When my wife was pregnant with our first son, I was naive in the ways of health insurance. It was during the days before COBRA.
I took a job in a different state and we had to move out of our HMO‘s area. It never dawned on me that we would lose our health insurance.
Fortunately, the area we moved to had an older General Practitioner who befriended us and gave my wife good pre-natal care until I was able to straighten out the insurance snafu.
If you were to ask either of my sons, they would say that I am stubborn and unable to learn. The truth is not quite as bad as they say. I may be stubborn but I am able to learn.
I learned several things from that experience. Much of what I learned has changed over the years. One lesson that is still appropriate is that HMO plans are restricted to a geographical area. If you have a HMO plan, take your health insurance in consideration before you move.
It should not be a big deal if you are in relatively good health. As long as you get new health insurance in the area you move, you should be in good shape. It is not as high a priority as getting the key to your new house. However, it is not something that you can ignore.
If you are currently pregnant, or receiving medical treatment, you will need to pay special attention to your health insurance. If you are a member of a HMO, you may have to wait until after the baby is born to make your move.
I like to advise that people in good health should use the driver’s license test. Many states require you to get a new driver’s license within 90 days of moving to a new state. Ideally, you will get your new health insurance ID card before you get your new driver’s license.
A couple of weeks ago, a young lady called me with a similar dilemma to the one we went through with our first-born. The difference is that she was smart enough to plan ahead.
This young wife was not currently pregnant but she wants to start a family. She had enough wisdom to investigate her insurance options before she became pregnant. I wish that all young wives would do the same.
What she found is that her current health insurance will only pay for “complications of pregnancy.” It will not pay for normal pre-natal or routine delivery charges.
Where I live, the cost of a “natural” child-birth is anything but natural. Depending on which of the several hospitals that are around Houston you use, the final bill is between $ 8000 and $ 12,000. That is a lot of money for any young couple to come up with. I understand why a young wife would “freak-out” over health insurance.
Many individual health insurance plans specifically exclude coverage for routine maternity. For them, pregnancy is a voluntary condition. Health insurance companies will pay for complications of pregnancy, because an ”atopic pregnancy” is beyond your control.
After years and years of scientific study, they know what causes pregnancy. Apparently, it is a voluntary act. Health insurance plans are priced based on pure chance. No health insurance plan will pay for “self-inflicted” issues.
I understand that many babies are “accidentally” conceived. Never-the-less, the activity that causes a pregnancy is one in which people choose to participate.
In 2014, every American is required to purchase an “Essential Benefit” health insurance plan. One of the “Essential Benefits” that are required by the Patient’s Protection and Affordable Care Act is maternity coverage. In 2014, the issue of health insurance for young wives will be a moot point.
Until 2014 we must operate under the current insurance rules. Whether they are morally right or wrong can be debated. They are, however, the rules. If you or your daughter is thinking about having a baby, here are her options.
SAVE - Where I live there are several hospitals and OB-GYNs from which a young couple may choose. The costs for a routine birth range from $8000 to $ 12,000. If you are wanting to have a family, you have the option to save that amount of money.
If you opt to save up money, contact an insurance agent or tax accountant. There are plans that will allow you to save up the required amount in tax-preferred accounts. Be advised that you will need a qualified, high-deductible health plan before you will be allowed to take advantage of Health Spending Accounts (HSAs).
MATERNITY RIDER - Some, but not every, individual insurance plans offer Maternity Riders. These rider will pay for routine pre-natal and delivery fees.
However, before you rely on a Maternity Rider, make certain that you read and understand the terms of the rider. Often Maternity Riders must be in effect for a couple of years before they will pay fully. Every insurance company is different and each state has different regulations regarding maternity. Until the Health Insurance Exchanges start operating in 2014, there is no minimum standard for maternity coverage that is required for health insurance companies.
MEDICAID - Medicaid is different from one state to another. Here is my state, there is a special division of Medicaid specifically devoted to expecting mothers. I am not an expert in Medicaid law. I expect there is some type of qualification that is required by Medicaid. However, if you are expecting and have no health insurance to help you with the fees that doctors and hospitals charge, I would encourage you to call the Medicaid office in your city. See what is available to help you.
GROUP HEALTH INSURANCE - The best maternity coverage, in my opinion, is going to be found in group plans. Although there are some loop-holes that business owners can use to eliminate maternity coverage, most group plans cover routine pre-natal and delivery costs the same as any other illness.
What that means is that if a husband and wife are both employees of a business that they also own, a group of 2 employees may be formed to provide solid maternity coverage. It can be quite expensive and is not the ideal but it can be done as a last resort.