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I wanted to share the hardships of the past year a half of trying to obtain health insurance in texas with maternity coverage (not just complications). This was an extremely stressful adventure for me and my wife. I lost my job after 3 months of getting married and decided it was best to go back to school. However, without health insurance options from my wife's job and me concentrating exclusively on school it was a huge nightmare to find anything in Texas with maternity coverage. I tried using agents but none of them could offer maternity coverage and in fact they all tried to convince me that I did not need it because they would cover complications. I thought that they were crazy. So, I would like to create this thread and share my experience in hopes that others who might be in our past dark situation can have some light from the experienced without the stress that we had to deal with.
We used my COBRA policy for 15 out of the maximum 18 months at a whooping $650/month with a $5000 deductible for the two of us. When we decided to start thinking about trying for children we suddenly had a huge problem with a COBRA time bomb that was about to expire. Given that pregnancy is a +-9 month process there literally was no point in continuing our COBRA policy with only 3 months remaining.
I had no problem obtaining a good individual health insurance policy but my wife was a problem when it came to this. She has some pre-existing conditions that kept her shut out from being accepted into any health insurance coverage policy by every company she applied for. Also, we found out that all individual health insurance plans in Texas do not come with maternity coverage options except for the Scott & White Traditions plan which is not advertised on their website anymore. In fact, you have to call them and ask about it and insist that you know about it to even get them to consider helping you with it. My wife applied for it and was denied coverage due to her pre-existing conditions. This left us with only one option that we could see at the time. That option being to exhaust our COBRA policy and put my wife on the Texas State High Risk Pool. Well guess what...this incredibly expensive option does not have maternity coverage but it does have coverage for complications. That was a thumbs down for me. I did some more digging around and found an alternative non creditable coverage option called Christian Healthcare Ministries (CHM). They cover normal maternity conditions and complications at the pre, delivery, and post stages of the process. This turned out to be a major positive find. At only $150/month $125,000 max coverage with the option to purchase a $1 million dollar maximum coverage using the Brother's Keeper program it was a no brainer. Also, the waiting period for the maternity benefits to become active is only 45 days, this was no problem at all for us. This appeared to be a great deal for pregnancy but not everyday medical expenses before and after pregnancy because benefits are only paid after $500 per incident. Not bad if you only want cheap catastrophic coverage or have a baby. So, I looked ever further and found the pre-existing condition insurance plan also known as PCIP. This is considered creditable normal insurance and it does cover normal maternity conditions, complications, and is a major medical policy for every day medical needs with an annual deductible. This appeared to be the best option until I realized the eligibility requirements. You have to be without creditable health insurance for at least 6 months prior to applying, been denied health insurance because of a pre-existing condition and can prove it with a denial letter. The only problem for us was having to be uninsured for 6 months. I finally put 2 and 2 together after a while and decided to drop our COBRA policy and go exclusively with CHM as a good non creditable coverage option. Our plan at the time was to have CHM for at least 6 months while waiting to become PCIP eligible. I verified with PCIP to make sure that CHM was not considered to be creditable coverage and I got the definite answer of "NO" from them. So far, our experience with CHM has been extremely positive. They are very easy to work with and seem to want to look for ways to pay your benefits rather than looking for ways to not pay them. Quite the opposite experience when comparing my past health insurance stories.
Today, my beloved wife is pregnant and CHM has proven itself to be very generous with their maternity program. At the end of this month my lovely wife will be PCIP eligible and we will continue to have CHM since they will also pay our PCIP deductible and maximum out of pocket co insurance expenses very similar to a supplemental insurance policy.
I wanted to create this thread and share my story so that others in our situation or a similar situation will know what to do without the hardships of looking and thinking their are no good options out there. If you do not have a pre-existing condition, keep in mind that pregnancy does count as a pre-existing condition in the state of Texas. This could assist with making you PCIP eligible. I hope sharing my experience here will reach others that need to know about this.
I am a woman. I had private coverage for many years in my 30's. You're right - most insurance companies don't offer maternity coverage. And honestly, I don't blame them. Having a child is elective. Most insurance companies don't cover elective things. If they offered it, women would buy coverage for 10 months while they are pregnant then drop it. Even if she's paying $500 a month for those 10 months, she wouldn't come close to covering the cost of pregnancy and having the child.
I am a woman. I had private coverage for many years in my 30's. You're right - most insurance companies don't offer maternity coverage. And honestly, I don't blame them. Having a child is elective. Most insurance companies don't cover elective things. If they offered it, women would buy coverage for 10 months while they are pregnant then drop it. Even if she's paying $500 a month for those 10 months, she wouldn't come close to covering the cost of pregnancy and having the child.
