Pregnant & Uninsured?

[cadylou]

Pregnant And Uninsured? Don't Count On Obamacare | Kaiser Health News

This appeared today in the Kaiser News Items. I wrote to the author and said the following:

"So, why would this "new" diagnosis be different or have special privileges than any other? – The whole idea behind the enrollment periods and everyone buying in is to offset adverse selection. We ALL share the load to balance the risk. I have to purchase insurance with maternity embedded in it even though I'll never need it. In fact, the bulk of people I service in their 40s, 50s and 60s, who are small business owners and do not qualify for subsidy money, are subject to rates 2-3 times their old ones because of these embedded benefits.

I guess I could expect to go uninsured, and then when I get a cancer diagnosis, just pick up some insurance? That's not the way it works. Why should pregnancy create a different set of rules?

You can't buy homeowners once the house is on fire . . . .so why is this different?

Personally I'm sick of paying for everyone else . . . .this is what happens when you "give" people benefits. Instead of being thankful, they ask for more . . . . .

Get rid of the tax penalty, and I'd bet many would just drop insurance due to the exorbitant rates & the fact that these new policies include all sorts of stuff people don't want or need. Women of child bearing age should have "access" – yes. They should be able to purchase a separate maternity rider when the time came. Unfortunately for us, the EHBs baked these useless benefits into every plan so that they'd look like employer based offerings. The thing our government forgot is that the individual market is made up of self-employed people who already pay double for Medicare & Social Security benefits in the form of self-employment tax. Now they can't even control their own health insurance expenditures by purchasing a catastrophic style plan (just hospitalization with some drug coverage) if they wanted to.

I think in a few years we'll see a whole new group of "newly uninsured".

Very unfair. . . . ."

What do you all think?

 

[Tkruger]

One thing to note is that even those women who are making a decent living are still being shuffled off to Medicaid...at least in FL I can say with no doubt. If they qualify for ANY tax credit Medicaid takes over. We're not talking share of costs Medicaid, we're talking ZERO cost for the duration of the pregnancy.

So I was thinking the other day...the maternity bennies that are built into the MM off exchange are not necessarily being used.

I have one client that makes damn good money, but just short of the 400% FPL for the house hold size...sure enough..the wife who is pregnant was shuffled off to and qualified for Medicaid.

I think that part of what is being missed with your point is that the addition of a child to a family is an SEP...regardless of if it's by adoption or child birth. A new uninsured member of the family needs coverage.

Adding a Critical illness like being diagnosed with Cancer as you noted to your health when you had the chance to get coverage and you choose not to isn't the same thing.

 

[cadylou]

In this area, where we didn't expand Medicaid, I'm not sure that pregnant women are being moved to Medicaid - even for a determination that will never come - but I have not personal experience to date with that here, so it may be happening.

But if you apply a SEP like this, people who do not qualify for subsidy, could go uninsured & then suddenly hop on when pregnant. I guess I don't see how you think that situation differs from just "hopping on" when you get a critical illness. I see them as being the same in terms of theory (take the Medicaid consideration out of it for this line of thinking . . .)

In your example above, the gal was already pregnant - and I assume - applying during the enrollment period. This isn't the issue. If someone goes uninsured & gets pregnant in April, why should they be able to suddenly purchase a policy?

 

[AllenChicago]

Same here in IL. If you put on the FFM application that you're pregnant, and you/family is under 400% FPL, that person is ineligible for subsidy and shunted directly to Medicaid.

I assume that once the baby is born, a SEP is triggered, enabling mom/child to join the family's plan, w/subsidy, or if single, obtain a subsidized policy?

