Pregnant and uninsured
September 30, 2016 9:27 AM   Subscribe

I am pregnant in the state of Maine. I want to keep it. How do I not go into medical bankruptcy?

My partner and I are head over heels ECSTATIC. But we were planning on waiting 10 months or so. So it's a bit of a surprise, thanks to a broken condom.

We had a wedding this year but my husband forgot to get a marriage license and we honestly haven't gotten around to it. I could get insured through his work BUT it wouldn't be until January 1, plus we would have to get married, plus he'd have to work enough hours before then to insure himself and myself, or we would pay to get me added on without him working all the extra hours.

I could also stay unmarried and try to get mainecare. I have decent savings and own a house in my name so I don't know if that would be a problem.

Our original plan was for him to work a bunch, get a marriage license and then insure me July 1, 2017 (it's open every 6 months), then try to get pregnant. What now?

Also how soon do I need to see a doctor?
posted by pintapicasso to Human Relations (21 answers total) 2 users marked this as a favorite
 
You may be eligible for MaineCare, but it's unclear. Your house won't hurt you, but the savings likely will. Also, they investigate 5 full years prior to your application, so transferring funds away now won't solve that problem.

You should make an appointment to talk with someone at one of the Maine HHS offices. In fact, you are required to do this before you apply, so it's worth doing now. All the offices and their hours are here.
posted by yellowcandy at 9:32 AM on September 30, 2016


One thing you could look into is private birth centers, midwives groups. I harangued my husband to turn his contract job into a full-time with benefits job so that we could have health insurance when I was pregnant and had my baby. For all sorts of reasons, this was a good thing. However, my out of pocket costs on the insurance plan that we had was more than my friend who went to a birthing center, attended by midwives that she worked with throughout her pregnancy and paid for with cash.

Also, are you sure you have to be married? So many employers will allow unmarried couples now. Check into that ASAP. Additionally, marriage is a life event that should enable you to get coverage immediately, if you go that route.

Contact MainCare and ask what your options are.
posted by amanda at 9:35 AM on September 30, 2016


You shouldn't have to wait for the enrollment period if you have a major life event, and marriage counts as one of those events. (https://www.healthcare.gov/glossary/qualifying-life-event/)

So if you get the license and get officially married you should be able to enroll around that event.
posted by that girl at 9:35 AM on September 30, 2016 [41 favorites]


it's unclear if the husband can claim insurance with his provider now or not .. If he's eligible, generally, a life change event means you can sign up immediately.. A life change event includes marriage and birth of a child.. But if getting married isn't going to happen NOW, then having baby covered (but not your pre-natal) might not help much.

If I'm misunderstanding, then you can probably get sliding scale prenatal care via PP or similar orgs, and then sign up 01-Jan.
posted by k5.user at 9:36 AM on September 30, 2016 [1 favorite]


How do I not go into medical bankruptcy?

Have you looked at Maine's Obamacare exchanges? How much would a high deductible plan cost you?

You might need to get married in order to trigger a qualifying event to get on an exchange plan, but your pregnancy won't count against you.

Also how soon do I need to see a doctor?

Technically, you never need to see a doctor, but it might be an idea to find one you like and then decide what's best for the two of you insurance-wise.

Maybe you should pay out of pocket until Jan 1. Maybe on Jan 1 you should go with your husband's insurance. Maybe on Jan 1 you should go with the exchange. Maybe you should go on the exchange until Jan 1 and then switch to husband's insurance.

All these maybes depend on the numbers, and its hard to work out the numbers without knowing what insurance will cost vs. paying out of pocket.
posted by sparklemotion at 9:39 AM on September 30, 2016 [2 favorites]


Getting married is a "qualifying event" and allows you to make changes to your insurance enrollment outside of the open enrollment periods. So you should be able to be added right away should you choose to get legally married. That doesn't address the additional costs. You can certainly apply for public insurance but its likely your partner's income will be counted toward eligibility if you live in the same household.
posted by drlith at 9:41 AM on September 30, 2016 [7 favorites]


Typically marriage counts as a "life event" so you should be able to get added to your partner's insurance without the waiting period.

