insurance dilemma

Asked December 13, 2016, 11:52 AM EST

I am currently pregnant. My birthday is in May, and I will turn 26. Baby is due in Feb/March. My parents insurance will NOT cover the baby after the hospital visit. So my boss has enrolled me and paid for the premium in the marketplace (with caresource) starting January for both my husband & I, and so I can add our baby once she is here. Now, my parents could not REMOVE me early from their policy without being penalized and paying even more for my sister until I age out, which again is in may. So my name will remain on the policy until then. NOW, should I began just using ONLY the caresource from marketplace as my primary come January since it is in my name? Or do I use both, as a primary and secondary until may comes just for myself? With this benefit me or disadvantage me???

Cuyahoga County Ohio

1 Response

Greetings,

You indicated that you are turning 26 and aging out of parent’s coverage. Some insurance companies cover young adults until the end of the month in which they turn 26; others extend coverage though the end of the plan year. You will want to understand how long you are covered through your parent’s policy.

It is not clear from your question whether your husband has insurance coverage through some other source; such as, work or his parent’s insurance policy. If both you and your husband have other insurance it might be that you both use your current coverage until the baby is born in Feb/March.

Part of your decision on whether to use your employer-sponsored healthcare insurance may be influenced by what your parent’s insurance policy will cover for you. All Qualified Healthcare Plans available through the Marketplace must cover certain services for pregnant women, including:

§ All prenatal care visits with no copay

§ Labor and delivery services

§ Breastfeeding support, supplies, and counseling with no copays (this includes visits with a lactation consultant, breastfeeding equipment, and breast pumps)

Given that you are pregnant you should review your employer-sponsored plan’s Summary of Benefits and Coverage, which includes a coverage example that shows the costs a typical pregnant woman might have when having a baby under that plan. The coverage example is just a hypothetical snapshot; the actual costs that you will pay depends on the actual services you receive and where you receive care (depending on the type of plan – in network providers or out-of-network providers).

You will also want to check that the medical team you are currently seeing are participating in the employer-sponsored plan. If not, you may want to search for an OB-GYN that is in-network and will be covered by the employer-sponsored plan prior to the delivery of your child.

Finally, after gaining clarification on when your coverage actually ends under your parent’s policy, I suggest you call 1-800-318-2596 (or use the website link below to find a local Navigator) for assistance with your insurance coverage questions.

Questions you will want to ask:

Q1: Having a baby triggers a Special Enrollment Period (SEP). Will it be possible to use the Special Enrollment period to enroll in your employer-sponsored plan for coverage for your entire family?

Q2: When using the SEP, will it be possible to request employer-sponsored coverage retroactive to January 1, 2017 to cover all costs associated with the birth of the child?

NOTE: If retroactive coverage is possible and you want to continue seeing your current health care provider (OB-GYN etc.), and your current health care provider is not in-network for the employer-sponsored plan, then you might want to stay on your parent’s policy until the baby is born. But you must be sure to have documentation of the ability for retroactive coverage to ensure insurance payment of medical costs that will not be covered on your parent’s plan.

Q3: Are there recommendations for using the employer-sponsored and the parent-sponsored health insurance as primary and secondary insurers?

Here is the number 1-800-318-2596. Or you can find a local Navigator, a person who is trained on the healthcare policies, by entering your city and state or zip code at localhelp.healthcare.gov

I wish you the best and congratulations on your upcoming birth.

Dr. Carolyn Bird