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4 Crucial Questions to Ask Before Your Baby Arrives

Oct 14, 2024

I get it… reviewing your health insurance plan details before your new baby arrives sounds like third trimester torture! That’s why I’m here— so it doesn’t have to be! I’m Jules, founder of Medical Bill Academy and I’m a Health Insurance and Medical Bill Educator. I help people in the U.S. with job-based health insurance save time, save money and learn how to PLAY the game instead of be played BY it…  

I’m 30 weeks pregnant (with my third) as I write this, so this isn’t my first go-around! If you’re like me… you want to be prepared before baby comes, not scrambling to correct your mistakes with a newborn. Believe me, I’ve done that before and you just don’t want to go down that road! 

When you give birth to your little bundle of joy, you go through something called a “Qualifying Life Event” in the world of U.S. health insurance terminology! This life event allows you to enroll in health insurance outside of your employer’s regular annual enrollment period.

Some other examples of qualifying life events are getting married, losing health coverage, moving zip codes, adopting… or… you guessed it! The birth of a baby! You have 60 days to take advantage of this special enrollment period from the birth of your baby, but wouldn’t it be nice to have your health insurance decisions made BEFORE the baby arrives? (I hope your answer is yes! You’ll want to be spending more time with baby than an open enrollment guide!) 

 

So what are four smart health insurance questions you should ask yourself BEFORE your baby arrives? 

 

1. Will you change your Health Plan?

Many employers offer more than one health insurance plan that you can choose from during your open enrollment period. For example, you might get to decide between two of the most common plans offered by employers— a PPO plan or a High Deductible Plan. Each health insurance plan will have a different premium (aka the cost of the health insurance plan). They also will have different deductibles, co-insurance, and out of pocket maximums!

If you aren't sure what all these health insurance terms mean...you can check out this free training “3 secrets to confidently save on medical bills” where I simplify these terms & more!

High Deductible Plans are usually characterized by having lower premiums and higher deductibles which essentially means that you’re going to pay less each month for the cost of your health insurance... but when it comes time to use it, you’ll owe more up front!

PPO plans on the other hand are usually characterized by having higher premiums and lower deductibles! This means that the cost of the health insurance plan will be lower for you each month, and when it comes time to use it, your deductible won't be outrageously high so your health insurance will start to share in the cost sooner!

Which one will be better for you now that you are bringing home a baby? If you don’t expect to have a lot of medical costs, you might consider a plan that has a higher deductible since the premiums won’t be as expensive as a plan with a lower deductible. On the other hand, if you expect regular medical care, a planned procedure, or specialist visits, you may consider enrolling in a health insurance plan that has a lower deductible so that your health insurance will start to share in the cost with you quicker.

 

2. Will you change your HSA/FSA election?

HSA and FSA accounts are tax advantaged accounts that allows you to use your pre-tax earnings for qualifying medical expenses. You contribute a certain amount of money each month to an HSA or FSA and submit a reimbursement for your qualifying expenses. HSAs and FSAs each have specific rules in order to qualify for the accounts, so you might be eligible for a different type of account if you decide to switch health insurance plans. 

Health Savings Accounts (HSAs) require you to be enrolled in a high deductible health plan and these funds are eligible to roll over to the next year. These accounts can grow interest year over year (tax-free). 

Flexible Spending Accounts (FSAs) are similar to FSAs, but these accounts are set up through your employer and do NOT roll over year to year. You have to use all the funds in the year you contributed to the account. 

Once you determine which account you are eligible for, it’s time to decide how much you want to contribute to the account. Do you want to contribute more or less to your HSA or FSA than you originally decided during the previous enrollment period? Now you can!

Just don’t forget about the IRS annual maximums for these accounts and consider if your spouse is also contributing to an HSA or FSA through a different employer! If you have a spouse enrolled in an HSA plan, this typically disqualifies you from being enrolled in an FSA. Check with your local CPA if you have specific questions about taking advantage of these accounts (particularly if you want to switch from one type of account to another)! 

 

3. Will you start to SAVE money now? 

How much does it cost to have a baby anyways? In a study performed by KFF, the average additional health spending for women enrolled in large group plans who give birth, compare to those who do not give birth from 2018-2020 was about $2,800. If the mother had a c-section deliver, this was closer to $3,200, but around $2,600 for a vaginal delivery!

But having a baby isn’t the only medical expense you’ll have… so you need to take those other costs into consideration! It’s time to review your out-of-pocket maximum and consider if this is something you are prepared to pay in case of extreme health circumstances!

Another figure you can use to estimate an amount to save is to look at your medical expenses from last year and add the average added expense to give birth ($2800) to come up with a savings estimate to set aside before baby comes or start incorporating into your monthly budget! 

Example:

Last Year Medical Expenses = $2,500

+  Avg. Birth Expenses = $2,500 

Estimated Medical Expenses for the Year = $5,000

Lastly, divide $5,000 by 12 months and this is about $417 per month you can plan in your monthly budget and stay AHEAD of your estimated medical expenses!

 

4. Will you be an advocate for you and your new baby? 

You are the advocate for yourself AND your child! Nobody will make these decisions FOR YOU! You have to learn it yourself and get your questions answered! Hear me out... The U.S Health System is a business. Even though you as the patient are the customer, health insurance companies, hospitals, and providers all want to make money at the end of the day.

Advocating for you and your baby means preparing ahead of time and asking your questions NOW if you have them (don't wait until your maternity leave if you can avoid it). Are words like deductible, co-insurance, and out-of-pocket maximum intimidating? Are you nervously anticipating the hospital bill that will come during your maternity leave?

What will you do to prepare to advocate for you and your brand new baby?

 

I learned the hard way...

I didn’t do ANY of these 4 things before I had my first child, and I scrambled to pick up the pieces before important deadlines came up! YES, I’m still here and we didn’t ever lose health insurance coverage, but it added even more stress on top of a complicated birth and NICU stay! It does NOT have to be that way for you! By starting with these 4 decisions BEFORE baby arrives, you will be ahead of the game!

 

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