Insurance for a New Baby?
May 20, 2014 6:51 AM Subscribe
We're expecting our first in a few weeks! How and when do we get insurance coverage for the little one?
My husband and I are both insured through work, but our employers really don't offer affordable plans for dependents. Can you insure just a baby through the affordable healthcare act plans? (We would probably not qualify for any subsidies). Is it cheaper to go through a private company? Do we need to wait until the baby is born to find a plan? Thanks for any help/wisdom you can share!
My husband and I are both insured through work, but our employers really don't offer affordable plans for dependents. Can you insure just a baby through the affordable healthcare act plans? (We would probably not qualify for any subsidies). Is it cheaper to go through a private company? Do we need to wait until the baby is born to find a plan? Thanks for any help/wisdom you can share!
Congratulations! Given your timeframe, your best short-term option is to put your baby on one of your plans rather than trying to wrangle some funky setup, which (a) may be impossible, and (b) may risk a gap in coverage which you absolutely do not want for a newborn, let alone anyone.
Beyond that, I'm surprised your optimal route isn't to consolidate all three of you on one plan, unless one of you has some special coverage need. Family coverage is usually more-or-less double the individual rate, so you should be seeing real savings there.
posted by mkultra at 6:59 AM on May 20, 2014 [1 favorite]
Beyond that, I'm surprised your optimal route isn't to consolidate all three of you on one plan, unless one of you has some special coverage need. Family coverage is usually more-or-less double the individual rate, so you should be seeing real savings there.
posted by mkultra at 6:59 AM on May 20, 2014 [1 favorite]
I think this is relevant: If you’re eligible for job-based insurance, you can consider switching to a Marketplace plan. But you won’t qualify for lower costs based on your income unless the job-based insurance isn't considered affordable or doesn’t meet minimum requirements. You should try calling Healthcare.Gov after the baby is born to discuss your personal situation to see if baby would be eligible for coverage. Without a subsidy, I can't imagine individual coverage would be cheaper than putting him/her on one of your workplace plans.
posted by ThePinkSuperhero at 7:01 AM on May 20, 2014
posted by ThePinkSuperhero at 7:01 AM on May 20, 2014
Start making these phone calls now. Generally you have 30 days to add a newborn to your plan, but that's for a plan you are already on - it may not be true for a new plan through the ACA marketplace that covers the infant only. Also, you don't want to be dealing with something like that during your first 30 days of figuring out how to be parents!
posted by peanut_mcgillicuty at 7:04 AM on May 20, 2014 [5 favorites]
posted by peanut_mcgillicuty at 7:04 AM on May 20, 2014 [5 favorites]
Seconding that you need to start yesterday. Childbirth should be covered under mom's plan, but the baby him/herself is also going to receive medical care and incur costs, starting in minute one. And those can be very expensive if there are any complications, heaven forbid. If you are each insured separately under separate employers, chances are that the coverage for 3 of you under one of those plans is going to be cheaper. Typically, "change of status" allows you to switch coverage under employer plans as of dates other than the re-enrollment date, and having a baby is a change of status. Check that out with both HRs.
posted by beagle at 8:58 AM on May 20, 2014
posted by beagle at 8:58 AM on May 20, 2014
Typically, through private insurance, a baby is covered on mom's plan through six weeks without needing to be registered for it. You should check if this is the case with your plan.
But, I think you may need to accept that insurance plans are expensive once you move into the family coverage territory. If you each have your own plan, now may be the time to combine under one plan through one or the others' employment insurance.
posted by zizzle at 9:25 AM on May 20, 2014 [1 favorite]
But, I think you may need to accept that insurance plans are expensive once you move into the family coverage territory. If you each have your own plan, now may be the time to combine under one plan through one or the others' employment insurance.
posted by zizzle at 9:25 AM on May 20, 2014 [1 favorite]
Are you and your spouses plans comparable coverage wise? i would put the baby on the less expensive of your two plans, providing that plan covers well child care etc. I imagine the baby will automatically be covered under its' mothers plan for atleast 30 days at any rate. you will have to check with your insurer's.
