for that fever.

Edit: Remember that the $700 is (presumably) pre-tax.  Premiums for private plans are post-tax. Depending on your marginal tax rate, this could be important to your calculations.

I think you are wrong about tax treatment:

http://www.healthedeals.com/articles/are-health-insurance-premiums-deductible

Read it, still think my statement is correct.  Health insurance premiums are tax deductible as medical expenses, but only to the extent that they are over 10% of AGI,  which means that for most people they are not deductible.  Employer-provided coverage is generally paid with pre-tax money, so it reduced taxable income.  Do you read something different?

Iplawyer

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Re: Private Health Insurance for 32 yo F & newborn - FL
« Reply #10 on: February 16, 2017, 01:54:00 PM »
No - sorry - I thought you had it the other way around. 

I still don't know why the OP doesn't think her spouse is getting a good deal doing insurance through his employer.  And there are no ACA subsidies if you can get such insurance.  I find it very difficult to imagine that the employer offered insurance is more expensive than private insurance at the end of the day.

MrsCoolCat

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Re: Private Health Insurance for 32 yo F & newborn - FL
« Reply #11 on: February 16, 2017, 02:04:08 PM »
No - sorry - I thought you had it the other way around. 

I still don't know why the OP doesn't think her spouse is getting a good deal doing insurance through his employer.  And there are no ACA subsidies if you can get such insurance.  I find it very difficult to imagine that the employer offered insurance is more expensive than private insurance at the end of the day.

I keep hearing it sucks. No details. HR doesn't get back to him. He doesn't want to keep asking HR. So ultimately I'm pretty much doing this insurance thing on my own w/o his help or details on what exactly is this sucky insurance that his employer offers... He works for a small company. I'm lost.

historienne

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Re: Private Health Insurance for 32 yo F & newborn - FL
« Reply #12 on: February 17, 2017, 11:42:54 AM »
No - sorry - I thought you had it the other way around. 

I still don't know why the OP doesn't think her spouse is getting a good deal doing insurance through his employer.  And there are no ACA subsidies if you can get such insurance.  I find it very difficult to imagine that the employer offered insurance is more expensive than private insurance at the end of the day.

No worries, and I agree with this!  Unless you qualify for subsidies, group insurance is usually going to be a better deal.  For healthy adults, it might be worth going on the private marketplace to get a higher deductible plan, if the company plan only has a low-deductible/high-premium option.  For a baby, though, I'd not be very excited to take that gamble.

frugal rph

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Re: Private Health Insurance for 32 yo F & newborn - FL
« Reply #13 on: February 17, 2017, 08:24:05 PM »
I have a friend who lives in Orlando, FL who looked into Obamacare for her husband and daughter because she also worked for a small company and adding them to her insurance was very expensive.  It was going to cost about $700 for the 2 of them for a plan with a $10,000 deductible that was not an HSA.  I would definitely go with your husband's company plan.  I believe you have 30 days after you lose coverage to get on his plan.  He's going to have to push the HR and tell them he needs to enroll you.  That's their job. 

CanuckExpat

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Re: Private Health Insurance for 32 yo F & newborn - FL
« Reply #14 on: February 17, 2017, 10:44:03 PM »
What is your income level? Medicaid kicks in at higher income  levels for pregnant women and children

SimpleCycle

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Re: Private Health Insurance for 32 yo F & newborn - FL
« Reply #15 on: February 18, 2017, 02:15:49 AM »
What is your income level? Medicaid kicks in at higher income  levels for pregnant women and children

Florida is not a Medicaid expansion state, and OP is not pregnant anymore.  So baby is eligible up to 200% of FPL until age 1 ($40,180 for a family of 3) but adults with children are only eligible up to 30% of FPL ($6027).  In addition, adult coverage has an asset limit of $2000.

OP, there is a state run insurance plan for kids called "Sunshine Health Stars" that costs $220/month and doesn't have an income limit.  https://www.healthykids.org/cost/fullpay/

Then you could get individual coverage for just yourself, which is in the $400/month range with pretty sizable deductibles.

I suspect you're better off adding both of you to your husband's plan.

Elle 8

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Re: Private Health Insurance for 32 yo F & newborn - FL
« Reply #16 on: February 18, 2017, 05:39:27 AM »
No - sorry - I thought you had it the other way around. 

I still don't know why the OP doesn't think her spouse is getting a good deal doing insurance through his employer.  And there are no ACA subsidies if you can get such insurance.  I find it very difficult to imagine that the employer offered insurance is more expensive than private insurance at the end of the day.

I keep hearing it sucks. No details. HR doesn't get back to him. He doesn't want to keep asking HR. So ultimately I'm pretty much doing this insurance thing on my own w/o his help or details on what exactly is this sucky insurance that his employer offers... He works for a small company. I'm lost.

I suggest you call the health insurance company directly with any questions you have, rather than HR.

Cranky

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Re: Private Health Insurance for 32 yo F & newborn - FL
« Reply #17 on: February 18, 2017, 10:44:48 AM »
Again - I don't think you can get state insurance or a subsidized policy if you are eligible for your spouse's policy (and I don't think you'll pay less or get better coverage by buying an individual policy.)

Iplawyer

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Re: Private Health Insurance for 32 yo F & newborn - FL
« Reply #18 on: February 19, 2017, 10:07:39 AM »
Yes - why leave this in your apparently inept husband's hands?  Just call his insurance and find out.  Isn't this important enough for him to pursue?  If it isn't - I might suggest you replace HIM.

CanuckExpat

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Re: Private Health Insurance for 32 yo F & newborn - FL
« Reply #19 on: February 19, 2017, 01:18:40 PM »
Florida is not a Medicaid expansion state, and OP is not pregnant anymore.  So baby is eligible up to 200% of FPL until age 1 ($40,180 for a family of 3) but adults with children are only eligible up to 30% of FPL ($6027).  In addition, adult coverage has an asset limit of $2000.

