Baby on it's way/health insurance problem
July 9, 2014 8:50 AM   Subscribe

My pregnant wife and I are leaving our job at the end of the summer (not our choice) with no new job lined up. We will need to get our own health insurance when we leave the job. We don't really live anywhere now, and we aren't sure where we will have the baby yet, maybe NH, or NY, or RI, or ME, or the VI. Is there an insurance plan that offers us coverage in multiple places? PPO, HMO, walk me through this. This is our first time buying insurance.

She's pregnant and we will be taking some time off, and/or freelancing and consulting. We have had employer provided health insurance, and I guess we are eligible for COBRA coverage. Only problem, it's $2600/month. We have also had trouble with our current insurance because we are almost always "out of network". We travel 52 weeks a year and have been for 5 years now.

We own a home in the US Virgin Islands that we haven't lived in (yet) and I've been paying income taxes there as well, and she has paid taxes and has a driver's license/voter card in NH. I assume we need to be "residents" of wherever we get insurance? We've only been in each location about 10 days/year over the last 5 years. Are either of us considered residents? If so, am I eligible for coverage under my wife's residency in NH, and/or is she eligible in the VI as my spouse? The USVI isn't a part of Obamacare, but does offer Blue Cross/Blue Shield.
posted by karst to Health & Fitness (6 answers total) 1 user marked this as a favorite
If it makes sense, use the USVI address as your permanant address. Most insurances will cover you if you're traveling, although you'll get dinged for going out of network (which presumably is your 'local' area.)

So, what makes sense. Two options:

Gold standars Blue Cross, that you pay through the nose for, and that covers you no matter where you are.

High Deductible: Where you pick an insurance plan, but it has a $4,000 deductible. This means that you pay $4,000 out of pocket before they start paying. You get the negotated rates, so you're not paying full price for medical procedures, and you have lots of lattitude for what and where you spend your medical bucks on. You do have to be willing to wade in though.

Here's my anecdata:

I had laser eye surgery this year. Regular cost if I were to pay cash $3,400. What I actually paid from my Health Savings Account-$875. So yes, I had to pony up a chunk of dough, but it was considerably less than the non-insured cost.

You can contribute to your HSA pre-tax dollars, and you can roll it over from year to year.

I'd recommend an HSA in your situation, especially if you're getting a nice bonus for separation.

Also, shop around for your wife's birth. Costs vary wildly and you may find a bargain out there!
posted by Ruthless Bunny at 8:58 AM on July 9, 2014

It looks like you can qualify for the Federal ACA Healthcare exchange as long as you have residence in a state this is part of the ACA along with your residence in the USVI.

And your change in circumstances definitely makes you eligible for enrollment. Time to call all 1-800-318-2596 and get answers from the source.
posted by brookeb at 9:12 AM on July 9, 2014

I think your best bet is to figure out where you want this baby to be born and "reside"/purchase insurance there. That way, you can find providers/facilities that you know are in-network and limit your out-of-pocket costs. Trying to find a plan that could possibly cover you in a half-dozen states sounds like a recipe for madness.
posted by ThePinkSuperhero at 9:14 AM on July 9, 2014

I agree it's a good idea to decide where you want to be living. In my state (Massachusetts), it's not too difficult to establish residency for health insurance purposes - basically a signed lease or utility bill or something like that will do it. You don't have to have been living here for years or anything, it's not like in-state college tuition.

If you're going to use ACA healthcare, you will have to pick one state to be a resident in (are you planning to keep traveling or are you going to settle down, even for a few months?). If the cost/availability of health insurance is going to be a factor in your decision, go to the healthcare websites of the states you're considering (and/or and check out what kinds of plans are available.
posted by mskyle at 9:21 AM on July 9, 2014 [1 favorite]

Separate from the health insurance dimension, it would probably be useful for you and your wife to figure out where you would like to be living when the baby is born and figure out whether she'll need to be getting most or all of her prenatal care there. While I'm sure clinics like Planned Parenthood are willing to schedule single prenatal appointments at random times during her pregnancy, the vast majority of OBs and midwives will want to either take her on as a patient and provide care through the entire pregnancy and birth, or not take her on at all. (Nearly all commercial health plans pay a lump-sum that covers all prenatal care to the doctor or midwife who does the delivery, so hopping from doctor to doctor for your prenatal visits is likely to mean that those doctors won't get paid for the single visit--which is why they may refuse to schedule a single prenatal appointment at all unless you're committing to come for the entire pregnancy.)

In terms of insurance, if both you and your wife are unemployed it's extremely likely that you'll be routed into Medicaid rather than subsidized insurance through the Obamacare exchanges. (They look at income and not assets when making that determination.) No reason to not apply and check in the state you're looking at living in--getting fat subsidies to purchase insurance is always a good thing!--but if that's unpalatable to you in terms what providers you'd have available, you can continue to buy insurance directly outside of the Obamacare exchanges, you just don't get a subsidy.

If you are determined to keep traveling, I'd absolutely recommend going with a PPO and not an HMO; with an HMO, you get absolutely no coverage for care provided out-of-network, and HMO networks tend to be smaller anyway. With a PPO, you're going to pay more to see an out-of-network provider but you can still take advantage of the plan's negotiated rate (usually discounts things by 20-50%, and lab tests by around 90%) and the plan will kick in some portion of the cost. I'd look especially at BCBS plans and ask whether those plans have reciprocity agreements with other state's BCBS plans, which will sometimes get you the ability to see doctors in other states as in-network providers if they belong to another state's BCBS network.
posted by iminurmefi at 12:10 PM on July 9, 2014 [2 favorites]

Your wife can certainly walk into an emergency room wherever you are when she goes into labor, but many women want to have a doctor or midwife who is familiar with them and their pregnancy. This would mean you would need to stay in one place for long enough to have a number of prenatal visits with that doctor.

Talk to your wife about how she wants to handle the birth arrangements. Depending on what she wants, you might have to stop traveling for a few months to make that happen. Get insurance that covers wherever you'd want to be for that time.

If you want to keep traveling right up until the birth, you should learn as much as possible yourself about what to do when someone has a baby and there are no trained people around to help them.
posted by yohko at 5:48 PM on July 9, 2014

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