 

[kgmom219]

1. Maternity should not be an SEP. If we want it treated as "any other illness", its any other illness.
2. In most states, if you are uninsured and get prego, you get immediate "Pregnancy Medicaid" (Its called something else, but that's what it is). Regardless of if you are a Medicaid Expansion state or not. These programs were in place long before Obama.
3. The theory is this...if women get prenatal care, its cheaper in the long-run. Less complications at delivery. (Which gets paid for with tax dollars) Healthy children (anybody want to figure out the cost of a sick newborn? Or the long term cost of preemies? They cost more...forever. Special Ed, etc)
4. The pregnancy question is OPTIONAL. And I had prego women say "yes" and receive a subsidy. They were not shunted over to Medicaid.

Having said all that, letting someone prego get an SEP and PAY for insurance (take the subsidy issue out of it, not that many people get a subsidy. The 87% number only applies to On Ex. It doesn't include all the Off Ex policies.), really doesn't bother me. I would rather them pay for coverage then my tax dollars pay for Medicaid.

That should be a fun SEP. "Prove your pregnant".

And.....this is all theoretical. Nothing is going to change until after the next election (unless SCOTUS blows it all up). We can't a bill out of both houses that makes any sense and Obama will veto anything that changes ACA.

 

[AllenChicago]

Before the adoption of our children was finalized, we had to take them to the Medicaid doctors. Nice physicians, but the rest of the experience was horrible.

My most recent pregnant client chose to endure the Medicaid experience, rather than pay $350 per month for high-deductible Obamacare. Depending on how the state law reads, she might be able to stay on Medicaid after the baby is born in May, if she wants to.

 

[Tkruger]

4. The pregnancy question is OPTIONAL. And I had prego women say "yes" and receive a subsidy. They were not shunted over to Medicaid.

Hmmm, I assume it was a TX client that this occurred with. Maybe a glitch in the system? I also don't recall the question as optional through out the application. I could be wrong...only had a hand full of these that we worked with, 5 specifically I handled...all of which were sent to medicaid. That's all I can base my comments on.

That should be a fun SEP. "Prove your pregnant".

Upload a picture of the "Stick"

 

[AllenChicago]

""Updated Wednesday 2/18/15 3:37 EST: In a statement today, HHS Secretary Sylvia Mathews Burwell said the department has not included pregnancy as a qualifying life event because "we have based it on how insurance companies made the determinations when they have periods for open enrollment or not." But HHS is open to considering the issue, she said.

The administration last week said it was considering adding a special enrollment period for people who discover they owe a tax penalty due to lack of coverage.""

Ref: http://www.mprnews.org/story/2015/02/18/npr-pregnancy-uninsured

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2-19-2015

From the just-released Health Care Services Corporation (HCSC = BCBS of IL/TX/MT/NM/OK) "Special Enrollment Period 2015" agent guide:

Uninsured and pregnant

If an uninsured woman gives birth:
• The mother and the entire tax family are eligible for an SEP
• The child is covered from date of birth (assuming plan selection is within 60
days of the child's birth
• For an Off Exchange plan, Mother (and any other family members being
added) is covered beginning the 1st of the month in which the child is born
(assuming app is submitted within 60 days of child's birth), which means the
delivery will be covered.
Note: For special enrollment due to birth (newborn) in Montana (MT) a credit will be manually applied on the member's policy that effectively serves as the proration to make the first 31 days of coverage for a MT newborn free.
ac

 

[russelltw]

WOW...Just wait until you deliver, then apply. Get the delivery covered even though you did not have insurance at the time. Even now, as long as you don't get pregnant in Jan - Mar, you are likely going to be pregnant during AEP, which means you can get covered. I guess it was unfair for those who got pregnant in Jan - Mar.

Waiting for the "Ambulance SEP" - "If uninsured and traveling in an ambulance, customer can purchase a plan before arrival at hospital..."

Then people will complain and the powers that be will give them 30 days from the ambulance ride to enroll...

All this leads me to this question...why are we in a hand basket and what's that sulfur smell...

 

[VolAgent]

I feel so discriminated against!!!

I just had a car wreck and State Farm is telling me I can't buy insurance now and have them cover it!?@?@

They need to fix this. Where is my Obamacar?