How to deliver a baby in the US without health insurance?

August 9, 2005 12:06 PM

Having no health insurance, how can we possibly afford to pay for the delivery of our coming child? How do freelance/self-employed American families survive without health insurance? Anyone have any experience with Medicaid?

My wife and I recently returned to the US after many years abroad and we've just discovered she is pregnant. Neither of us have health insurance yet as we are both (low-paid) freelance writers. We know little about health insurance as neither of us have had to deal with this issue before. How can we possibly afford to pay for the delivery of the child and the child's health care? What options do we have? Would we qualify for Medicaid? Is the care you get on Medicaid reasonable? What do other freelancers/self employed people do for insurance? Sorry for the laundry-list of questions, but I'm worried.

posted by anonymous to health (19 comments total)

I don't know where you live, but I expect there may be something similar to New Hampshire's Healthy Kids program (website seems to be down at the moment). If you qualify, this will cover your maternity charges as well as the baby him/herself. Contact your state's Department of Health and Human Services.
posted by schoolgirl report at 12:25 PM on August 9, 2005

It would help greatly to know your state and county residency and your income. Some health programs have low-income qualifications. If you're on middle-class income though, you're pretty much fucked.
posted by rolypolyman at 12:31 PM on August 9, 2005

I did a search for the CHIP program and found this; that should take care of the insuring-your-child part of things, with the details worked out on the basis of what state you live in.

As concerns prenatal care, I would contact your nearest Planned Parenthood center. They don't always have the greatest hours in my experience, but they do offer care, advice, etc. on a sliding scale. Their website is here.

Good luck - and congratulations!
posted by kalimac at 12:49 PM on August 9, 2005

We just had our second child and it was, like the first one, a home birth. If you pregnancy isn't going into complication, a home birth is a really cool thing to do. You do a home birth with the help of a midwife (and an assistant.) As we were selecting midwives in our area (SF Bay Area) we found one running her business as a non profit one -- all money collected goes to charities. She indicated that we could give what we wanted, we could also not give anything at all.
posted by NewBornHippy at 1:38 PM on August 9, 2005

You might want to check and see if your state offers Medicaid for Pregnant Women. MPW usually has higher income limits than regular Medicaid so, even if you wouldn't qualify for Medicaid, your wife may qualify for MPW. Check with your state's Dept. of Health and Human Services, as someone else suggested.

Good luck and congrats!
posted by whatideserve at 1:41 PM on August 9, 2005

Government-subsidized (or -provided) insurance for your child is probably doable. The family income limits are usually quite high for the kids to participate.

Coverage for yourself and your wife is going to be harder to get. The income limits are going to be tight (although perhaps somewhat relaxed during pregnancy), and you could encounter some very unsympathetic caseworkers -- married couples who do intellectual work are, needless to say, an uncommon public assistance demographic.

An uncomplicated pregnancy and delivery costs an HMO $3,000 to $6,000. Hospitals and doctors mark that rate up heavily for the uninsured but you can often negotiate that back down to the HMO rate if you start to shop around. It's saving now and a chunk on your Visa when you're discharged, but it's not the end of the world.
posted by MattD at 1:46 PM on August 9, 2005

Boy, it would really help to know which state you live in.

What about KidCare? It covers children AND pregnant women. (Link is to the Illinois KidCare program.)

Have you priced out an HMO plan on the open market? It can be costly, but so is covering the cost of a pregnancy and delivery on your own. Blue Cross Blue Shield has a program called Entrepreneur, which requires that you are a company employing two people. Perhaps you can incorporate and be eligible? (Link is again to an Illinois program.)

Finally, aside from one of you going to work at a company that offers benefits, you may want to look into health care discount cards. While not an insurance program, card programs do entitle you as a member to discounted rates with contracted health care providers. Just be very, very careful about the plan you choose and verify with the doctor you choose that they do participate in the program. Some of the discount clubs are quite shady.