Yes, I have to agree. While pregnant both times, I was either on my work's insurance or my husband's and both covered routine visits/tests and a portion of delivery -- we paid the rest. I will add that both times we had fairly decent maternity coverage from pretty decent well-known medical insurance providers.
That said, pregnancy and having a child is purely elective. If you really want to strike a nice balance between cost and proper maternity care and don't have dependable medical insurance, it makes sense to use a clinic that provides care to uninsured and use a midwife or the like (out of pocket) for delivery. It's cheaper than you might think. Then you also circumvent the preexisting condition concern.
While I wish there were better most cost-effective options for maternity coverage out there, let's face it, it's elective and you choose to be pregnant -- it's categorically not the same as having ANY kind of accident, being diagnosed with cancer or some other condition suddenly -- situations in which independent insurance coverage tends to be more generous by definition --.... this is not Canada.
Anecdotally, (not necessarily for the OP) you can work at Home Depot part-time and they provide medical insurance to you and your family. I know if two independent home inspectors in the Austin area who do just this... work at HD only two three nights a week so their families still receive medical coverage, one is due to have a baby in 6 weeks and he raved about the insurance coverage.
Yes, I agree the pregnancy is an elective. It sounds like to me though that the issue was that his wife was unable to get any kind of coverage, let alone coverage for maternity.
However, if someone is wanting to get pregnant, the sad thing is that it is not an option with any kind of coverage unless it is group. I have not heard of ANY company offering health coverage to part time employees, especially in this economy. I find it very hard to believe that Home Depot can afford to give this option. I read on another thread that the premium is way too expensive and the coverage payout was limited to $20,000. That does not sound like good coverage to me. I also know of a lot of parents who believe they have good coverage until the bill comes AFTER delivery.
Sounds like this particular family had two options, to go on the risk pool, or join PCIP. and even with those two options, it took way too long, and too much research to even know those options exist. That is sad.
Even if pregnancy is an elective, there should be a plan to elective to have pregnancy be an option if someone is wanting to start a family. Lack of insurance coverage to have a healthy baby and mother should not be something should not be the only reason someone cannot start a family.
I am glad you found options. Thank you for sharing. Texas does not make health insurance easy, especially for those with pre-existing conditions.
mm57553,
Yes, pregnancy is an elective. Everybody knows that it is an option and not an illness such as cancer. Most health insurance companies that even offer a maternity rider include a long waiting period as long as 12-18 months. This is to prevent people from buying the maternity coverage rider for only 9-10 months and leaving the insurance company with a financial loss. Only problem is that the plans that I read with these riders are NOT offered in Texas. I do not agree with your idea of not blaming insurance companies for not offering maternity coverage given that all of them have waiting periods to cover themselves from financial loss.
Idlewile,
I am talking about individual coverage and I am speaking out for options for those that DO NOT have a group coverage option through their employer. These type of people can be self employed, unemployed, or work for an employer that does not offer health insurance. Many people I know have used midwife services and have been successful with using them. However, some of my friends could have prevented having a miscarriage if they were not using a midwife and monitoring their pregnancy more closely in a NON midwife situation. Home Depot does not offer medical health insurance to part time employees per their website; it clearly states under their health benefits section that is offered only to full time employees. Your friend's situation may not be typical for Home Depot, and I wonder how he or she was able to obtain health insurance through them only working three nights a week. Also, Home Depot's health insurance is classified as a mini med plan. These type of insurance plans are offered to employees deemed as being in a low wage category or who would otherwise would not have health insurance. Your friend needs to be careful because mini med plans have extremely limited benefits coverage as lksvad commented on. Other companies such as McDonalds and Blockbuster Video fall under the same mini med plan category. Be lury about working for companies that offer mini med plans if you are solely working their just to obtain their health insurance benefits. I can only imagine the financial disaster that could happen if a new born were to be put in NICU care for an extended period of time under a mini med plan type of policy.
lksvad,
Yes, the dilemma was not only no coverage for maternity until I exhausted nearly every possible outlet I could find. It was also not being able to get good major medical health insurance coverage for my wife on an individual plan in Texas even without maternity coverage because of her pre-existing conditions. I created this thread to get the word out about my long hours of stress and research to help others who are trying to obtain individual health insurance as well as individual health insurance with maternity coverage in Texas with pre-existing conditions. I wonder how many people put off creating a family because they cannot get good health insurance coverage or cannot afford to pay out of pocket for it even at a place that is intended for the uninsured.
I have not heard of ANY company offering health coverage to part time employees, especially in this economy.
Starbucks.
Quote:
Because health care is important to our partners, Starbucks offers comprehensive benefits packages to eligible partners working at least 20 hours per week, with 64% of eligible partners currently enrolled.
The original concept of insurance seems to have been lost. The fundamental purpose of insurance was not to cover all your expenses, or even to keep you from any loss. The purpose was to buffer you against unusual loss, to keep you from being wiped out by extraordinary events, if they were to occur.
