Insuring our planned pregnancy

March 16, 2006 6:03 PM

My fiance and I have been talking about having a baby. We will be getting married in 2 months and have talked about having the baby within a year of the wedding. We feel that we are ready for the responsibility, however we're unsure of what to do about insurance. Neither of us has insurance of any kind what-so-ever at this point, but we would like to get some after our wedding. I'm looking for recommendations on health insurance that will cover the upcoming planned pregnancy. Thanks in advance!
posted by anonymous to health & fitness (25 comments total)

That would make a nice wedding gift, ya know.
posted by furtive at 6:04 PM on March 16, 2006

Are either of you working at jobs that offer group health coverage, or are you looking strictly for individual insurance plans? If so, find out when the open enrollment period is. If it's already passed for the fiscal year, you may be out of luck till it rolls around again (usually open enrollment periods are at the end of the calendar year, but it varies. Talk to your HR dept., if applicable.) Otherwise, you might be eligible for insurance through various professional associations you or your fiance might be a part of (or able to join), or if you're self-employed, you might be able to qualify for a small business plan through a state or private company.

In other words, what's your employment situation and location? Both will have an impact on the types of coverage that might be available to you. Also, what's your and your fiance's general state of health (aside from planning to get pregnant)? If either of you have a history of medical conditions (including taking maintenance medications), smoke, and/or are overweight, you'll potentially have a harder time getting individual coverage because you'll be seen as a less desirable risk, and so you'll have to consider health plans from a different pool of options.
posted by scody at 6:13 PM on March 16, 2006

having a baby and marriage generally qualify as life changes that allow insurance changes, at least for group plans.
posted by kcm at 6:20 PM on March 16, 2006

Illinois has a federally-funded SCHIP program called KidCare. If you're having trouble affording private insurance, you might qualify.

But seriously, it would be better to wait until at least one of you has a solid insurance plan through an employer.
posted by junkbox at 6:44 PM on March 16, 2006

I'm not quite sure what this open enrollment period is all about - how does this affect me if I'm going to be signing up for new insurance coverage?

Open enrollment is relevant only for group plans through an employer (it's the annual when everyone in the group can switch plans -- say, switch from the HMO onto a PPO -- which is distinct from the period when you're first hired and become eligible for coverage), so it's not relevant in your situation right now.

Here's a page of health insurance resources for self-employed/freelancers. Since you're both young and fit, that works in your favor. One risk to getting health insurance yourself (as opposed to through an employers) is that given the astronomical and ever-rising costs of health insurance these days, what might start out as a seemingly affordable monthly premium might go through the roof a year or more down the road. Which is not to say that health costs don't impact employer-sponsored plans too (and those employers, in turn, often pass on part of the increased cost to their employees), but rather that when you're in an employer-subsidized plan, you tend to be cushioned more from those rising costs. Which is all a rather long way of saying that while you both sound like good candidates for individual coverage, it might be safer financially for one of you to get a full-time job that offers a health plan.
posted by scody at 6:56 PM on March 16, 2006

What kind of writer is your fiance? I work at a company in Des Moines that is currently seeking a Junior Copywriter and we have decent insurance. Feel free to email me if you're interested.
posted by scottreynen at 7:01 PM on March 16, 2006

Get a job that comes with insurance. The pregnancy rider on individually purchased insurance will be very costly, and will be full of loopholes that cost you even more. The health insurance system sucks - good insurance is very very difficult to get on your own, and very expensive if you do find something.

However, if you have to go it alone - Blue Cross is usually the best deal. I'd go talk to an insurance agent to get educated - but really, finding gainful employment that comes with corporate insurance will save you thousands and thousands of dollars. Having a baby can easily rack up $20,000 in medical bills for a fairly normal pregnancy.

Last year I had individual Blue Cross for my family (wife and 2 kids). I was paying about $1000 a month - with pretty big deductables on top of that. And that was without the pregnancy rider - since we aren't worried about that anymore.
posted by COD at 7:07 PM on March 16, 2006

oh, and open enrollment is also the period where, if you previously didn't elect coverage when you first got hired, you can choose coverage for the coming year. I mentioned it only because I couldn't tell from your initial post if either of you had a job that offered health insurance that you just hadn't happened to select initially.
posted by scody at 7:10 PM on March 16, 2006

If you're both free-lancers, doesn't that qualify as being business owners? You could get some kind of deal that way, as Scody pointed out.