The cost for the clubs ranges widely, although generally it is quite affordable. You can purchase them online or through most of the mega retailers--Sam' Club, Wal-Mart, etc.
posted by Sully6 at 2:03 PM on August 9, 2005

Is an HMO going to cover a pregnancy that already exists? I know the Kaiser application asked several times about the date of a woman's last menstration.
posted by reverendX at 2:07 PM on August 9, 2005

My HMO doesn't cover pregnancy at all. If I already had kids, it would cover their health care, but pregnancy itself is a no-go. Are there "riders" that one could purchase to add on to an HMO like this to just handle the pregnancy/delivery?
posted by xo at 2:14 PM on August 9, 2005

Technically, you aren't medically-pregnant until a doctor says you are pregnant. Therefore, if you go get insurance after you-know-but-it-aint-official, you are covered. I know this works, since a lawyer friend did just that with his wife. They complained, but paid. YMMV.
posted by Invoke at 2:16 PM on August 9, 2005

Is an HMO going to cover a pregnancy that already exists?

That depends. I'm not sure if the rules are different for someone joining an employer's plan versus purchasing their own plan.

From the Health Insurance Portability and Accountability Act (HIPAA), effective July 1, 1997:

"HIPAA limits the time you can be denied coverage for a preexisting condition under your employer's health insurance plan....Pregnancy cannot be denied as a preexisting condition by an employer's insurer."

Incidentally, given the cost of puchasing individual insurance and your self-described low wages, I would pursue this only if there is no federal or state program that will cover you.
posted by Sully6 at 2:26 PM on August 9, 2005

Another thought: What about a professional association, guild or union you could join and get health insurance through? For example, the National Writers Union offers health insurance to its members in select markets.

Also, depending on your income, when you are self-employed, your health insurance costs are tax deductible, so you'll probably see some of your money back at tax time. (Just use a good accountant. Seriously. A friend's accountant told her that even the car mileage to and from appointments was tax deductible.)

You asked how other freelancers did it. Several years ago when I was a freelance writer I asked that same question to many of the more established writers I met. The answer was always the same: They had a spouse who worked at a job with benefits. Perhpas there are some Mefites out there, though, who have more creative solutions.
posted by Sully6 at 2:42 PM on August 9, 2005

I had both my children on medicaid - one in Colorado,one in Maryland. Almost every state has a program for pregnant women, just like the one they have for kids, but the pregnancy one seems to actually work. State offered health insurance for kids? Sign your child up now - s/he may get through the waiting list about the time s/he enters school. I would say that your chances of finding private insurance to cover an existing pregnancy are nil - this is purely anecdotal, but I do have a friend who tried that route with no luck whatsoever.

To find out about your options, go to Planned Parenthood or your OB/Gyn - they will almost certainly know who to talk to and where to go. Or, you can call or visit your local social services office, but try to get the information from a doctor's office first, because social services is hell and it's designed to discourage you. This way, too, you can find out if your doctor takes Medicaid: not all of them do, and you need to know that right now.

What to expect? Well, it's fine once you're enrolled but the enrollment process, at least in Baltimore, is grueling. Be prepared for it to be really bad - worse than you think it's going to be. The social worker, who is horribly overworked and miserably underpaid, will not like you: educated people are not supposed to be on social services. The offices are grim and bleak and full of miserable families. Expect to be there all day - they'll tell you to show up at 8:30, they may see you by 3:30 or 4:00 or tell you to come back next day. You cannot reschedule or miss an appointment. Bring something to read. Bring every scrap of paper you can muster that attests to your identity and any income you've ever had.

After that, clear sailing. You'll get an ID card and the doctor's office will bill medicaid, and you will have a small copay. It will cover all the prenatal, the whole birth and your wife's 6 week checkup. It may cover your child's first year of medical care as well. The doctor's office will not be fazed or treat you unkindly: they're used to this and they want to help you.

However, as in any medical situation, read a lot and be aware. Some doctors may assume that if you are on Medicaid you are automatically stupid or need to be tested for drugs or any number of other things, or, after the birth they may try to run too many tests on your baby. My son was 10 pounds (unusual for a medicaid baby) so they immediately started running a bunch of crazy tests on him and even wanted to do a spinal tap. He was totally healthy, completely fine and may the gods forever bless my pediatrician, who finally showed up and told them to stop that nonsense.

Email's in the profile if you have any more questions - some of my info may be out of date, since my youngest is 13 now. And congratulations!
posted by mygothlaundry at 3:25 PM on August 9, 2005

As an aside, please consider a non-medical birthing procedure. The hospital-standard "on your back, knees bent, puuuuush" is pretty much the worst possible way to deliver.

A midwife will be of great assistance in choosing a good birthing method.
posted by five fresh fish at 3:48 PM on August 9, 2005

She should be taking folic acid supplements, generally included in a good multivitamin for women. This is critical; it absolutely prevents neural tube defects, and should happen immediately. Pre-natal care is important, so call the nearest hospital and ask to speak to a social worker to find a sliding scale clinic. She needs regular blood pressure monitoring and screening for any risk factors.