In the mean time, call private insurers and go to healthcare.gov and compare costs with your current plan. healthcare is just high - no way around it. often your employer based plan will be competitively priced, especially if you work for a large company with a large amount of employees covered. young children have lots of checkups and vaccinations even if they are healthy, now is not the time to take a bargain basement major indicident only plan. You can easily make up the difference in the premiums in doctors visits that first year.
posted by domino at 9:39 AM on May 20, 2014
In the mean time, call private insurers and go to healthcare.gov and compare costs with your current plan. healthcare is just high - no way around it. often your employer based plan will be competitively priced, especially if you work for a large company with a large amount of employees covered. young children have lots of checkups and vaccinations even if they are healthy, now is not the time to take a bargain basement major indicident only plan. You can easily make up the difference in the premiums in doctors visits that first year.
posted by domino at 9:39 AM on May 20, 2014
I recently looked into finding insurance for my daughter's child. She's insured through my insurance because she's under 26, and the child was not elegible on my policy. The father was not insured and so the child was not insurable through him.
In Pennsylvania it is absolutely impossible to commercially insure a child separate from a parent. Nobody - Blue Cross, Aetna, etc. will write a policy for a child without a parent. I called two attorneys specializing in insurance as well as several independent agents and the insurers themselves because I was absolutely astounded to hear this. Fortunately, because of the family income, the child was elegible for CHIP with an affordable premium. I found out from one of the attorneys who specializes in healthcare law for children that in PA CHIP is available to all children, but the cost varies according to income.
Obviously, this is not Kansas, and maybe this won't be directly applicable, but I was very, very surprised to find that except for this option, insuring a child without a parent is impossible. If this option is not available in Kansas, you might be stuck adding the little one to your policy, even if it is costly to do so. As a last resort you might place a call to your state's Insurance Commissioner's office to find out what the rules are regarding children's policies.
posted by citygirl at 10:24 AM on May 20, 2014
In Pennsylvania it is absolutely impossible to commercially insure a child separate from a parent. Nobody - Blue Cross, Aetna, etc. will write a policy for a child without a parent. I called two attorneys specializing in insurance as well as several independent agents and the insurers themselves because I was absolutely astounded to hear this. Fortunately, because of the family income, the child was elegible for CHIP with an affordable premium. I found out from one of the attorneys who specializes in healthcare law for children that in PA CHIP is available to all children, but the cost varies according to income.
Obviously, this is not Kansas, and maybe this won't be directly applicable, but I was very, very surprised to find that except for this option, insuring a child without a parent is impossible. If this option is not available in Kansas, you might be stuck adding the little one to your policy, even if it is costly to do so. As a last resort you might place a call to your state's Insurance Commissioner's office to find out what the rules are regarding children's policies.
posted by citygirl at 10:24 AM on May 20, 2014
Adding to my post above to say that the 30 day after birth coverage period only covered while the child was in the hospital. Once the baby went home, pediatrician visits were not covered - My daughter found out the hard way. It took several weeks before she was able to get CHIP and nothing was covered until that came through. Another loophole we did not ancitipate, as we assumed that 30 days was 30 days. Apparently not if you are discharged to home.
Again, this is PA, but she was covered by a very good Blue Cross policy, not a barebones policy.
posted by citygirl at 10:45 AM on May 20, 2014 [1 favorite]
Again, this is PA, but she was covered by a very good Blue Cross policy, not a barebones policy.
posted by citygirl at 10:45 AM on May 20, 2014 [1 favorite]
but our employers really don't offer affordable plans for dependents
Nobody does. Not trying to be flippant, it's just that in my experience adding a dependent to a health insurance plan in general is going to be expensive, you don't want to take the risk of not being covered to save what might be a small amount of money.
Normally you only get the option of changing insurance policies once a year, during annual enrollment. There is a special exception for the birth of a child -- you get thirty days to add them to your existing policy in most cases. If you miss that window and can't find another insurer willing to cover them as an individual rather than a dependent, then they might end up uninsured until the next annual enrollment period.
Also, based on my own experience, if you discover that your baby has some congenital health condition at birth, that is not a "pre-existing condition" for purposes of being added to the parents' insurance plan at birth. But if you wait until the baby is six months old to insure them, then conditions they were born with might count as "pre-existing" at that time. I know they can't deny coverage anymore under Obamacare, but there seem to be some problems with finding coverage for individual children with pre-existing conditions even so (see last section of linked article.)
I strongly agree with mkultra: Given your timeframe, your best short-term option is to put your baby on one of your plans rather than trying to wrangle some funky setup, which (a) may be impossible, and (b) may risk a gap in coverage which you absolutely do not want for a newborn, let alone anyone.