The idea that a group policy would cover normal expenses to came out of the early HMOs, which basically offered an "all-you-can-eat" buffet of health care in exchange for a regular monthly payment. And in fact... back in the Stone Age... my daughter was born under one of the first of these plans, and we were very fortunate to have this coverage, because she was born prematurely and spent her first couple of weeks in an incubator. The cost would have bankrupt me if we didn't have that plan.
But today, honestly, I think I'd be too scared to have a kid at all if I didn't have a major health insurance policy through a good group policy offered by an employer.
My heart goes out to you for the predicament you find yourself in. And my heart goes out to us as a country if we don't figure out a way through this mess together, and soon. If people can't afford to have babies we have no future.
Idlewile,
I am talking about individual coverage and I am speaking out for options for those that DO NOT have a group coverage option through an employer. These type of people can be self employed, unemployed, or work for an employer that does not offer health insurance. Many people I know have used midwife services and have been successful with using them. However, some of my friends could have prevented having a miscarriage if they were not using a midwife and monitoring their pregnancy more closely in a NON midwife situation. Home Depot does not offer medical health insurance to part time employees per their website; it clearly states under their health benefits section that is offered only to full time employees. Your friend's situation may not be typical for Home Depot, and I wonder how he or she was able to obtain health insurance through them only working three nights a week. Also, Home Depot's health insurance is classified as a mini med plan. These type of insurance plans are offered to employees deemed as being in a low wage category or who would otherwise would not have health insurance. Your friend needs to be careful because mini med plans have extremely limited benefits coverage as lksvad commented on. Other companies such as McDonalds and Blockbuster Video fall under the same mini med plan category. Be lury about working for companies that offer mini med plans if you are solely working their just to obtain their health insurance benefits. I can only imagine the financial disaster that could happen if a new born were to be put in NICU care for an extended period of time under a mini med plan type of policy.
I know you are referring to individual coverage and not group coverage options through an employer which is why I suggested a clinic for routine maternity care which you never mentioned. There are plenty of mothers in this town who are self-employed (or their spouse is) and go to a clinic for their routine maternity care. Maybe your wife should check into the Austin Mama online -- it largest online community for Austin mothers. AustinMama Blog There have been many posts on this subject.
When my husband and I were self-employed and thinking of having children, we chose to stay in Colorado so we would have access to Kaiser Permanente. For us, when we were planning on having children, we knew we owed it to ourselves to be thoughtful about the financial planning surrounding that important decision, and that included insurance, before and after the children arrived.
I can't speak for the facts or verbiage on HD's website but I can tell you the home inspector for our home works for a well-known inspection company and told us he works at the Home Depot on 620 , in the plumbing department, three nights a week and will maintain this job commitment because it specifically provides his family coverage. Further, he said his main reason for continuing to work there for said coverage is because his wife has complex on-going medical issues and they can't beat the insurance considering her issues. Perhaps the number of hours worked during his 3 days a week is considered full-time and not part time.
As for the midwife concern, having worked at one of the top 10 pediatric hospitals and NICUs in this country, in partnership with leading OB/midwife practices, I can tell you you are incorrectly characterizing an entire professional healthcare establishment and are ill-informed on the topic. I would never see a midwife without receiving the option for the SAME monitoring I received from my OB during my two pregnancies. Your friends, unfortunately, sought out 100% subpar medical providers and are the exception rather than the rule; proper midwives offer all the same testing as specialists (OBs) do. Further, professional midwives offer the same access to doctors for specific invasive advanced testing procedures for special circumstances. You just need to do the research to find the best fit provider for you, midwife or not... certainly it makes the search more difficult without insurance but there are competent, professional and terrific providers out there seeing patients without insurance.
Last edited by Idlewile; 08-18-2012 at 06:27 PM..
Reason: added more info
We already have a very well respected and experienced OBGYN doctor at an established facility in Austin. This is where we are currently using Christian Healthcare Ministries to cover our maternity expenses. It is good that you mentioned the Austin Mama blog. That should be helpful to others who read this thread.
I am glad that your friend seems to be getting good coverage with HD. I only advise good hearted caution to any limitations their health plan policy could have.
I spoke a bit abruptly on the midwife situation and I apologize. I highly respect the people who use them and people who perform midwife services. I was only speaking about the experiences my friends have had in the past and it is true. I did NOT mean to come across as negatively characterizing an entire medical profession. Most of them were successful with a few unfortunate losses and I cannot speak for the quality of services that they sought out or the options that they elected or did not elect.
The main focus I want to impose on this thread is how people can obtain good health insurance benefits when options are limited to the individual level. In particular those individuals with pre-existing conditions seeking a good major medical health insurance policy with maternity coverage.
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