Doctors' Appointments to Budget for Health Insurance

[state26]

First post here and excited to learn more from you all! It's my employer's open enrollment period right now, and I'm trying to figure out what health insurance plan to get for 2023 - hoping to get some feedback on what sort of medical expenses to budget out.

My plan is to start TTC in Aug-Sept 2023 (either after Oktoberfest if I can make that trip happen or after a friend's late-summer wedding). I want to budget out the most optimistic scenario for 2023 (e.g. where I get pregnant on my first cycle) to make sure all possible expenses are covered.

Do you all know what kinds + frequency of OB-GYN appointments I should expect to have through the first 2-3 months of pregnancy? I know I want to do some sort of fertility testing for me and my husband once I go off birth control (thinking that would happen in early 2023), but I'm curious to hear what else is expected / recommended /encouraged. TIA!

 

[tim_o]

@state26 Your company should be sharing the “summary of benefits and coverage” for each of their plan options. Looking at mine (Kaiser CalPERS HMO) they break down pregnancy charges into: office visits, childbirth/delivery professional services, and childbirth/delivery facility services. That should give you a good idea of what to compare (% you pay in co-insurance between plans, what your out of pocket limit is).

From lurking the other pregnancy subs, it seems like a rule of thumb is to expect to hit your out of pocket limit, and to potentially consider the family out of pocket limit because they will count the child once it’s here? Which is wild to me. My husband works for a state school and there is no charge for any pregnancy-related care, which I’m so grateful for and enraged that this isn’t the norm.

 

[sisi]

@tim_o They do count the child under the family plan, but their expenses are very minimal unless they are in extended NICU or something. The child is covered under the mother's insurance for their first 30 days of life and only after that do they need to be added to your plan. In the normal scenario with a kid without complications, their visits after 30 days are well checks and therefore "preventative" and free under most plans.

Weirdly I didn't hit my out-of-pocket limit with my second child's birth, we only paid $750 (for a very simple and uncomplicated birth), and that was Kaiser. With my first we had United Healthcare definitely waaaay hit my out-of-pocket limit (though I was in the ICU after for postpartum sepsis, but I still think just the birth hit it), but not even close to the family out-of-pocket. So it depends.

 

[tim_o]

@sisi Yeah I think it just depends on what’s covered by your plan and what the hospital charges (not sure if that applies to you or not though, if you gave birth at the same hospital). Birth costs vary so wildly by region or even hospital to hospital.

The Kaiser cost calculator estimates my delivery costs in Bay Area (not counting pregnancy care or newborn care) to be from $21k for vaginal delivery, no complications to $41k for c-section with complications. If I had to pay say, a 20% co-insurance, I would definitely be hitting my out of pocket limit real quick!

OP I would probably opt for the lowest out of pocket plan if you can afford the monthly payments. But like Scruter said, the big costs don’t seem to happen til actual delivery so you likely have the next enrollment period to think about that.

 

[sisi]

@tim_o Oh yeah, the actual total for my second child's uncomplicated vaginal birth with less than 24 hours in the hospital after the birth was $24,374. But with Kaiser's contractual adjustment and HMO payment, our out of pocket total was $750 (even though my individual out of pocket limit for the year is $2,000). I had a baby in January, and now it's November and I still have $1,120 before I'd hit my out-of-pocket for the year, which is of course hopefully not going to happen. I did go for the HMO option of 3 plans to choose from with lower out-of-pocket expenses. But it's complicated! Edit: looked it up and it's because our Kaiser plan has a set rate of $750 for inpatient hospital stays, rather than coinsurance plus deductible if I had chosen the DHMO.

 

[sisi]

@state26 Fertility testing is not recommended by medical consensus or generally useful until 12 months of trying (6 months if 35+). Here is an explanation of why. It absolutely would not be covered by insurance before that (and for most plans in the US, not even after that), so that wouldn't be a consideration for insurance.

As for insurance, you will not have very many doctor visits in the first few months of pregnancy. The first visit is usually at 8-12 weeks pregnant to confirm and date the pregnancy, the second at 12-16 to do a nuchal scan and/or prenatal testing, and then the big anatomy scan at 20 weeks. The next appointment after that is 28-30 weeks for the glucose test. You may or may not have another visit before 36 weeks, and then it's either weekly or every other week (Assuming everything is normal). The big expense is birth, so it's 2024 insurance that will really matter, because the early pregnancy expenses aren't much.

 

[qancer]

@state26 Typically your first OB visit is at 8 weeks and includes a dating scan. Most ultrasounds aren’t considered “preventative” so you’ll have to pay for those. Mine on my high ded plan were a couple hundred each.

You’ll go for visits once a month until you get to like 32 weeks, then you’ll go every two weeks. The last month you’ll go weekly. Assuming a low-risk pregnancy, of course.

Your next ultrasound is the anatomy scan at 20 weeks. You usually don’t have another scan unless there’s a concern about baby’s size or position. The GD test is around 24-28 weeks, I think. All other visits are quick - pee in a cup (or all over your hand, cuz pregnant), blood pressure check, quick chat. Typically in and out in 15 minutes for me.

A lot of OBs ask you make payments throughout your pregnancy towards their fee (for care all through pregnancy and L&D). For my first pregnancy I had a visit with my OB’s billing department at the end my first visit to chat about their fees and payment options. You could ask your OB, if you know who you’ll see, how they handle that part.

My youngest was born in March, so everything I paid from June-Dec the year prior didn’t count towards the deductible and out of pocket max for his birth, since it all reset in January anyway.

If you’re anticipating spanning two terms of insurance, I’d look for lowest out of pocket max in the year you’ll deliver, but just try to minimize copays and the like in the year you’ll begin your pregnancy.

 

[monotoko]

@state26 I don’t know anything about fertility testing, but normally, you just go in for a dating ultrasound (8-10 weeks usually). Depending on the doctor, you’ll usually get an NT scan or offered genetic testing around 12 weeks. Other than that, you don’t have a lot of appointments in the beginning, but as you get further along they do schedule them more frequently.

Also I’d look into your medical insurance plan and see what’s expected of you to pay/them to pay (if you’re in the US).

You do have a lot of bloodwork around 16 weeks, depending on insurance, it can be pricey. I know that’s not 2-3 months, but that was an oof expense.

 

[katrina2017]

@state26 I got pregnant in August/September and the bill from my doctor will come mostly after the birth. For my appointments I just have a $20 co pay. So $80 from October-December for the appointments and then I have to save for the hospital bill. Every plan is different so just call yours and ask.

 

[bbsergeant]

@state26 If I could go back in time I’d try to time my pregnancy to take place within the same calendar year so I could hit my deductible before paying for labor and delivery.