pregnancy without health insurance

[Marta Proniagina 119]

13 hours ago, Mansini77 said:

If someone already suggested this, I apologize as I don't have time to read the entire thread.

 

My wife became pregnant in 2015 and we didn't have insurance.  We made too much to qualify for Medicaid, so we had to somehow fit the bill.  Luckily, we were able to open enroll into a platinum level coverage via Kaiser Permanente in December or Janurary(can't remember exactly).  While the health insurance payments were nearly a thousand dollars a month, the insurance covered every bill that would have been been 30k out of pocket without insurance.  The following open enrollment, we canceled the platinum plan and enrolled in a cheaper bronze monthly package.

 

 

Hi! could I ask you the question that bothers me about getting insurance now?
You said your payments were about a $1000 a month which is quite a lot (for us at least). And you've been having that plan for, let's say, 4-5 month. Did you have to pay anything else above this sum or did it cover everything? because paying 5000 for insurance and then paying extra seems to bee too much and no different from paying cash and asking the hospital for discount

[yuna628 9,676]

Just some info here to clear up some things:

 

1) In general it is wise for any immigrant coming to the US via a K1 or marriage based visa to get heath insurance as soon as possible. I don't know which one the OP came on. If it was a K1 and she's just received her actual green card now and still hasn't got health insurance, she's missed her open enrollment window. If it was a marriage based visa, and they arrived with a green card already, they can qualify if they act quickly. When you need to register outside of open enrollment, you need a special qualifier. Pregnancy is not one of those qualifiers but having the baby already popped out, is (I know right?!). However things like new marriages, a new job, losing previous coverage, immigrating or moving to a new country also are. However if you're going to use a special qualifier, you need to act and fast, because there's only so long they will allow a person to sign up using that qualifier. K1s ideally need to register shortly after they get married; wait too long, and you've missed the window.

 

2) Pregnancy is a pre-existing condition (haha I know right?!) but that doesn't really matter once your spouse already has insurance. One poster wondered if they would be covered on their spouse's plan if they are pregnant. Of course they will. Pre-existing conditions are always covered by insurance now. The problem is signing up outside of open enrollment if you haven't acted fast enough. This does not apply if the spouse has already got insurance and wants to add their spouse. If you've got insurance via workplace, then please sign your wives up if they are pregnant. That won't be a problem.

 

3) Medicaid is a big no no for immigrants. It is entirely possible, depending on certain select states to utilize certain forms of Medicaid without consequence. I say without consequence for now, because there has been some rumblings this may change in the future with this current administration.

 

So what are the OP's real options?

 

They or the husband can obtain health insurance privately and sign up that way. They are going to pay for it, and should not expect it to be cheap. But honestly, even if they were able to open enroll onto the federal exchange they should not expect it to be cheap either. For any further options they should read this article regarding pregnancy outside of open enrollment. https://info.healthplans.com/5-things-to-consider-if-you-get-pregnant-outside-of-open-enrollment/

 

As one poster stated, they went private and they opted for a platinum plan (a higher tier plan) which was about $1,000 per month. This worked for them, until they were able to switch back to a cheaper one during open enrollment. Plans usually operate on bronze, silver/gold, and platinum. The more expensive the plan, the cheaper it will be on out of pocket cost.

 

Open enrollment will be back up in a few more months. The OP is going to have to go through the options and decide what they can afford. They can speak to health insurance advocates (just google) or insurance reps from any insurer that offers in their area. They can also speak to the exchange people and see if for some reason they could qualify in their difficult situation. Again, if a USC chooses to bring their foreign fiancé or spouse to the US it is part of their responsibility to ensure a solution for health insurance is provided, especially if there is a baby involved. The cost is difficult, but it is the part of the burden we all face. On average and depending on circumstance, the OP can expect to pay somewhere between 400-800 per month for a mid-level out of pocket private plan. There's other costs to consider, such as copays and deductibles. The same would be entirely possible for a marketplace plan obtain in open or special enrollment. Any real 'savings' is for the select few. Workplace plans are usually more affordable, because the employer is going to front a big chunk of that cost. If the cost of a premium per month is thought to be too expensive, I understand certainly... however the cost incurred because of pregnancy and birth will be bankrupting. Pick your poison, as they say...