Asset tests should not exist in any state anymore for Medicaid after ACA changes (As of this writing)

Quote
I suspect you're better off adding both of you to your husband's plan.

This is probably true, but I've seen (and had) some extreme cases where an employer would provide coverage for employee, but no coverage, or the non subsidized coverage for spouse was incredibly expensive.

Would need to hear more details about OP's case.

MrsCoolCat

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Re: Private Health Insurance for 32 yo F & newborn - FL
« Reply #20 on: February 19, 2017, 01:40:57 PM »
We finally got some details on his employer's HMO & even details on Avmed from the broker since my daughter's pediatrician is in network with Avmed. Has anyone used them? His insurance is a zero $ ded $ & it's $55 PCP/$100 specialist copay. The in network HMO is like 600/month? Idk plus not exactly sure if the pediatrician is covered. I might have to go with Avmed...

*Are there any benefits with a zero $ def but those high copays since we're gonna see the pediatrician at least six more times?
« Last Edit: February 20, 2017, 06:02:39 AM by MrsCoolCat »

Iplawyer

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Re: Private Health Insurance for 32 yo F & newborn - FL
« Reply #21 on: February 20, 2017, 08:32:23 AM »
You are likely not going to do better than that.  No deductible is huge.  It is easy to determine if your pediatrician in on the plan - call either the insurance or go on line - and your pediatrician could tell  you.   You might need to find a different pediatrician to stay on hubby's plan.

boarder42

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Re: Private Health Insurance for 32 yo F & newborn - FL
« Reply #22 on: February 20, 2017, 08:40:03 AM »
why not do healthshare.  seems to be the best bang for you buck IMO.

historienne

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Re: Private Health Insurance for 32 yo F & newborn - FL
« Reply #23 on: February 20, 2017, 10:49:13 AM »
We finally got some details on his employer's HMO & even details on Avmed from the broker since my daughter's pediatrician is in network with Avmed. Has anyone used them? His insurance is a zero $ ded $ & it's $55 PCP/$100 specialist copay. The in network HMO is like 600/month? Idk plus not exactly sure if the pediatrician is covered. I might have to go with Avmed...

*Are there any benefits with a zero $ def but those high copays since we're gonna see the pediatrician at least six more times?

Is the plan ACA compliant?  If so, then well visits will not be charged a co-pay.  I can't tell - are "his insurance" and "the in-network HMO" the same plan?  Or does he have multiple options, one of which is an HMO?

little_brown_dog

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Re: Private Health Insurance for 32 yo F & newborn - FL
« Reply #24 on: February 20, 2017, 11:04:46 AM »
We finally got some details on his employer's HMO & even details on Avmed from the broker since my daughter's pediatrician is in network with Avmed. Has anyone used them? His insurance is a zero $ ded $ & it's $55 PCP/$100 specialist copay. The in network HMO is like 600/month? Idk plus not exactly sure if the pediatrician is covered. I might have to go with Avmed...

*Are there any benefits with a zero $ def but those high copays since we're gonna see the pediatrician at least six more times?

Is the plan ACA compliant?  If so, then well visits will not be charged a co-pay.  I can't tell - are "his insurance" and "the in-network HMO" the same plan?  Or does he have multiple options, one of which is an HMO?

+1 - under the ACA all well baby and pediatric visits and corresponding vaccinations and screenings (iron, lead) should be fully covered as preventative services. My daughter is 16 months and I'm still paying 0 for her pediatric appointments.

MrsCoolCat

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Re: Private Health Insurance for 32 yo F & newborn - FL
« Reply #25 on: February 20, 2017, 03:32:21 PM »
The max OOP family is like $13,700 😣

boarder42

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Re: Private Health Insurance for 32 yo F & newborn - FL
« Reply #26 on: February 20, 2017, 05:26:27 PM »
The max OOP family is like $13,700 😣

Again health share

CanuckExpat

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Re: Private Health Insurance for 32 yo F & newborn - FL
« Reply #27 on: February 22, 2017, 06:37:48 PM »
How long will you off work for. When you go back to work will you have employer provided healthcare?

Did you hit the OOP maximum on your previous plan while giving birth? If so, maybe it's worth it to consider COBRA ?

jim555

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Re: Private Health Insurance for 32 yo F & newborn - FL
« Reply #28 on: February 23, 2017, 06:05:02 AM »
Check out the CHIP program to see if you are eligible.  Would cover all expenses for the child.

catccc

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Re: Private Health Insurance for 32 yo F & newborn - FL
« Reply #29 on: February 23, 2017, 07:32:22 AM »
Check out the CHIP program to see if you are eligible.  Would cover all expenses for the child.

 Yes, try this!  CHIP can be very affordable and in PA, there is no income limit, but premiums are on a sliding scale.  The year I was a SAHM, DH had insurance through his employer.  It would have been prohibitive to add us due to cost.  I applied for CHIP for DD, but it turned out at our income level (dropped from about 100K to 20-25K when I left my job), DD qualified for medicaid.  Strangely, even though we were in the same household with the same financial picture, DD qualified for medicaid but I did not.  Also, qualification was all income based.  We had about $150K in assets at the time across various accounts, retirement accounts included.  I ended up paying for a high deductible ($10K?) indemnity plan for a couple hundred dollars a month for myself.  It was pretty useless, as this was pre-ACA (2008) and nothing was covered before the deductible, but it was basically in case of a catastrophe.  At the time, PA also had another plan called "adult basic," but for some reason that wasn't the best choice for me.  Or maybe there was low availability or something.  I can't remember, it was so long ago.

Anyway, good luck, I hope you find something suitable!