Monday, January 27, 2014

Week 19: Insurance Saga, Part 1

Since my husband entered graduate school, our insurance situation has been a bit dicey. It changes every year, every pregnancy, and every new massive-healthcare-law-and-associated-regulations-passed.

With my first pregnancy, I was on my employer's insurance plan. There was a deductible, there was a co-pay, and I'm certain we achieved out-of-pocket maximums that year, but they weren't especially high.

With my second pregnancy, I carried my husband's student insurance plan as my primary and held Medicaid as secondary. Little did I know, but carrying two insurance plans is apparently a *major* pain for your doctors. Also, little did I know, but Medicaid is apparently a major pain for doctors, too. In fact, it's such a major pain that I called 22 doctor's offices and only one of them would accept Medicaid patients. I drive 45 minutes each way for my appointments.

In 2011, at the end of the first year of my husband's Ph.D. program, the school dropped dependent coverage for their Ph.D. students. This was a bit of a crisis for us. I signed up for an "open enrollment plan" through Blue Cross Blue Shield. It cost us $500 per month, and the premium increased by about $50 per year each year I was on it. The deductible was high and the out-of-pocket maximums were high, but fortunately most doctors accepted this plan. Unfortunately, the plan did not cover maternity costs.

So when we conceived our third child in the fall of 2011, I went back on Medicaid. My OB's office administrator confessed to me that it had been such a disaster to bill Medicaid as secondary insurance the last time they had me as a patient that they were no longer willing to do so. Medicaid would have to be primary, or they wouldn't accept it. I had difficulty explaining to the Office of Family Services why my private insurance couldn't really be considered primary for the pregnancy (since it didn't cover maternity). And although I never followed up on all this, it seems to have been resolved satisfactorily to all parties. In the process, I also learned that private insurance pays about $3,000 for a vaginal delivery. Medicaid pays only $900.

When I became pregnant this time, we were expecting that the roll-out of the healthcare law would give us more options. My private insurance premiums had increased yet again, and I was paying $600 per month. I also learned that Blue Cross Blue Shield in Virginia had decided to voluntarily cover all abortions, for any reason, under their new plans. The new plans also all covered maternity expenses, but they were going to cost us more per year than we were currently paying (the difference of about $1,000-$1,500 per year). Given our income level, I would have certainly qualified for a subsidy, but I applied and never heard back. I went on the website twice and got kicked off twice. I've had so many bad experiences trying to get answers from the Office of Family Services about anything that I decided it was not worth the anxiety of waiting months and months and months to finally be told, "Please send us more information about your income," in spite of the fact that I submitted all the information they asked for (and more) the first time.

We finally decided to make the jump to Christian Healthcare Ministries. This means that I will be paying only $150 per month for "coverage," but all my routine diabetes expenses will be out of pocket. This includes prescriptions, doctor's visits, and bloodwork. Unless it is an unexpected complication of my diabetes, hospitalization, or new diagnosis, my medical bills will not be eligible for "sharing" through the program. 

This sounds frightening, but when I calculated the actual costs of my routine diabetes care without insurance, it came to about $7,500 per year. If you add $1,600 for the Christian Healthcare Ministries program to that, it's about $9,100. The insurance premium plus deductible for the plan that I was on already cost about $9,000 per year, and the new insurance plans I was looking at (without subsidy) cost about $10,000 to $10,500. So I will now be paying roughly the same, or perhaps a little bit less. I know that some healthcare providers (pharmacies, etc.) will also charge a little less for people who are paying out of pocket, because then they don't have to deal with crazy insurance company billing rules. I'm hoping that, between these two things, I will at least break even. I also won't be paying for abortions, nor supporting an insurance company which is taking upon itself the task of making abortions seem like routine health care, rather than the intentional killing of another very small human being.