Author Topic: Quick General Question about Health Insurance  (Read 3969 times)

MrsCoolCat

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Quick General Question about Health Insurance
« on: July 19, 2016, 07:46:14 PM »
Hi. Ok, maybe my hormones are making me less patient than normal and second guessing myself, but me getting a new job and new health insurance qualifies my husband to cancel his current insurance to be added on mine prior to open enrollment, correct? Second question, because of Obamacare and pregnancy no longer being deemed a pre-existing condition I am covered with this new insurance? Granted this question may or may not be a bit more complicated, or am I just losing my mind? If it matters I live in Florida. Thank you.

Mother Fussbudget

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Re: Quick General Question about Health Insurance
« Reply #1 on: July 20, 2016, 09:18:32 PM »
You should be cool on all counts, cat.  Chill, and take some time to breathe in the satisfaction in landing a new gig.  The insurance should be fine for both you and hubby.  Stay Cool!

Choices

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Re: Quick General Question about Health Insurance
« Reply #2 on: July 21, 2016, 01:27:01 AM »
You should all be covered, but pay close attention to your new plan. Many are high deductible, and it's per person and per family, often around 6k/12k.
So build a strong emergency fund before the baby comes and plan for delivery charges and pediatrician visits.

And congrats on your new job and motherhood!

Kaydedid

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Re: Quick General Question about Health Insurance
« Reply #3 on: July 21, 2016, 08:09:39 AM »
Yes, you legally have to be covered.  As Julie mentioned, watch out for the deductible/OOP max.  My husband switched jobs midyear, and we had to pay 2 full deductibles and almost 2 full OOP maxes.  We planned for it, but it was still a hit.

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forummm

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Re: Quick General Question about Health Insurance
« Reply #4 on: July 23, 2016, 10:33:30 AM »
Hi. Ok, maybe my hormones are making me less patient than normal and second guessing myself, but me getting a new job and new health insurance qualifies my husband to cancel his current insurance to be added on mine prior to open enrollment, correct?

Yes. Your husband could cancel his health insurance even if he hadn't gotten other coverage. Gaining alternate qualifying coverage lets him avoid paying the penalty for not having qualifying coverage.

Second question, because of Obamacare and pregnancy no longer being deemed a pre-existing condition I am covered with this new insurance? Granted this question may or may not be a bit more complicated, or am I just losing my mind? If it matters I live in Florida. Thank you.

Probably, but you need to check. If you have a grandfathered health plan, then several of the ACA requirements do not apply. Something like 20% of all employer plans are grandfathered. It's best to read up on their benefits anyway. Even if pregnancy-related care is "covered", it could be covered with a certain deductible and copays, and have other rules about use that you should know.

MrsCoolCat

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Re: Quick General Question about Health Insurance
« Reply #5 on: July 23, 2016, 02:29:18 PM »
Thanks everyone! I will def look more into it, but I got the insurance information (member ID and group number) and already scheduled my appointments. I will double check about pregnancy but the plan is $300 deductible and $1,500 max OOP for each member with a max of $900 and $4,500 per family. Yeah, my husband's HR lady confirmed that he can cancel his insurance. His deductible is higher than the one I just mentioned and I didn't use any deductible towards insurance this year, so we're good to switch over without worrying about carrying over the deductible.

I also realized that after pregnancy I'm not sure I'd utilize my benefits much since I am healthy and usually just go for my well woman. I'm thinking about those chiropractic visits since I do slouch and already have to pay about $91 a month for the health insurance, dental and vision combined. It's not bad if you use it, but I've generally not used insurance much aside from my yearly well woman exam which is covered (with this and most insurance plans). I can't really see myself trying to optimize my plan aside from chiropractic, dermatology and maybe seeing an allergist for my allergies. Maybe just check in with the cardiologist, too, since I went last year bc my PCP said I had a common yet slight heart murmur which the cardiologist concluded as pretty much nothing to worry about. I know it's good to have insurance especially when you're pregnant since it's a high expense, but my company only has that plan, so if I'm not using it, then well, I'm just not using it. Anyways, thanks again, everyone!
« Last Edit: July 23, 2016, 02:34:29 PM by MrsCoolCat »