 

 

Edited August 26, 2018 by yuna628

[EM_Vandaveer 2,408]

https://dhhs-access-neb-menu.ne.gov/start/?tl=en

 

You don't even have to call, you can fill in a questionnaire here to see if you're eligible for Pregnancy Medicaid or CHIP Perinatal.

I'd do that before getting a private plan, but I'm biased, having successfully naturalized after having two babies on CHIP Perinatal (then my third on Pregnancy Medicaid because I was a citizen by then).

Edited August 26, 2018 by EM_Vandaveer

[Mansini77 100]

14 hours ago, Marta Proniagina said:

Hi! could I ask you the question that bothers me about getting insurance now?
You said your payments were about a $1000 a month which is quite a lot (for us at least). And you've been having that plan for, let's say, 4-5 month. Did you have to pay anything else above this sum or did it cover everything? because paying 5000 for insurance and then paying extra seems to bee too much and no different from paying cash and asking the hospital for discount

My original response to your situation stated I was paying nearly $1000 a month for platinum coverage, which was correct.  I forgot to elaborate on the coverage and who it covered.  The coverage for that plan back in 2016 was for both my pregnant wife AND myself.  In general, the older you are the higher the insurance cost.  I'm nine years older than my wife, so I assume that the majority of the cost was because of my age compared to that of my younger wife.  If the plan only covered her, it would have probably been $350-$450 a month for just her.  As the years have gone by, health insurance rates have risen dramatically.  For my wife, 2 year old and myself now for the low bronze insurance package is running around $825 a month.

 

To answer your question of what we had to pay out of pocket, the simple answer is $1000.  This is what I owed the hospital after our baby was born.  The total cost of my child's delivery and hospital stay (2 days) was $28,000. Kaiser almost covered all of it, around $27,000.  Let me also add that Kaiser also covered several visits and examinations before our baby's delivery.  So, having five months of platinum insurance really saved us a lot money, you do the math.  After the calendar year was finished, we were given the option to completely drop the insurance or change our coverage.  I personally felt an obligation to stay with Kaiser as they pretty much bailed us out, so I rewarded them with our continued business and the bronze coverage package we pay every month since 2017 (even though we hardly use it).  

 

I advice you to get in contact with a health insurance broker and discuss with him/her your families' options.  That's how we got started and got a lot of questions answered.  We never had health insurance, so it was a crash coarse in coverages, deductables

[NikLR 13,227]

Most people dont understand the coverage they have.  My husband hasn't a clue how our coverage actually works. His best friend from the military also had issues after becoming a civilian. What works for one person, wont work for another.  For example we have a High deductible plan that also provides an HSA.  So we have to pay 3k out of pocket, unless it's a routine visit, before insurance covers 95%.  But insurance can reduce the rates we pay if we visit a specialist, urgent care, or the ER. We rarely go to the dr. If I had kids in the USA though, this wouldn't be a plan I would choose.  

[Marta Proniagina 119]

On 8/26/2018 at 9:59 AM, EM_Vandaveer said:

https://dhhs-access-neb-menu.ne.gov/start/?tl=en

 

You don't even have to call, you can fill in a questionnaire here to see if you're eligible for Pregnancy Medicaid or CHIP Perinatal.

I'd do that before getting a private plan, but I'm biased, having successfully naturalized after having two babies on CHIP Perinatal (then my third on Pregnancy Medicaid because I was a citizen by then).

