Tuesday, May 6, 2008

Pregnant with no insurance


I feel this is one of biggest issues in modern day healthcare: The fact that there is basically no way you can get affordable private healthcare that includes maternity. I'm serious, start researching it yourself and you will be extremely frustrated!

I should probably mention that, no I'm not pregnant and yes I do have insurance, but not too long ago I was in this situation.

Due to a series of unfortunate events, I found myself 3 months pregnant with no insurance, there was a major lapse in coverage (though I thought I was covered) and so the whole, "pregnancy can't be considered a pre-existing condition" thing totally went through a loop hole.
We looked into almost every option and talked with a bazillion other people, but could find absolutely no solution. Either the waiting periods were so long I wouldn't be pregnant when it was off, or the monthly premiums were so high that I could not feasibly afford to pay it (around $1000 a month).
I am what the industry has coined, a Mom in the Middle. I don't make enough to pay for outrageous private healthcare, but I also make too much to qualify for any federally or state funded insurance.

So recently I decided to do a little research on it to see if times had changed and if any progress has been made to help the Moms in the Middle. I should have known better because it hasn't.

So what are some options for moms in the middle? Unfortunately, none are ideal.

1. NASE: If you own your own business there is an association for the self employed called NASE (National Association for the Self Employed). You have to pay a sign up fee of $75 for the year then you are part or a "corporation" so you are offered health benefits like if you were employed. They do have a maternity rider because since they aren't a huge corporation ie- Starbucks they don't have the cost for maternity spread out to all employees (even males) so that the cost is lower. The rider is something like $300-400 extra per month for 12 months and then they will pay 60% of cost up to $3000. If you pay the extra $300-400 premiums for 24 months, they will cover 80% up to $7000. Obviously, this is NOT a good deal.

2. Private Healthcare with a maternity rider:
Only like 1 or 2 companies offer this. I saw that Humana offered a maternity optional coverage, which was an extra $150 a month (in addition the $250 premium for Lyric and I). Then there was a $5000 deductible. Then after you paid the deductible, for the first 2 years, they would cover up to $2500 worth of pregnancy related expenses, then 3 years they would cover $5000 and then after 4 years of paying this extra premium they would pay up to $7500 of maternity related expenses (which is the max).
Well I had a baby in a hospital with an epidural, and my delivery fees alone (not including the doctor) were $10,000. It would never be worth it.

3. CHIP (if you live in Texas)
Women who can't qualify for Medicare might be able to qualify for CHIP. They just started a program for maternity. It doesn't give a whole lot of financial wiggle room (especially if you are a 2 income family), but it's a sliding scale based on how big your family is. It might work for you, click here to find out the income guidlines. I think a family of 4 (they count your pregnancy- so if you just have 1 child, but you are pregnant, they count you as a family of 4) you can make up to $42,000 a year. If you can qualify, you pay like $50 every 6 months and they cover all your expenses. The only drawback is if you have a preferred doctor, they may not take CHIP, but heck, if you can qualify and aren't insured, I would make that sacrifice, or at least pay your doctor out of pocket. The most expensive part of pregnancy is the hospital/delivery anyways.

4. Part-Time Job:(if you are a Stay at Home Mom look into getting a part time job at a large corporation. Here is a list of places that offer great benefits to part time employees. Places like Starbucks and Fed Ex will let you work just 20 hours a week and have a wide variety of hours to accommodate almost any schedule. It wouldn't be ideal, but hey, you can do anything for a short period of time right? Especially if it will save you thousands of dollars.

5. COBRA: (as long as you are with a company employing at least 15 individuals) This coverage can be carried up to 18 months after you left your company. Essentially, you would be covered under your previous employers coverage but paying your portion PLUS the portion your company was paying. This would also protect you from falling under any pre-existing clauses as you would have continued your healthcare coverage, therefore eliminating the 63 day clause (however, if you let the COBRA coverage lapse more than 63 days the the pre-existing clause comes back into play). As you can see, this once again is VERY expensive. If I paid the full healthcare bill for Lyric and I that my company pays, it would cost me almost $1000 a month. Ick!