Even if your current plans really are more expensive than some alternative, it will only be ~6 months of coverage you'll be paying for, assuming your annual enrollment is at the end of the year. You can use that six months to shop for something better and enroll him/her (and probably one or both of you) once that time is up.
posted by OnceUponATime at 10:49 AM on May 20, 2014
Nobody does. Not trying to be flippant, it's just that in my experience adding a dependent to a health insurance plan in general is going to be expensive, you don't want to take the risk of not being covered to save what might be a small amount of money.
Normally you only get the option of changing insurance policies once a year, during annual enrollment. There is a special exception for the birth of a child -- you get thirty days to add them to your existing policy in most cases. If you miss that window and can't find another insurer willing to cover them as an individual rather than a dependent, then they might end up uninsured until the next annual enrollment period.
Also, based on my own experience, if you discover that your baby has some congenital health condition at birth, that is not a "pre-existing condition" for purposes of being added to the parents' insurance plan at birth. But if you wait until the baby is six months old to insure them, then conditions they were born with might count as "pre-existing" at that time. I know they can't deny coverage anymore under Obamacare, but there seem to be some problems with finding coverage for individual children with pre-existing conditions even so (see last section of linked article.)
I strongly agree with mkultra: Given your timeframe, your best short-term option is to put your baby on one of your plans rather than trying to wrangle some funky setup, which (a) may be impossible, and (b) may risk a gap in coverage which you absolutely do not want for a newborn, let alone anyone.
Even if your current plans really are more expensive than some alternative, it will only be ~6 months of coverage you'll be paying for, assuming your annual enrollment is at the end of the year. You can use that six months to shop for something better and enroll him/her (and probably one or both of you) once that time is up.
posted by OnceUponATime at 10:49 AM on May 20, 2014
Response by poster: Update for those in a similar situation:
I'm aware that healthcare is expensive. The deal with our employer insurance plans is that they offer an option for individual + entire family coverage, but not employee + single dependent. So, they'd be a great deal if we had five kids.
After speaking to a human with the gov/ACA, it looks like the state marketplace is our best option. I can insure the baby on her own plan, I have 60 days after birth to submit my application, and the cost will be about 20% of what it would cost to add her to either of our plans (and that's not for a catastrophic plan, either).
Baby is covered on my plan for 30 days after birth, including pediatrician visits. I have been making calls, but I like to run things by the hive mind. Thanks for the input.
posted by mmmbacon at 10:53 AM on May 20, 2014 [1 favorite]
I'm aware that healthcare is expensive. The deal with our employer insurance plans is that they offer an option for individual + entire family coverage, but not employee + single dependent. So, they'd be a great deal if we had five kids.
After speaking to a human with the gov/ACA, it looks like the state marketplace is our best option. I can insure the baby on her own plan, I have 60 days after birth to submit my application, and the cost will be about 20% of what it would cost to add her to either of our plans (and that's not for a catastrophic plan, either).
Baby is covered on my plan for 30 days after birth, including pediatrician visits. I have been making calls, but I like to run things by the hive mind. Thanks for the input.
posted by mmmbacon at 10:53 AM on May 20, 2014 [1 favorite]
Is the baby's other parent eligible to be covered by your insurance or vice verse?
It is likely far cheaper for the three of you to be on one plan than to have two plans....unless there are reasons the baby's other parent can't be, which I understand happens. If that is the case, then the marketplace is probably the best option.
posted by zizzle at 10:59 AM on May 20, 2014
It is likely far cheaper for the three of you to be on one plan than to have two plans....unless there are reasons the baby's other parent can't be, which I understand happens. If that is the case, then the marketplace is probably the best option.
posted by zizzle at 10:59 AM on May 20, 2014
My daughter has had her own insurance plan for the past 12 years because it has been MONUMENTALLY cheaper (even with the latest rate hike) to have her own her own plan The company her father and I both work for doesn't cover any of the spouse or dependent portions of the premium.
My husband and I pay $35/month for our employer coverage ($70 total) Our daughter's individual policy is $110 so a total of $180/month for everyone.
In contrast here's what it would cost for us to all be put on either of our employer sponsored plans:
employee + child(ren): $364/month!
employee + spouse + children: $822/month
posted by vespabelle at 4:44 PM on May 20, 2014
My husband and I pay $35/month for our employer coverage ($70 total) Our daughter's individual policy is $110 so a total of $180/month for everyone.
In contrast here's what it would cost for us to all be put on either of our employer sponsored plans:
employee + child(ren): $364/month!
employee + spouse + children: $822/month
posted by vespabelle at 4:44 PM on May 20, 2014
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posted by mskyle at 6:54 AM on May 20, 2014