80/20 plans

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80/20 plans

Postby emily » Jun 19, 2004 9:10 pm

How on earth to have an HG pregnancy with an 80/20 medical plan??? With my 1st pg I lucked out beyond belief. I only paid $500 total for 2 hospitals stays plus the hospital stay when I actually delivered, months of Zofran.... etc etc. DH's potential new employer offers an 80/20 plan (I am not sure about the max out of pocket annually). Anyhow, I am pretty sure I would be paying the max out of pocket since my first pg was $70K not even including my perscriptions. Ugh. This does not seem doable!!! I am so frustrated!
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Postby otiam » Jun 20, 2004 8:38 pm

Hello Emily,

The first thing you need to do is find out how much would be your deductable for the year. After you know that number I would start saving to pay that amount. They usually pay the rest then after you have paid that amount. A friend of mine had a bad insurance plan with just a regular pregnancy and she actually just put all of her cost together into a loan...she has had 3 babies and they are just paying it all off slowly...that is another way to do it. I hope you can figure it all out and find a way if you really would like to have another baby. Let me know how it goes!!!

Amber
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Postby aaronsmommy » Jun 21, 2004 10:41 am

I think a lot of people with normal pgs end up paying the max with these plans, luckily with some the max is actually pretty low. I have one like this now and initially I freaked, but I think the max is $2000/year which isn't much more than I paid for my pg with my HMO plan.
When you are budgeting, remember you will probably need to pay the max for the family, since the baby will have his own charges. Also, sometimes things like the deductible, copays and pharmacy costs count toward the annual max, sometimes they don't.
I had an HMO plan with my son and it had an annual max too, I thought I had hit it after a bunch of hospital admissions that I had to pay $125 copay each, but it turned out hospital copays didn't count.
Then, there's trying to get everything planned within the same calendar year so you don't have to pay it all twice.
The medical bills for me and my son totalled about $750,000. HG can be expensive!!
Aimee

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Postby aaronsmommy » Jun 22, 2004 11:26 am

An idea for helping out with the costs of your insurance would be "hospital income insurance" This kind of plan would pay you a certain amount for each day you spend in the hospital, that you could use toward anything you need. If you don't spend much time in the hospital, you don't get much out of it, but it wasn't very expensive when I looked in to it.
Here's a description http://www.statefarm.com/insuranc/health/hospinco.htm
If you apply individually, they would probably exclude hg, but a lot of times you can get these plans through an employer, or a union, or professional organization with less of a health history.
I think it would be worth looking in to at least.
Aimee

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Postby emily » Jun 22, 2004 5:01 pm

I think I am just going to have to realize that another baby is going to really cost me. LOL I had thought about the one calendar year thing too. So, I guess I will be waiting until January to TTC. I found out I was pg with my dd Dec 14th and by Jan 1, I had already been hospitalized. My DH is doing an internship for a company that is supposed to go full time the end of August, and they didn't give him benefits info because he is just an intern now and not eligible for benefits. BUT- he can look things up on the intranet which is how I know it is an 80/20 plan with a deductible. Usually, with these types of plans I have seen in the past, you have to meet your deductible, then they pay 80%, and when you reach a certain out of pocket amount they then pay 100%. We will see. Just out of curiosity, has anyone done HG on medicaid?? Does medicaid cover HG?
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Postby dwtegli » Jun 23, 2004 10:28 pm

Hi,

I am on medicaid that covers what our insurance company doesn't. We also have and 80/20 plan that works just like you described and medicaid is paying all of my copays and the 20% that we are supposed to pay. I didn't have it yet when I was hospitalized, but they have covered all my doctor bills and all my prescriptions. Including the Zofran. so far I haven't run into anything that they won't cover.
Wendy,
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