6. State Insurance Pool: This would be good if you were already pregnant, had a major lapse in coverage, are working part time and your company doesn't offer insurance or you have a pre-existing condition of some sort. It's a little on the expensive side, but not as bad as the private healthcare. It's still has a high deductible and only covers I think 80% of the cost... here is a link to the Texas insurance pool

7. Birthing Center- No new mom likes to hear this option as they immediately envision some overweight woman with long hair tied back into a braid wearing pioneer style clothes putting a leather strap in your mouth and telling you to push that baby out. No pain meds? However, childbirth doesn't have to be straight out of an old western. More and more women are choosing natural childbirth at either their home or a birthing center. The midwifes are all certified and very experienced. Obviously the drawback is no pain meds and doctors/surgeons in the room if there is an emergency, but they give you different coping mechanisms that you don't get to use in the hospital and should all be experienced enough to know when an emergency is presenting itself. I personally haven't done it, but know many women who have. The bright side? The cost of this is between $2000-4000. More than half of what you would pay at the hospital and most will work with you as far as payment plans go.

8. Maternity Card: I personally never used this, and had done some research on it. I've found that you either love it or you hate it. Basically you pay a monthly fee to this company and they TRY to negotiate better rates. I found that I could do this on my own, without having to pay the $50 fee, but some people find it easier to just let someone else. I can see both sides. All the research I've done on it, just seems to result in people saying it's not really worth the $50 a month. But to check it out, click HERE

So how can we change this? Some people say we need Universal Healthcare like in Europe. I'm a bit more for what Hilary is vying for. That would be to keep private healthcare intact for those who want it, but then open up the insurance that federal employees have and then use a sliding/affordable monthly premium based on how much money you make. No pre-exisiting condition crap, it would meet you where you are and your premium works with your current lifestyle.
Unfortunately, I'm not sure, even if Hillary gets elected, if any of this will change. I'm not sure if it should, since it could most likely bankrupt our nation trying to pay for it all... but the bottom line is the healthcare situation for uninsured mothers are ridiculous.
Hundreds and thousands of women are pregnant right now and are in that "Mom in the Middle" category and they have no hope. It's not so much the fear that their normal delivery will cost too much, it's the fear of the unknown. What if they have to do an emergency c-section? What if the baby is born prematurely, what if the baby has an unknown condition and needs to go in the NICU for a few weeks? We are talking about 40-100k for complicated childbirth. Talk about a hefty bill!

I'm interested to hear your thoughts and personal experiences on this matter. Not so much healthcare in general, but maternity healthcare. If you want to add anything to the list of options for mothers, email me at desandjon@gmail.com

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12 Comments:

Blogger Mercedes said...

When I found out I was pregnant with Kennin I was without insurance. Mamzie wanted to put all of the bills on a credit card but my mom and I talked her out of it. It's a good thing too because I had to have a c-section and just weeks after Kennin was born Mamzie passed away. I ended up being eligible for Medicaid because we weren't making any money back then.

When I got pregnant with Grayson we had insurance through Charlie's work. Just a month after I found out I was pregnant, Charlie lost his job. So we were in the same predicament as the first time. But 2 years later we were making a significantly more money so I wasn't eligible for Medicaid. I looked into some different discount cards but they charge you for the card and you really don't get that big of a discount. Luckily Charlie got a new job and we got new insurance and we were covered. We did, however, pay a fortune for the insurance!

May 6, 2008 3:07 PM  
Blogger Brad Shull said...

This is such a good blog!

It's something you only understand if you have gone through it yourself.

Working at Starbucks has been great for me! It's the best part time job I've ever had.

I Like Hillary's health care plan also! Most people just assume she wants National Health care, but if you do the research you see that her plan is very smart and obtainable.

May 6, 2008 3:17 PM  
Blogger Missie Rose said...

well you know where i'm at with all this. the thing i've learned in my most recent situation is that if your state offers a poor people health care plan and if you can still somehow manage to survive on one income, do it. we made it by a meager $1,000 under the income cap since i lost my job and boy that's scary because i don't know what we'd be doing otherwise. apart from selling plasma and our free wic milk. :)

um ps-you should submit this post to one of the local papers.

May 6, 2008 3:30 PM  
Blogger Des said...

I SO wish we could survive on 1 income, but with 2 car payments and a $1300 mortgage, that is currently impossible... but you never know for the future!