Illinois has a federally-funded SCHIP program called KidCare. If you're having trouble affording private insurance, you might qualify.

The poster lives in Iowa. (Or maybe you were just pointing out a program that might be duplicated in Iowa?)
posted by Airhen at 7:26 PM on March 16, 2006

She might want to try calling up the local health department. They'll have OB clinics, and they'll either help your fiance get enrolled in Medicaid or base fees on a sliding scale. Even while Medicaid is pending, the health department should be able to provide all prenatal care and postpartum care up to a couple of months after delivery. OB/Gyn or FP physicians with OB priveleges associated with the health department are tapped for delivery.

She may qualify for WIC as well.
posted by herrdoktor at 7:28 PM on March 16, 2006

I would recommend that one of you obtain a job that has insurance. Even part-time positions sometimes offer this benefit - I know UPS does, for example. This would allow you to still work on your freelance career on the side. If you're going to be raising a family, it's imperative that at least one of you has a stable job and that health insurance because medical care is super-expensive.

Freelancing is great (I do freelance work as well, and I have a one-year old) but I would not dream of trying to have/raise a baby without health insurance through an employer. In my case, my husband's insurance covers all of us. Even then, we have to pay upwards of $300/month for coverage.

And you are both young ... there is no need to rush here. If you put the pieces into place before you have a child, things will be much easier! The best of luck to you both.
posted by Ostara at 7:38 PM on March 16, 2006

Step 1: Get health insurance BEFORE she gets pregnant. Otherwise, insurance companies will consider the pregnancy a "preexisting condition" and may refuse to cover it.

Step 2: Make sure any insurance policy you get covers maternity. Then call a representative and ask what "maternity" entails. Does it cover pre-natal care? Post-natal care? Doctor's fees? Some plans that say they cover maternity only cover the room and board fees at the hospital, which is a small percentage of any fees childbirth might incur. Get the answers in writing, and file the writing away, along with the rest of the policy, somewhere safe.
posted by equipoise at 7:49 PM on March 16, 2006

Yeah, the mansion is a fun building to work in. The Meredith experience sounds good to me, but I wouldn't be doing the hiring as I do web development. I'd be happy to help if she's interested.
posted by scottreynen at 8:26 PM on March 16, 2006

I think the various forms of "get a job that gives you insurance" is strange advice. It seems totally absurd to me to base the very significant career and lifestyle choice between being self employed, and working for someone who offers benefits, on the relatively minor issue of obtaining health insurance.

Since you're young and healthy, individual plans to cover the most catastrophic accidents/diseases will cost you less than $200/mo. It's such a minor issue that basing your career path on it seems totally paranoid like a significant miscalculation of risk. Millions of people have no insurance at all by choice. The just choose to pay their way. I did that for most of my 20's.

My wife and I are both self-employed. We have individual policies with high deductables. The purpose of those policies is to insure the furtunes of our families--parents and grandparents--who'd likely consider paying if something catastrophic happened and one of us needed expensive long term care. Barring that, we save our money and pay for our medical expenses ourselves.

Also, having a baby is not necesarily a medical event that requires doctors or insurance at all. As I type this, I have a 5 week old baby snoring quietly in a sling around my neck. He's our first. We hired two midwives for $2800 for the whole thing--pre- and post- natal care and a birth at home. No doctors, no hospital stay, no huge bills--just one bill that we could afford to pay out-of-pocket. (Although it turned out my wife's $75/mo health insurance covered half!)
posted by nonmyopicdave at 12:33 AM on March 17, 2006

Most work health insurance you have to be working for nine months before it's covered, otherwise it's a pre-existing condition.

While it is possible to give birth at home uneventfully, it is also possible for things to take a bad bounce and it can get expensive fast in that case. In this, as so many things, life is a crapshoot.
posted by unrepentanthippie at 5:21 AM on March 17, 2006

The poster lives in Iowa.