I tried that website and it said smth along these line "you may qualify for Medicaid with co-payments" so I guess it's better to call them directly or have a visit (however, I'll call first as it takes about an hour or more to get there from our town)

[Marta Proniagina 119]

15 hours ago, Mansini77 said:

My original response to your situation stated I was paying nearly $1000 a month for platinum coverage, which was correct.  I forgot to elaborate on the coverage and who it covered.  The coverage for that plan back in 2016 was for both my pregnant wife AND myself.  In general, the older you are the higher the insurance cost.  I'm nine years older than my wife, so I assume that the majority of the cost was because of my age compared to that of my younger wife.  If the plan only covered her, it would have probably been $350-$450 a month for just her.  As the years have gone by, health insurance rates have risen dramatically.  For my wife, 2 year old and myself now for the low bronze insurance package is running around $825 a month.

 

To answer your question of what we had to pay out of pocket, the simple answer is $1000.  This is what I owed the hospital after our baby was born.  The total cost of my child's delivery and hospital stay (2 days) was $28,000. Kaiser almost covered all of it, around $27,000.  Let me also add that Kaiser also covered several visits and examinations before our baby's delivery.  So, having five months of platinum insurance really saved us a lot money, you do the math.  After the calendar year was finished, we were given the option to completely drop the insurance or change our coverage.  I personally felt an obligation to stay with Kaiser as they pretty much bailed us out, so I rewarded them with our continued business and the bronze coverage package we pay every month since 2017 (even though we hardly use it).  

 

I advice you to get in contact with a health insurance broker and discuss with him/her your families' options.  That's how we got started and got a lot of questions answered.  We never had health insurance, so it was a crash coarse in coverages, deductables

Thank you very much! yes, I see, paying 5000 was much better than 27000....

I'll sure check the insurance providers during the open enrollment and see if any of them sell me the insurance. Hopefully, it'll be possible and everything will work out this way. Otherwise we'll try the Emergency Medicaid (if it's even our case here in Nebraska).

Anyway, thank you very much for such  informative and detailed comments. I really appreciate it! Makes me calm down a little.

 

P.S. I've seen so many good reviews about Kaiser. Unfortunately, they don't work in our state, otherwise I'd be glad working with them

Edited August 27, 2018 by Marta Proniagina

[EM_Vandaveer 2,408]

1 hour ago, Marta Proniagina said:

I tried that website and it said smth along these line "you may qualify for Medicaid with co-payments" so I guess it's better to call them directly or have a visit (however, I'll call first as it takes about an hour or more to get there from our town)

You can also apply online. That's what I always did. If you prefer face-to-face, I totally understand. Take proof of income (bank statements, payslips, etc) with you.

[Mansini77 100]

8 hours ago, Marta Proniagina said:

Thank you very much! yes, I see, paying 5000 was much better than 27000....

I'll sure check the insurance providers during the open enrollment and see if any of them sell me the insurance. Hopefully, it'll be possible and everything will work out this way. Otherwise we'll try the Emergency Medicaid (if it's even our case here in Nebraska).

Anyway, thank you very much for such  informative and detailed comments. I really appreciate it! Makes me calm down a little.

 

P.S. I've seen so many good reviews about Kaiser. Unfortunately, they don't work in our state, otherwise I'd be glad working with them

I understand your stress, we've been through it.  While both of us were excited of the pregnancy, I was worried about the pending bills the pregnancy would bring to our family. 

 

I'm hardly an insurance expert, so I again recommend you speak to a health insurance broker that can find you and your family coverage that will fit your budget.  Let him/her answer the questions, it's their job to do so.  Don't worry about paying the broker, they'll get a cut from the insurance carrier as payment for brokering the package.  In Colorado, we have a few options: Kaiser and Centura to name a few.  Kaiser had the best rates and we've been members since.  Whatever state you are living in, a health insurance company comparable to Kaiser should be available.  It's almost September, and while enrollment isn't possible now, you can still contact an insurance broker to at least get some price quotes and rates of companies in  your state and get some preliminary paperwork started.  That way, once open enrollment begins, you will be ready to dive right in.

 

How many months are you pregnant btw?  And congratulations   So much fun, so many laughs, and oh...sleepless nights haha!