MrsCoolCat

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Re: Quick General Question about Health Insurance
« Reply #6 on: July 25, 2016, 07:34:47 AM »
Btw there shouldn't be a grandfathering of pre-existing conditions like pregnancy, correct? What is the company is government & not private; does it matter? I'd have to ask HR but didn't want to ask too soon. Guess I will have no choice.

notactiveanymore

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Re: Quick General Question about Health Insurance
« Reply #7 on: July 25, 2016, 08:47:32 AM »
I also realized that after pregnancy I'm not sure I'd utilize my benefits much since I am healthy and usually just go for my well woman. I'm thinking about those chiropractic visits since I do slouch and already have to pay about $91 a month for the health insurance, dental and vision combined. It's not bad if you use it, but I've generally not used insurance much aside from my yearly well woman exam which is covered (with this and most insurance plans).

Are you saying your premium will be $91/month and you feel like you need to use it more to get your $91 worth?

I know it's good to have insurance especially when you're pregnant since it's a high expense, but my company only has that plan, so if I'm not using it, then well, I'm just not using it.

Do you try and optimize your car insurance by getting into fender benders? It sounds like you've got a pretty decent plan with a reasonable premium ($91 for family?) and a family deductible of $900 with OOP max $4500. That's pretty good insurance. The point of insurance isn't to try and squeeze as much healthcare out as possible, it's to insure against risk. $1100/year is not much to insure against bankruptcy by medical bills.

As for grandfathered plans, my impression has been that nearly all the grandfathered plans are private individual policies, not group plans through employers. I could be wrong on that, but it does seem like you'd have to be given clear notice that your group plan was grandfathered. More info: https://www.healthcare.gov/health-care-law-protections/grandfathered-plans/

MrsCoolCat

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Re: Quick General Question about Health Insurance
« Reply #8 on: July 25, 2016, 09:45:36 AM »
I should prob rephrase that, but anyways. Given I didn't have any cheaper options to choose from it would be nice to utilize whatever I can with my insurance aside from just the yearly Well Woman. I'm just thinking if I have it I should use it. Not saying I should fake a cold/fender bender to use it bc well, that just increases car insurance. Health insurance, if other older members have health issues that will prob effect an increase on my future premiums, then ur damn right I better utilize my insurance.

But actually ur right. I redid the math & $91/month is not a lot, so maybe just the dermatologist.

Plus that whole health insurance issue is a whole other topic that I don't want to debate about. I try & keep myself healthy, but I know at my age I am def subsidizing another person's health issues through my premiums (much like Social Security). It is what it is as it's debatable if I will one day be that person (and ill, etc.) or if that person truly neglected their health by choosing to eat badly & not exercise, or is it genetics, whatever. It's a never ending argument with a never ending solution.
« Last Edit: July 25, 2016, 09:59:42 AM by MrsCoolCat »

forummm

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Re: Quick General Question about Health Insurance
« Reply #9 on: July 26, 2016, 12:11:38 PM »
Btw there shouldn't be a grandfathering of pre-existing conditions like pregnancy, correct? What is the company is government & not private; does it matter? I'd have to ask HR but didn't want to ask too soon. Guess I will have no choice.

If you have a grandfathered plan they can exclude coverage for preexisting conditions like pregnancy. It doesn't matter if the employer is a government or private firm. You can just get the plan coverage documents and see what they cover. If it is a grandfathered plan, HR should know. The plan is required to state that it's grandfathered in the plan materials.

Miss Piggy

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Re: Quick General Question about Health Insurance
« Reply #10 on: July 26, 2016, 12:27:11 PM »
Be careful. Some employers are now "requiring" the spouse to be on his/her own insurance IF he/she has an option available.

Bettis

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Re: Quick General Question about Health Insurance
« Reply #11 on: July 27, 2016, 07:13:46 AM »
Yep, my employer would make me pay an extra $100/week if my wife worked at a job that had health inusrance but chose to be on my family plan.  I'm surprised it's even legal, it's certainly not ethical.  We pay more for a family plan than a single plan already.