May 6, 2008 3:38 PM  
Anonymous Anonymous said...

This is such a great blog! Kudos on the research...although, I'm sorry you didn't find anything that even remotely looks like a realistic option. When I found out I was pregnant with Saeler, we had just gotten on with our church's insurance. Thankfully, they took pregnancy as a pre-existing condition. We paid our deductible but also had to pay for my epidural (as most anesthesiologists in MI are opting to not accept any insurance and are pretty much contracted out by the hospital there). We've been without insurance since we moved to TX, which is kind of scary after having insurance for so long. Now that Aaron has this new job, I was hoping that the size of the corp. would lessen what we actually have to pay for insurance...I have recently found out that that is not the case. We'll still be out quite a bit monthly, just so we can carry maternity for a "just in case" situation. I think our deductible will be like $5000...which to me, is a lot! I wish there were more options, or ones that were more realistic for people...but alas, if you didn't find any, I doubt they're out there.
~C.

May 6, 2008 4:20 PM  
Anonymous Jennifer McClain said...

You are so right about what happens if there are complications, when Storie was born early her bill after the ten weeks she was in the NICU was up, it was in the 700,000's. Luckily my mom had awesome insurance because all we had to pay for my hospital bill c-cection and recovery, was $100. And after Storie's $700,000 we only had to pay $100. I don't think you can really get any better than that. But if we didn't have insurance, I would have been royally srcewed.

May 6, 2008 4:35 PM  
Anonymous K said...

Bottom line folks! Paying for insurance sucks!
It doesn't matter if your employer has insurance or not to get coverage you have to pay. Dan carries the entire family with the school district and pays over $750.00 a month- that's with maternity. They used to have Spouse and child- so we could split the family up, but now most insurance companies have done away with that and have spouse and "family". We pay the same insurance premiums as people that I work with who have 5 kids. Even when I was at home with Truth- our insurance was over $800 a month- and we paid it on his income. You do what you have to do.
One of my friends knew they wanted another child and saved up for it.

May 6, 2008 8:42 PM  
Anonymous Mariana said...

Des,
I was also a "Mom in the Middle". I found out I was pregnant with my second child a few weeks after my insurance was canceled (due to a late payment). To cut costs, I decided to try for a homebirth, but at 34 weeks had to transfer to an OB when I was diagnosed with GD. I also had to see a specialist once a week to keep an eye on my condition, and the cost of all the tests really escalated. Anyhow, to make the story short, I had a healthy baby daughter, but unfortunately am still paying off the bill 10 months later. The great thing is that the hospital gave us a discount for not having insurance, as well as a very low interest rate. The anesthesiologist doesn't charge us interest at all. The OB was the only thing we had to pay in full right away.
Thank you for writing this post! I know it'll help someone out there who's in this situation.

May 7, 2008 10:09 PM  
Blogger Jenny, the Bloggess said...

Featured: http://blogs.chron.com/goodmombadmom/2008/05/bs_sunday_2.html

May 27, 2008 8:37 AM  
Blogger Sarah said...

This Blog was so helpful! I am in a really sticky situation right now, and i have no idea what to do! For 2 years my husband and I tried for a baby, and i was covered by my work, with an amazing health plan, but last month i quit... and then i got pregnant. I have no health insurance, the company wasn't big enough for COBRA, we earn too much for government, but not enough to pay for it without insurance!! I think I might just go home to England and have the kid!!! At least i will get amazing healthcare without any questions asked.
National health insurance is just what America needs. I'm with Hillary on that too.

June 19, 2008 12:49 PM  
Anonymous Anonymous said...

This is some good information BUT Texas Risk Pool does not cover pregnancy. It only covers complication of pregnancy like any other health plan.

June 24, 2008 1:17 AM  
Anonymous Anonymous said...

This was an amazing blog. My husband and I recently found out we were dropped from our insurance plan just 1 week before finding out we were pregnant. I have been so nervous and stressed, which is aweful for pregnancy. It makes me furious that I work in the healthcare industry, with the pediatric population and cannot get reasonable health insurance. I am going to investigate some of these options discussed and with the help of our families, my husband and I are looking forward to bringing our little miracle into the world - with or without insurance!

June 24, 2008 1:46 PM  

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