I have no idea how this stuff works, since luckily, I've never had to use my health insurance for anything other than annual doctor visits and minor prescriptions. So I see I have a deductible of $X, I pay Y% of the cost after deductible, and there is a $Z max out of pocket expense. Can I just budget for the hospital bills to cost $Z? Is it possible to get charged in excess of $Z? Thanks for any insight!
Trying to figure out health insurance and expected costs (US). Anyone know how this stuff works?
- Thread starter sewtacky
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- waiting for baby
@sewtacky From what I've gathered, unless you plan to get pregnant Jan -> early March, pregnancy usually spans two calendar years (and some insurance "years" start in other months - I think mine runs Sept -> sept), so your yearly deductible and out of pocket max is reset. So I'd plan for double the out of pocket max as a safety.
@sewtacky This really depends on your insurance. Prenatal care is preventative care so it is generally covered 100%. Often times you pay a co-pay on your first visit and then you are covered for all your regular visits there on. However this does not include tests or Ultrasounds so that would go towards your deductible and what not. I have heard of ultrasound costs with insurance ranging from 80 - 300 dollars. Also I had a friend tell me to budget for at least 1 ER visit during the pregnancy and another one within the first 3 months of birth, because lets be honest your probably are going to freak out one way or another. 
@sewtacky Honestly, I'd discuss it with your medical provider's billing office. They're more familiar with how they charge and what your insurance will cover and what it won't -- and they'll probably even tell you how much things typically run on a prospective basis (since you're WTT right now).
There are SO many variables in play here, between your medical provider, the hospital or birthing center (if you choose to use either), and your insurance.
There are SO many variables in play here, between your medical provider, the hospital or birthing center (if you choose to use either), and your insurance.
@sewtacky Are you me? I've been making spreadsheets and trying to wrap my mind around any possible loopholes I could fall through all day. The thing that has cinched it is that the plan we are on this year has an In-network and an Out-of-network OOP Max, so in an emergency where I might need care immediately with no regard to whether that doctor is covered or not, we're still looking at a concrete number. The plans with lower premiums and co-pays didn't offer that and quickly were cut from my short list. It's also worth pointing out again that silver plans have a cost sharing aspect that reduces the deductible and OOP Max and are where I believe you get the most bang for your buck, assuming you're looking at healthcare.gov.