Gin1984

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Re: Quick General Question about Health Insurance
« Reply #12 on: July 27, 2016, 07:25:40 AM »
I also realized that after pregnancy I'm not sure I'd utilize my benefits much since I am healthy and usually just go for my well woman. I'm thinking about those chiropractic visits since I do slouch and already have to pay about $91 a month for the health insurance, dental and vision combined. It's not bad if you use it, but I've generally not used insurance much aside from my yearly well woman exam which is covered (with this and most insurance plans).

Are you saying your premium will be $91/month and you feel like you need to use it more to get your $91 worth?

I know it's good to have insurance especially when you're pregnant since it's a high expense, but my company only has that plan, so if I'm not using it, then well, I'm just not using it.

Do you try and optimize your car insurance by getting into fender benders? It sounds like you've got a pretty decent plan with a reasonable premium ($91 for family?) and a family deductible of $900 with OOP max $4500. That's pretty good insurance. The point of insurance isn't to try and squeeze as much healthcare out as possible, it's to insure against risk. $1100/year is not much to insure against bankruptcy by medical bills.

As for grandfathered plans, my impression has been that nearly all the grandfathered plans are private individual policies, not group plans through employers. I could be wrong on that, but it does seem like you'd have to be given clear notice that your group plan was grandfathered. More info: https://www.healthcare.gov/health-care-law-protections/grandfathered-plans/
I worked for the state of NY and our plan was grandfathered in. 

notactiveanymore

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Re: Quick General Question about Health Insurance
« Reply #13 on: July 27, 2016, 07:58:54 AM »
I also realized that after pregnancy I'm not sure I'd utilize my benefits much since I am healthy and usually just go for my well woman. I'm thinking about those chiropractic visits since I do slouch and already have to pay about $91 a month for the health insurance, dental and vision combined. It's not bad if you use it, but I've generally not used insurance much aside from my yearly well woman exam which is covered (with this and most insurance plans).

Are you saying your premium will be $91/month and you feel like you need to use it more to get your $91 worth?

I know it's good to have insurance especially when you're pregnant since it's a high expense, but my company only has that plan, so if I'm not using it, then well, I'm just not using it.

Do you try and optimize your car insurance by getting into fender benders? It sounds like you've got a pretty decent plan with a reasonable premium ($91 for family?) and a family deductible of $900 with OOP max $4500. That's pretty good insurance. The point of insurance isn't to try and squeeze as much healthcare out as possible, it's to insure against risk. $1100/year is not much to insure against bankruptcy by medical bills.

As for grandfathered plans, my impression has been that nearly all the grandfathered plans are private individual policies, not group plans through employers. I could be wrong on that, but it does seem like you'd have to be given clear notice that your group plan was grandfathered. More info: https://www.healthcare.gov/health-care-law-protections/grandfathered-plans/
I worked for the state of NY and our plan was grandfathered in.

"nearly all" ...if a plan makes any real alterations then it loses it's grandfathered status. Therefore, many of the remaining grandfathered plans are individual policies.

MrsCoolCat

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Re: Quick General Question about Health Insurance
« Reply #14 on: July 27, 2016, 08:37:36 AM »
Thank you, all. I work for a large company & they don't seem to care about adding dependents since the price to add them is the same as my single rate. Usually it's like 3x the amount to add your spouse. Anyways, I think I'm good, but will confirm for sure by calling.

Sibley

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Re: Quick General Question about Health Insurance
« Reply #15 on: July 27, 2016, 09:56:55 AM »
Oh, and re the using your insurance train of thought. OP, you're going to have a baby. Your previous norms no long apply. You will have to come to a new norm, and that will take time. Hopefully, your new norm will be similar to your old norm, but you do not know.

And you're resetting your norms with EACH pregnancy, regardless of the outcome.

MrsCoolCat

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Re: Quick General Question about Health Insurance
« Reply #16 on: July 27, 2016, 02:53:36 PM »
Already entertaining weird thoughts about how I will be less Mustachian & spend my money on diet meal plans to be delivered after birth. Prob right about certain things going on the back burner. Oh I am soo not gonna dwell on it now or I'm gonna get annoyed by the worst case scenario of me juggling too much. Joy