Maternity health insurance SF (sales, how much, to buy)

[joden]

Hello, I recently moved to SF from Europe. I initially had an European "expat"- health" insurance but it is about to run out. Since I have my green card and since I am planning to stay here I need US health insurance. I am self employed so I need individual coverage. I am hoping to get pregnant soon but before I do - what kind of health insutrance should I get? I have been trying to navigate the different insurance providers web pages, but really, it is beyond rocket science...

So of anyone can help me I would be eternally greatful:

-My husband and I need insuarnce that covers all helath issues for both of us- we have no pre-existing problems.
-I need health insurance that covers maternity. Since I am quickly getting older I would like to get pregnant asap.
- Is there a waiting period during which I cannot get pregnant, ie before the maternity insurance kicks in?
-Is any one company better than the others ( for instance there has been alot of negative stuff about Kasier Permanente in the media)
What is financilally best - high deductible, low copay, out of pocket maximum? I really do not get it...
-The most important thing is that worst case scenarios are covered, ie NICU etc
-If I were to become pregnat before the insurance is finalized - is there any way to get coverage once already pregnant?

I hope someone can help! Thank you!
Joanne

[KT13]

Originally Posted by joden

Hello, I recently moved to SF from Europe. I initially had an European "expat"- health" insurance but it is about to run out. Since I have my green card and since I am planning to stay here I need US health insurance. I am self employed so I need individual coverage. I am hoping to get pregnant soon but before I do - what kind of health insutrance should I get? I have been trying to navigate the different insurance providers web pages, but really, it is beyond rocket science...

So of anyone can help me I would be eternally greatful:

-My husband and I need insuarnce that covers all helath issues for both of us- we have no pre-existing problems.
-I need health insurance that covers maternity. Since I am quickly getting older I would like to get pregnant asap.
- Is there a waiting period during which I cannot get pregnant, ie before the maternity insurance kicks in?
-Is any one company better than the others ( for instance there has been alot of negative stuff about Kasier Permanente in the media)
What is financilally best - high deductible, low copay, out of pocket maximum? I really do not get it...
-The most important thing is that worst case scenarios are covered, ie NICU etc
-If I were to become pregnat before the insurance is finalized - is there any way to get coverage once already pregnant?

I hope someone can help! Thank you!
Joanne

The insurance plans available to you depend on where you live and of course your personal history, your age, and how much you think you can afford each year out of pocket. Maternity insurance can be purchased on its own and usually would have a separate deductible, like it's a separate plan. You can buy insurance by shopping around calling insurance companies in your area or the easier way is to fill out one of the online application forms with multiple websites (like ehealthinsurance.com, etc). You will be getting calls from multiple insurance seller agents within minutes of submitting your online form and the calls will keep coming sometimes even after 2 months since your application.

When you shop for insurance you will be speaking with the sales-people, not necessarily with the insurance underwriters or representatives of the insurance companies themselves. The agents usually deal with more than one insurance company and may have a large variety of plans they can offer you. A lot of them may pressure you to buy insurance through them as they are just sales people trying to make their commission, be calm and patient and make sure you explain to them exactly what you are looking for and ask lots of questions especially when it concerns coverage and maximum out of pocket expenses. If you settle for a plan with any agent, you will fill out application that would go to the actual insurance company and they will then start the process of underwriting (where they determine whether they can insure you for the amount quoted). They may have to ask you additional questions regarding your medical history or medications to determine your cost to them and if they feel that there is a problem they may either raise your deductible or your premium a little if you want to go with them. Sometimes there can also be a fee to start medical history search and underwriting process, but it's usually very small. Basically, the agents are just trying to sell you the plans, but they don't guarantee you'd be accepted, it's the insurance company that determines it at the end.

I cannot recommend any particular plan for you as I don't live in California, but I can help you with trying to understand what questions to ask and how to determine your total out of pocket cost and figure out what is worth it for you. I have shopped for maternity insurance myself and I was frustrated in the process especially finding out how much it costs out of pocket to have a baby in the US. My advice for you, if you aren't from the US, go back to your country to have a baby and save the money I seriously considered going to another country just to deliver a baby or even getting a surrogate (which may cost the same ). Most women giving birth in the US have insurance covering maternity from their employer or their husband's employer, or if they are poor and qualify for medical aid they get it for free. I am self-employed and must buy my own insurance, so I was looking for lower cost options.