Doh! My brain was clearly not working well last night. Sorry about that.

Iowa also has an SCHIP program -- hawk-i. SCHIP (State Child Health Insurance Program) programs are like Medicaid, but are designed for families who make too much money to qualify for Medicaid yet can't afford insurance on their own. Here in Virginia, we simplified our application so that you can be considered for both Medicaid and the SCHIP program (FAMIS) by filling out one form; most states will require a separate application for each.

More details about hawk-i on this page. I don't know if hawk-i covers pregnant women or not; some SCHIPs do, some don't.
posted by junkbox at 6:04 AM on March 17, 2006

Many policies, even those through groups (ie your employer) have waiting periods to be covered for maternity. Make sure you don't get pregnant if that applies to you during that period...
You can always save the cash and arrange with the hospital ahead of time. You can negotiate for labor and delivery. Retain a catastrophic policy in case things aren't "normal." If the baby's mom has pre-existing conditions like obesity, diabetes, asthma, depression or heart conditions this will not be a good road to go down since these conditions can and will complicate pregnancy and make the pregnancy high-risk right off the bat.
I would advise consulting an insurance agent, regardless. They represent many different product lines and a good one will help you find the best coverage for your situation.
posted by FergieBelle at 6:13 AM on March 17, 2006

equipoise: "Step 1: Get health insurance BEFORE she gets pregnant. Otherwise, insurance companies will consider the pregnancy a "preexisting condition" and may refuse to cover it."

I have yet to find an individual or family insurance plan that covers a pregnancy until a full year after buying coverage. Conversely, the group plans I've seen will cover you even if you conceive while the ink is still drying on the enrollment form.

nonmyopicdave: "Also, having a baby is not necessarily a medical event that requires doctors or insurance at all. . . We hired two midwives for $2800 for the whole thing . . . just one bill that we could afford to pay out-of-pocket."

My wife and I went this route as well. We were uninsured, but saved enough to pay cash. Unlike your experience, however, we had complications during birth, and my wife and new daughter were hospitalized (with my daughter spending her first three days in NICU). Both recovered quickly are are more than well, but we ended up with a $45,000 hospital bill that has changed how we live financially.

So, a birth doesn't necessarily require insurance, but it would have been nice.

After witnessing what we went through, my employer decided maybe it was time to provide insurance. Unfortunately, we couldn't make it retroactive...
posted by ewagoner at 6:20 AM on March 17, 2006

Are you college graduates? If so, check with your college alumni associations for group health insurance coverage at [possibly] reasonable rates.

Also check into group policies offered by any trade organizations you may belong to, or would consider joining.

Non-group policies will require physicals performed by the insurance company's screener (not necessarily a doctor or nurse, just somebody trained to take blood pressure and etc.).

They will look for ANY REASON to refuse you coverage. So very critically assess your fitness, health and lifestyle. You say you are both fit, but do you fit nicely into those insurance charts for height and weight? Is your blood pressure within normal ranges? Have you ever taken an anti-depressant or seen a doctor about a twinge in your lower back? Have you ever FELT a twinge in your lower back? What kind of work do you do, and is it possible that you will develop an RSI? Do you participate in any dangerous activities (sky-diving, recreational drug use, unprotected sex, etc., etc.)?

These are the kinds of privacy-invading questions you will be asked. You can lie, of course, and YMMV on the ethics of that, but if you lie and the insurance company finds out later through some kind of unforeseen medical issue down the road, your coverage will be dropped immediately.

You will also have to provide records from every medical procedure you've ever had, from organ transplants to every time you ever stubbed your toe. (And then they will probably issue you a policy, but with a Stubbed Toe Exemption, meaning your future stubbed toes will not be covered.)

Group coverage, especially through an employer, doesn't generally require quite so many hoops. And the application probably won't ask nearly so many questions.
posted by SuperSquirrel at 7:21 AM on March 17, 2006

Also, having a baby is not necesarily a medical event that requires doctors or insurance at all. As I type this, I have a 5 week old baby snoring quietly in a sling around my neck. He's our first. We hired two midwives for $2800 for the whole thing--pre- and post- natal care and a birth at home. No doctors, no hospital stay, no huge bills--just one bill that we could afford to pay out-of-pocket.

