Hellobee Boards

@Mrs. Sketchbook: I thought maternity care is covered at 100%, including hospital stay?

Let me know if I'm wrong! I casually looked into the plans, but we didn't purchase one.

@lilyofthewest: @Mrs. Jump Rope: Nope, maternity care is definitely not covered 100% with no cost-sharing. It is just an "essential health benefit" that has to be covered under all plans now--the insurers can (and do) still make you pay for it on top of your premium.

Maternity wasn't included in most individual-market private plans prior to 2014 (and as Mrs. Sketchbook refers to above, a lot of the pre-2014 private plans had lengthy waiting periods for pregnancy coverage). Most of the bronze level plans have something like 30% coinsurance for prenatal/delivery/postnatal, after you meet the (usually quite high) deductible, of course.

@Mrs. Sketchbook: The exchange website is http://www.healthcare.gov. Make sure you get the official site! Good luck! (Also, be sure to check the network for the plan you pick. The networks on the exchanges are often VERY limited.)

Have you looked at the platinum plans? They have higher premiums but low deductibles. It made more sense for us being pregnant!

@honeybear: yes, covered 100% without copay or coinsurance. I didn't mean it was free.

@Mrs. Sketchbook: can you do the math to compare plans? Make sure to include prescription coverage in your calculations.

We are insured through my husbands employer but we've seen a lot of the ACA benefits for a few years. We pay more upfront -- prescription and health benefits don't kick in until we've met our deductible -- but it's cheaper in the long run. Then it's 90/10, and our precariptions & co insurance go toward our OOP. In the end, we won't pay more than $6500 out of pocket for all services.

So right now, you could have a $3,000 deductible but also pay $20 for copays and prescriptions above and beyond that deductible.

Does that make sense?

@Mrs. Sketchbook: This was 6 years ago, but I know that with DS, I paid the OB fee and the delivery fee for the hospital. DS had to stay in the NICU, so we ended up with a bill for that, and one with a few more fees for me, since I delivered at 32 weeks and got some extra TLC in the hospital. My OB at the time was employed by the hospital (and mine is no, also, but I have state insurance this time around).

My understanding is that ACA makes insurance companies cover well-visits at 100% cost but it certainly does not mean having a baby is free! All of my maternity visits are covered (the routine pre-scheduled ones) and when the baby comes her well-baby visits will be covered at 100% as well. But I still pay out of pocket for lab work, ultrasounds, any non-routine visit (so if I had to go to the ER or to my doc for a problem), as well as for the birth. I mean, technically those things are "covered" but I have to pay my deductible first and then there is coinsurance (80/20).

I'm not in your situation because I'm not losing my insurance or anything but I was in the crappy situation of getting pregnant in one calendar year and delivering in another. Which means I got to pay out of pocket (bc I had not yet met my deductible) in 2013 for all my routine lab work, vaccinations, and 2 ultrasounds-- and now in 2014 I start back at 0 having to pay my deductible again for more ultrasounds and the birth.

It doesn't bug me either way, my birthing center doesn't take insurance.

@lilyofthewest: I know because I've studied the plans being offered on the exchange. In general, certain prenatal tests are covered with no copay/coinsurance, but in many cases, for prenatal/delivery/postnatal care you have to pay your deductible and then some amount of coinsurance. There are some plans I've seen with no coinsurance for these services, but you still have to meet the deductible.

@Mrs. Jump Rope: At least with respect to the plans I've seen, delivery is subject to the deductible and typically some amount of coinsurance. Some ACA plans also require deductible + coinsurance for prenatal/postnatal visits, so I don't think that's a no-cost-sharing-eligible preventive service.

@Mrs. Sketchbook: I totally understand your issue. My brother-in-law works for a huge corporation and his insurance went WAY up this year. They are hoping to have another baby this year and wouldn't even be able to afford the copay since it went from something like $3,000.00 to $25,000. (The family out-of-pocket deductibles are grouped together.) They can no longer afford insurance through his work. Thankfully my sister works for the state and her insurance wasn't affected by all of the recent federal changes. My husband also works for the county so I am able to go on his insurance (which also wasn't affected) since my private insurance also went through the roof.

@Mrs. Sketchbook: this is definitely very confusing!

Can you call customer service and ask questions before committing to a plan?

@Mae: Ah, that's helpful! It looks like there's some prenatal labwork and testing that's covered, but, it is pretty slim list compared to the things many providers routinely request. I can see that adding up pretty quick.

@scg00387: I haven't really ever found insurance to be too confusing. But yea... all my friends had their premiums and co-pays drastically go up. One girl was looking on the exchange or whatever its called, but because of the zipcode in which she lived, that exchange insurance was also going to be so expensive. We all pay so much in student loans and there's no way to factor that into anything.