I quickly found out by just browsing the internet for some most popular insurance provider plans that most plans only cover up to a certain amount (let's say 3K or 6K maximum) and these are really bad plans as they will still charge you premium and even deductable but won't necessarily pay for the entire cost of maternity. Basically, bottom line is: you have to pay into the insurance before you use it and most plans have a waiting period. They differ and you have to ask your agent what these plans are. You need to tell the agent that you are looking for a plan that covers the entire cost of maternity whatever this may be (and there is no limit on how much they pay). You need a plan with minimum waiting period (there are plans that have a waiting period of a year or more or 6 months but there are some that are less). Most important thing is to calculate your total cost out of pocket, most agents will tell you that. It depends on your deductible and co-pay and also the total of your premium payments from the start of your coverage to the end of your pregnancy (this includes the waiting period and of course the number of months it takes you to get pregnant). Maternity plan is like a separate insurance with its own deductible that has nothing to do with your general deductible usually. The co-pay is a percentage of the total cost you are obligated to pay after you meet your deductible, but it stops after you meet some amount (I call it 'second deductible') after which 100% of your expense is covered. For example, if your maternity deductible is 2500 and the co-pay is 40% (max to 3000), then you maximum out of pocket expense is 5500 (deductible + the maximum amount of copay). If this plan also covers the entire cost of maternity then your max out of pocket expense is 5500 regardless what happens (whether you need more expensive Cesarian or just a regular delivery). They usually also tell you that the complications to your health would be covered by your regular insurance. I am not yet sure how it works, but all the maternity tests, doctor visits, delivery charges and surgeries are supposed to be covered by the maternity plan. In the example of the plan I listed the max expense of 5500 is also added to the total of the premiums paid. If the premium is 200 a month and the waiting period is 6 months then 6*200 + 2*200 + 9*200 = 3600. 6 months waiting period during which you pay your premium + 2 months you take to get pregnant (maybe more) + 9 months of pregnancy during which you are still paying premium. So, the total cost of your maternity here is 9100. This is just an example, your premium may be more or less. Yes, these numbers look scary, but the real cost of uninsured maternity can be a lot more especially if you have any complications or require surgery.

Questions to ask:
-What is the amount of deductible?
-What is the amount of maximum copay? Or, what is my maximum out of pocket expense in any given year?
-What is the amount of monthly premium?
-What percentage of the maternity costs are covered? Tell them you are looking for the plan covering 100% of any maternity expense including hospital stay and surgery.
-What is the waiting period? Tell them you are looking for a waiting period of 6 months or less. When speaking about waiting period, it usually starts the moment you are approved by the insurance company, so you have to calculate the number of months from there and only try to get pregnant after the waiting period is over.
- Is there a limit on number of doctor's visits? Is there a limit on what tests may be performed?


If you are already pregnant, then it's considered 'pre-existing condition' and you can't get any maternity coverage at all. Nothing. No insurance would cover you for maternity. Your best bet in this situation is to try to go through some of the Maternity advocacy groups. These organizations help you to get discounts on your healthcare bills. They usually charge a fee for it (like maternity card) which can be similar to a premium of a maternity insurance itself or less. But they don't cover any of your medical expenses, they just take your bills and negotiate lower rates for you, giving you a discount, significant enough I guess to justify payment for their services. For example if you get a bill for 20K from the hospital, they can maybe reduce it to 10K or 15K, so you pay less, but you are still responsible for the rest of your payment.

Given that, really, I don't know why you would want to deliver your baby in the US. It's a very expensive country to give birth for a woman without any employer given benefits who also wouldn't qualify for medical assistance for the poor. Unless you are planning to get a job soon that provides maternity coverage I would seriously go back to your country of origin, given that you still have your health benefits if you still have citizenship there and deliver the baby there. I then would try to get the US citizenship for a baby, which shouldn't be a problem if you are a Green Card holder or your husband is a citizen.

Good luck

[joden]

Thank you for your long and very informative reply! It is really I difficult understanding how the insurance system works so I certainly appreciate your help!

[Jayson98]

Place to disscus FRAUD commited by american maternity advantage also known as Affordable HealthCare Options (AHCO)


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