You might also be eligible for Medicaid--typically pregnant women have much more liberal enrollment criteria because prenatal and newborn care is expensive and important. Staying single might be advantageous there.

I would strongly urge you to talk to the good folks at Planned Parenthood of Maine. They will have a social worker who can help you parse out the different options that are available to you insurance wise.
posted by The Elusive Architeuthis at 9:43 AM on September 30, 2016 [9 favorites]


Also how soon do I need to see a doctor?

When I was pregnant, the doctor wanted all early prenatal testing done by 12 weeks if that was a concern for me.* If you are a particular profile, they may recommend certain kinds of tests. I think hitting the six week mark would be a good time to go in and talk to someone. Make note of your likeliest conception date so that they'll have a benchmark for growth.

*Some people feel very strongly that they will not abort if their baby has abnormalities of any severity. I wanted to know as much as possible so I could make informed choices and/or prepare myself. Discovering that your baby has severe health conditions late in pregnancy could limit your options depending on the laws in your state.
posted by amanda at 9:47 AM on September 30, 2016 [1 favorite]


Are you near a Planned Parenthood? They are generally extremely well versed in the local options and can probably point you in some starting directions. They deal with them from both avenues - getting people to the resources and billing the resources for the people.

As others have said, marriage is a qualifying event and you do not have to wait for open enrollment to get on his insurance. But, if that financially turns out to be not a great option for you, the birth of a child is also a qualifying event and he could insure the baby when they are born even if you go your own route for your own coverage (if it turns out cheaper to do that, both for the baby and yourself).
posted by Lyn Never at 9:47 AM on September 30, 2016 [2 favorites]


Hi and congratulations! I remember your wedding question! Are you absolutely sure you don't have a marriage license? I had a courthouse wedding too (another state) but they wouldn't even schedule a judge to see us until we had a marriage license ready to go. The judge signed it right there in front of us.

Call your city/county clerk and double-check - at least it'll eliminate some options.
posted by kimberussell at 9:50 AM on September 30, 2016 [3 favorites]


Hi! Yes, it is totally wacky - we rented a special room at the courthouse and our uncle got ordained online, and after the ceremony we went to the clerks office to sign papers and they were like "???"

I did not realize that marriage could be a qualifying event. My husband also is uninsured as he hasn't put many hours into the pipe fitters Union and instead has worked lobstering, so good money but no insurance. He was planning on taking some downtime but now it looks like he should get hopping with pipefitting and we will go that route.

Thanks. I had intended to make this question anonymous but obviously didn't connect the dots. Oh well!
posted by pintapicasso at 10:00 AM on September 30, 2016


Also: Typically there's not much point in an OB/midwife visit before 6-8 weeks, which is the earliest a heartbeat will be apparent on an ultrasound. (Unless you're having bleeding or something). First trimester care is mostly about making sure you don't have other conditions that could be problematic (STIs, hepatitis, etc, making sure you've had a Pap), assessing the risk of genetic disorders so that they can recommend which screening/diagnostic tests to have early in the 2nd tri, and generally getting plugged into care. (Remember that you date pregnancies from the first day of the last period, so that at the moment the sperm meets the egg, you're 2 weeks pregnant. I know, it's just traditional).
posted by The Elusive Architeuthis at 10:03 AM on September 30, 2016 [1 favorite]


Since you know you have upcoming expenses, rather than just going for a cheap high deductible plan, you might actually be best off with something more expensive that offers better coverage. It's also worth keeping in mind that giving birth will be a qualifying event in its own right, so if that's complicated/expensive, you can upgrade and the new insurance is retroactive (our $30k NICU bill went poof!).
posted by teremala at 10:12 AM on September 30, 2016 [3 favorites]


I just wanted to note that contrary to your fears, neither your house nor your savings account (no matter how much $ is there) will count against you for the purposes of determining MaineCare eligibility. States can look at houses/assets/savings when determining eligibility for disabled or elderly folks, but pregnant women and kids are evaluated *solely* on the basis of their current income, no asset test allowed.

