Jock76

Hi. I'm new to this forum and have found lots of really helpful information, given that we may be moving to Texas in early 2014 from the UK. What I am finding increasingly confusing however is whether or not it is possible to get maternity healthcare insurance in place - however costly the premium.

We will be paying for our own healthcare plan as my husband's company doesn't provide this (as a start-up venture) and I was under the impression that no private plan will accommodate maternity care for people like us on an investment visa. However when you Google it lots of plans come up, until you start digging into the detail then it becomes increasingly unclear!

We have one healthy baby already but were hoping to try for another in early 2014 but we need to understand the costs, what provision may be on offer and what the real options are in terms of midwife vs consultant-led care. I want to go into this with my eyes wide open.

Are there healthcare plans available which cover maternity that anyone on this forum has used as an expat new to the US? Are there, for example, time restrictions that need to be adhered to (don't conceive until 8 months after setting up a plan is something I have read online)? Does a plan cover any issues relating to pre-term babies that require a longer hospital stay in a specialist unit or does that switch over to the family healthcare plan? My first pregnancy and delivery was relatively straightforward so fingers crossed we won't experience problems second time around but, again, we need to know what we may be facing financially.

Having had basic but incredible NHS care with my first child I know that the ante-natal AND post-natal care will be very different and every single thing will be charged for. Any advice around this topic would be extremely helpful.

penguinsix

There are plenty of plans that cover maternity coverage, though you may find when buying an "individual" plan (vs. a "group" employer plan) you have a delay before coverage commences. The first few months things are not covered, and if you then get on the plan you'll find that "pre-existing conditions" might not be covered for a certain period of time.

Basically--get cover long before "date night" with your husband as you'll want all the delays and exemption periods to end well before you discover you are pregnant.

If, however, you can get on a group plan, then the pre-existing conditions clause will not apply and you can basically start on the new baby as soon as you arrive.

This will all get upturned a bit when pre-existing conditions bars are outlawed in the new Obamacare health policy, taking effect over the next few months and years.

More on general insurance bits here:

http://britishexpats.com/wiki/Health_Insurance

Michael

That is a tough one. Starting in January 2014, the Affordable Care Act (ACA) becomes fully operational. The primary purpose of it is to provide affordable care for people that don't have employee provided health insurance through pooling, government subsidies, and reduced costs. Families of specific age groups and sizes all pay the same premium (families with lower incomes are subsidized) and does not depend on the health of the family. Maternal care is included in the program.

Primarily the program is for US citizens and legal permanent residents. I'm sure that they are the only ones that can get subsidies (except a few others such as foreign students) but I'm not sure if other visas are eligible to enter the program. Some states are running their own program and setting up health insurance exchanges (i.e. California) following federal guidelines while other states (i.e. Texas) will be using the federally mandated exchanges. California is the furthest along on defining it's program, has insurance companies lined up to offer insurance, and have estimated costs for premiums for the four plans available (bronze, silver, gold, and platinum).

Initially I assumed that only US citizens and legal permanent residents along with a few other visas could use the exchanges but upon reading the California documentation, it only states that you have to be a legal resident in California and just about anyone on a work visa is a legal resident. I know that the law will not allow subsidies for L, H, O, and E visas but maybe those visas can use the exchanges and just pay the full price. That would seem to make sense since that people on those visas could use the exchange but just can't be subsidized. However since the full rules still haven't been defined, we won't know until after October 1 of this year when the exchanges start operating.

The primary difference between the plans is the deductible and basically the bronze plan has a 40% co-pay, silver has a 30% co-pay, gold has a 20% co-pay, and platinum has a 10% co-pay. Each state that has their own exchanges can define the plan differently but overall they must meet those guidelines.

As stated earlier, Texas will be on the federal mandated plan which I currently don't have any documentation about.

The following is the California plan and it will likely be similar to the federally mandated plan. The initial page is a calculator to estimate the cost of the silver plan. There are tabs at the top of the page to give more details about the plans so you may have to search for the information that you want. So until there is more clarity during the next few months, it will be difficult to tell if you are eligible for ACA.

http://www.coveredca.com/calculating_the_cost.html

The page 4 of the following link give the co-pays for outpatient care. I'm not sure what the co-pay for hospital care will be but suspect those are the 10%, 20%, 30%, or 40% depending on the plan chosen.

http://www.coveredca.com/news/PDFs/C...let-8-6-13.pdf

Pulaski

Although much related to health insurance in the US appears to be an unregulated free-for-all, in fact there have been a number of regulations covering medical insurance for many years, and I think that it is required that insurance covers pregnancy, otherwise single men and most people beyond their mid 40's would opt for lower cost "no pregnancy' coverage.

sir_eccles

Most individual policies will probably only cover complications of pregnancy rather than the full maternity coverage you might get with a group policy.