What ewagoner said. You'd be nuts not to carry coverage and just trust that everything would work out nice and natural. Just ask the first 10 parents you can think of in your social circle what unexpected medical issues arose for them in pregnancy, childbirth, or the first few years of their baby's life.
posted by fourcheesemac at 8:27 AM on March 17, 2006

Just ask the first 10 parents you can think of in your social circle what unexpected medical issues arose for them in pregnancy, childbirth, or the first few years of their baby's life.

Amen. Do NOT take the risk of having a baby without insurance. One of my nephews also ended up in NICU (he's absolutely fine now) and i wouldn't be surprised if the charges hit the hundreds of thousands of dollars.

I think the various forms of "get a job that gives you insurance" is strange advice. It seems totally absurd to me to base the very significant career and lifestyle choice between being self employed, and working for someone who offers benefits, on the relatively minor issue of obtaining health insurance.

For many -- millions, I'd wager -- it's not a minor question at all. I have medical conditions that make me practically uninsurable on the open market (as I learned when I did live as a freelancer for several years) -- having a job with health benefits is essential to my financial and physical well-being. Given that catastrophic medical bills account for half of the personal bankruptcies in the US, it actually strikes me as very strange advice to be so blase about health insurance, especially when the OP is planning on having a child. (Not that insurance is a magic bullet -- plenty of people with insurance still get stuck with huge bills because of the fine print of their policies.)

/digress
posted by scody at 9:13 AM on March 17, 2006

nonmyopicdave writes "Also, having a baby is not necesarily a medical event that requires doctors or insurance at all. As I type this, I have a 5 week old baby snoring quietly in a sling around my neck. He's our first. We hired two midwives for $2800 for the whole thing--pre- and post- natal care and a birth at home. No doctors, no hospital stay, no huge bills--just one bill that we could afford to pay out-of-pocket. (Although it turned out my wife's $75/mo health insurance covered half!)"

Pregnacy without insurance is not a good way to start a family. My wife's pregnancy was totally normal. Right up until the emergancy C-Section because of my daughter's 99th percentile head. Mom and baby then spent three days each in the hospital. Mom for the c-section and baby because of jaundice.
posted by Mitheral at 11:19 AM on March 17, 2006

[one comment removed please do not turn this into a digression about the US health care system]
posted by jessamyn at 12:51 PM on March 17, 2006

For the record, I'm not advocating going without health insurance. My advice to the OP is to just buy individual insurance. I found it reasonable and it covers my needs as I described earlier. I found all of the companies that offered it in my state online at a state gov website and called them directly.

If you require more health care than you can pay for out of pocket to remain with us and enjoying life, then by all means go find the company with the best insurance benefits and figure out how to get employed by them. That can be a good deal for you and I support you in that.

Charlesroper doesn't sound like he's in that group, though. He's 24. Self-employed. Makes good money. Is in good health. Doesn't smoke or drink. Is thinking it through before he has a baby. Has a woman who loves him... This guy is not someone who should be sacrificing the work life he's created so far in the name of having the widest safety net available for health care. That seems unhealthy to me.

Simply get some basic insurance and keep rocking on.

Regarding the birth comment, as I mentioned, my wife and I recently had a great experience with natural childbirth. I wanted to pass on the unsolicited fact that one needn't necessarily plan on paying a hospital anything. It wasn't what he asked, but I found it relevant to his question. You can very reasonably plan to forgo medical intervention in childbirth. Is it better to do this with insurance than without? Of course. Can your plans go awry? Of course. What are the risks & rewards? Find out. It was worth finding out for us.

Also, JackFlash, thanks for that link to the Krugman piece. That was interesting.
posted by nonmyopicdave at 3:16 PM on March 17, 2006

I would second this advice. See if you qualify for Medicaid or some other community health plan. I was in the same situation as you and Medicaid paid for my wife's pre- and post-natal care, the delivery and one year of baby's health coverage.
posted by soiled cowboy at 3:52 PM on March 17, 2006