MaineCare covers pregnant women up to something like 214% of the federal poverty line. If you're unmarried and file taxes as a single person, that means you can qualify as long as your income is at or below something like $25,000. The nice part about MaineCare / Medicaid is that you're not going to have a deductible or big coinsurance requirements - basically, all your prenatal care and labor/delivery should be free (or nearly free) to you. On the downside, you generally have less choice of providers (a birth center and/or midwife might not be covered) and sometimes it's hard to get in to see the providers who accept it.

Agree with those above that getting legally married will allow you join your husband's insurance. One thing to look at there is the deductible, coinsurance, and maximum out-of-pocket costs - it's pretty likely you'll be paying something to have a baby with employer-based insurance, but that could range from a few hundred bucks to a few thousand, depending. You generally get more choice of what doctors/hospitals you can use (and it's often easier to get an appointment) with private insurance, but how much more that might cost is probably worth thinking about.
posted by iminurmefi at 10:16 AM on September 30, 2016


giving birth will be a qualifying event in its own right, so if that's complicated/expensive, you can upgrade and the new insurance is retroactive (our $30k NICU bill went poof!)

It's my understanding that the retroactive part only goes back to the qualifying event itself - in this case the baby's birth. So while your NICU bill went poof, if you'd had, say, a month of hospital bed rest prior to the birth it would not have counted. I'm pretty sure that even labor or C-section would not count until the time on the baby's birth certificate, so if you want to have an epidural or not have to worry about complications, you need to have insurance that will cover that before the event.
posted by Kriesa at 10:51 AM on September 30, 2016 [1 favorite]


Right now, make sure you're taking a good multivitamin, particularly one that has folic acid. You can get a more specific recommendation on a prenatal vitamin from your doc once you see one, but start taking folic acid now.
posted by msbubbaclees at 11:19 AM on September 30, 2016 [3 favorites]


Marriage in Maine

Ordained ministers can solemnize marriages in Maine. Talk with someone and see if your wedding "counts" as making you legally married. (Maine does not recognize common law marriage.)
posted by Michele in California at 11:34 AM on September 30, 2016


Yes, if you can get on Medicaid (not sure if that is the same as MaineCare) do it! I didn't have to report any of my savings when I was pregnant. It will be much easier to get on it you are still technically single, also.

Not sure if you're working, but it's income based in my state. So, that's probably the biggest factor. They will also date back for like 3 months, so if it takes awhile to sort it out, all your bills will be covered for the last 3 months. So get the process started soon. Anyway, the social workers are really helpful in this instance sorting it out. I think I filled out like a super short application, and then just had to wait for awhile for it to go through. However, I could still see a regular OB/midwife of my choice, and just told them (as per my social workers rec) to tell them I was waiting for medicaid to go through. No one ever blinked an eye.

It was amazing! You can work with regular OBs and midwives, and often it means your kid will be on medicaid for the first year, automatically. ugh, it was so wonderful to have socialized medicine for that time! SO GOOD! Never saw a bill And I was a bit high risk so had many, many appointments plus a longish hospital stay.
posted by Rocket26 at 5:03 PM on September 30, 2016 [2 favorites]


Re: tying up the loose ends, marriage-wise: A notary public can also solemnize marriages in Maine.

(And if you're in midcoast Maine, I have a friend who's a notary who's done a lot of weddings and knows all the ins and outs of the paperwork. Can't promise anything, but he's a very nice guy and would probably be able to recommend someone else if he can't do it himself. Send me a MeMail if you want his name and contact information!)
posted by virago at 5:52 PM on September 30, 2016


PS Rocket26: MaineCare and Medicaid are the same thing.
posted by virago at 7:43 PM on September 30, 2016


Not to belabor (har) the point, but the retroactive coverage is to the date of birth, not the time. Mine did in fact cover a c-section and several days' recovery in the hospital, though yes, day(s) of laboring beforehand wouldn't have been included.
posted by teremala at 6:37 AM on October 1, 2016


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