Published
November 13, 2023
With Open Enrollment in full swing, your employees likely have questions about how to choose the right plan for their specific needs. In our “Help Me Pick My Plan” series, we break down what they should look for in some of the most common scenarios. Feel free to send them a link to this post or use the information in it to help guide them.
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Dear SureCo,
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Dear SureCo,
My company is switching to an Individual Coverage Health Reimbursement Arrangement (ICHRA) for our health insurance. I’m excited to have more plan and carrier options to choose from, but I’m also overwhelmed. I’m expecting a baby girl early next year, and I’m thrilled — but nervous, too. There’s so much to plan for financially, and I don’t want to pick the wrong health insurance plan and end up with a huge bill on top of everything else.
Can you help?
Best,
Pregnant in Pennsylvania
Dear PIP,
First of all, congratulations! We’re happy to help you figure this out, so you can get back to worrying about something more fun, like your nursery theme and exactly how many tiny socks to add to your baby registry (veteran mom tip: skip the socks).
When you’re expecting a baby, your health coverage needs may be dramatically different than usual, so we’re glad you came to us for help. The good news about your company moving to an ICHRA is that you’ll be able to pick the plan that works with your preferred doctor(s) and budget. Here’s how Kevin Scott, SureCo’s lead Employee Experience Specialist, suggests tackling this one:
Step 1: Confirm your OB/GYN and hospital are in-network.
First, call your OB/GYN and ask if they are in-network with the plan(s) you’re considering. Be sure to tell them it’s an “individual plan” NOT a “group plan.” You’ll also want to make sure that the hospital where you plan to deliver is in-network, as well, so give them a call, too. If you haven’t talked about where you’ll deliver with your doctor yet, start the conversation. Your OB/GYN will need admitting privileges at the hospital you choose, which means you won’t necessarily be able to have your pick of any hospital in your area.
It’s worth noting that other birthing options outside of a hospital, such as a midwife center or home birth, aren’t covered by most insurance plans. Doula support during birth isn’t typically covered either, but if that’s something you’re interested in, it’s worth investigating. Take a look at each plan’s Summary of Benefits & Coverage (SBC), call the health insurance companies you’re considering, or talk with SureCo’s dedicated Employee Experience team if you’re a customer.
Step 2: Take a close look at deductibles and out-of-pocket maximums.
Before we get into the next step, let’s do a quick refresh on some of the insurance lingo you’ll be navigating:
Deductible: The amount of money you’ll pay before your insurance starts covering some costs.
Coinsurance: The portion of your healthcare costs you’re required to pay after hitting your deductible. For example, with 20% coinsurance, you pay 20% of the total bill and your plan pays 80%.
Out-of-pocket maximum: The total amount you’ll pay for covered services before your plan starts covering 100% of costs.
When you’re taking a look at a plan’s SBC, one of the most important details to check out is the out-of-pocket maximum. Why? With the cost of delivering a baby in a hospital clocking in at more than $14,000 for a vaginal delivery, you’re most likely going to meet that upper limit. So make sure it’s a number you’ll be able to cover, says Scott.
Related: How to Read a Summary of Benefits & Coverage (SBC)
Step 3: Consider your monthly expenses and savings goals.
If you’ve checked out the going rate for your average stroller, you’ve probably already noticed how much costs increase once a baby arrives. As you look at your financial goals, think about what you’re willing to pay per paycheck for your health plan premium and balance that number with what size bill you’re comfortable covering once your baby is born.
Some people may choose a plan that costs more monthly but has a waived deductible, so you can avoid any surprise bills, Scott explains. Or, you may decide to pay less per paycheck knowing that you’ll be able to cover your remaining deductible and out-of-pocket max after delivery.
You’ll also want to understand whether your baby’s first healthcare costs, such as initial tests, will be part of your coverage or if the plan will consider her to be a new individual family member from the date of her birth — and start her own deductible. To find out how your baby’s coverage will work, check the plan’s SBC, call the health insurance company, or talk to SureCo’s Employee Experience team.
Key takeaways
To recap, when taking a look at the SBC for each plan, consider:
- Is your current OB/GYN in-network with the plans you’re considering? What about the hospital where you’ll deliver?
- What is the plan’s deductible and out-of-pocket maximum? Would you be able to pay most of that cost at once, if needed?
- Would you rather have more money in your pocket each month but potentially be responsible for a higher bill after you deliver your baby, or would you prefer to pay more at each paycheck but have your plan’s coverage kick in sooner?
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