Home birth is great, but unlikely to be really cheap. Most midwives pay a fortune in insurance costs, and they don't necessarily have the resources to provide free care. I've known families who had a crisis at a home birth, so don't wing it. Birth is natural, and also has the potential to be pretty dangerous, women and babies used to die in childbirth a lot. Disclaimer: I had a medium-risk pregnancy and an emergency sugical delivery that probably saved my son's life. Then I had a nasty post-surgical infection and other complications, all resolved, but not fun.

Hospitals are not allowed to refuse care based on ability to pay. Find out who's got maternity facilities and be prepared to go there and expect good treatment. The people in Delivery won't know your financial status. Tour local delivery rooms and choose care regardless of ability to pay. You can probbaly get mortality rates, C-Section rates, and surgical infections rates. I had my child at a cutified Birthing Unit in a hospital and when I was in labor, none of the touchy-feely "We used designer colors" crap mattered a bit. It was all about the quality of the nursing staff. I know, I was there long enough to go through several changes of nursing staff. They were mostly excellent.

There's a special category of food stamps, WIC, for pregnant and nursing mothers. Food banks may be a good resource. The delivery of health care in the US is so screwed up - don't let them screw you into not getting good care, good nutrition, and enjoying your pregnancy and baby. Seriously, let your community help you out here. If you send me your postal address, I'll send a book or 2. I recommend Sheila Kitzinger's Complete Book of Pregnancy and Childbirth and I loved reading Spiritual Midwifery when I was pregnant. I don't have my copies anymore, but I have some other books.

Good luck!
posted by theora55 at 4:53 PM on August 9, 2005

i don't think that home birthing is necessary ... it depends on where you are, but many hospitals have nurse/midwifes who are good and if something goes really wrong, you've got a whole hospital of people around you to help with it ...

most certainly check out the WIC program ... the income requirements are not as stringent as they are with food stamps ... and if your wife can't breast feed, you'll have to buy formula and formula is godawfully expensive ... WIC can help considerably with that

medicaid can be a pain in the ass ... especially if they lose your case file which happened to me a few years ago ... on the other hand, it's been my experience that hospitals, when you arrive at them with a wife in labor, drop the usual waiting routine and get right down to business ...
posted by pyramid termite at 9:22 PM on August 9, 2005

one more really important thing ... don't let them force your wife and child out of the hospital within 24 hours! ... they should have 2 days to be observed there and make sure that everything's alright

they had us leave the day after my daughter was born ... we took her home and she cried and cried ... later that night we took her temperature ... she was running a high fever and we had to bring her back in for a whole week ... it turned out to be a serious staph infection

the doctor who treated her was REALLY pissed that they only kept her 24 hours after she was born ... the problem could been detected sooner and with less risk to our daughter ... he said that if we had waited the consequences could have been grave

make sure they're given 48 hours after birth
posted by pyramid termite at 9:32 PM on August 9, 2005

Hospitals are not allowed to refuse care based on ability to pay.

While this is certainly true, hospitals will usually go to great lengths to collect from you. I'm not trying to dissuade you from seeking medical care. Just realize that if you don't find coverage or otherwise make arrangements in advance, the hospital may choose to pursue you for the cost of treatment.

As someone mentioned upstream, when you are uninsured, hospitals do not charge you what they would charge an insurance company for service; they charge a lot more. Their argument is that when they lower the fees for an insurance company it's part of a neogiated discount. No one negotiates discounts for uninsured patients, so they're charged the full fee. Not to freak you out, but here is an article from the New York Times Magazine about charitable care and how hospitals collect from uninsured patients.

I think mygothlaundry's suggestion to visit Planned Parenthood is excellent. I'm sure your situation is one they have seen many, many times.

Good luck to you and congratulations!
posted by Sully6 at 7:49 AM on August 10, 2005

In my experience (two children, both delivered by midwives), midwives are vastly less expensive than hospital births (some midwives are in hospitals, of course). We'd see a lot of lower-income people take this option for the cost; we were fortunate enough to have good insurance to have a choice and we still preferred the midwife experience. Look for so-called "birth centers".

This is a bit late, included in the hopes of helping some later visitor.
posted by RikiTikiTavi at 9:16 PM on December 19, 2005