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Pregnant w/no insurance

2K views 27 replies 19 participants last post by  Norasmomma 
#1 ·
I have a little dilemma. I'm newly pregnant w/no insurance. My husband has insurance at his work, and we missed the open season, but he said that it was okay because once I'm pregnant, they'll add me on. Well, now I've learned that they'll add me on, once I have the baby. I think the wording confused my hubby and he assumed it would be how the oregon health plan is, where can add you on, once you get pregnant....anyway....we both felt pretty dumb when we realized how little we knew about insurance and pregnancy.

Now I'm wanting to get on the Oregon Health Plan, and I'm pretty sure we qualify, with our income. Here's the problem, when my dad passed away, he left me some money in a trust acct. The will says I don't have access to it, until I'm 30, unless it's for health expenses. ...but I was planning on using it towards our first house, and if anything out of the ordinary were to happen during my birth, it could drain the whole account. ...and I'll just feel like I've totally messed up and hurt our chances at getting a house, for my future family. I'm thinking of just not mentioning the trust acct on the application. I think it should be okay....but I'm very scared of getting in trouble. Could I? What do you think I should do?

Thanks a lot.
 
#5 ·
I think Medicaid will ask you for all financial information and maybe even tax forms. If you had to declare the money in the trust then it will show on your taxes. They may only ask for proof of income and, imo, if they don't ask specifically about the trust then you don't have to mention it.
If they do ask for all financial info, maybe you can get documentation that specifically states you do not take control of the money until age 30 but leaves out the medical portion you may be able to squeak by. Maybe some kind of an informal letter written by a secretary on letterhead?
Also, the goal of Medicaid for pregnant women is to assure prenatal care and healthy mama and babe. I would think, no matter what, you're going to receive some kind of assistance.
You might also look into things like WIC that, if memory serves, you're automatically eligible for once you qualify for Medicaid.
HTH and GL!
 
#6 ·
It depends on what type of account your "trust fund" is in. As long as it is not in a regular checking/savings account then I don't think you have to count it as income.

For example I have a sizable retirement account, and my kids have bigger college accounts than I had when I graduated from high school (sheesh!) but those accounts are never questioned.

Generally when applying for state health insurance, they want to know how much money you have "on hand"- savings/checking.. if your trust is in an account like that, use it to buy a house now OR change it into a different type of account.

I wouldn't mention it unless they specifically ask about it, and I have been on state health insurance and they never asked me about my tax forms. They wanted to see copy of last paystub, amount currently in my bank account- stuff like that.
 
#8 ·
I wouldn't lie on an application. First, its dishonest. Second, if they find out its fraud, and they can charge you with fraud. Call someone in the agency you'll be applying and explain to them the whole situation. They aren't out to screw you over. They want to help you as much as they possibly can.
 
#10 ·
I'm on the Oregon Health Plan.

They want to know about any checking or savings accounts that you have and the balance of each. They will also want to know your gross monthly income and mortgage or rent expenses.

I guess my question to you is, are you 30 yet? If not, then you don't have access to the trust from your dad and it can't be counted as an asset yet, so there is no need to mention it. If you DO have access to it now, then I think you do need to say something about it, as not doing so would be illegal.

It won't hurt to give them a call and ask. You don't have to give them your name or anything...just say you are trying to figure out if the trust money will disqualify you from getting a Care card.
 
#11 ·
Ugh I don't even want to think about this issue.

I thought we had maternity insurance when we bought our plan....turns out we don't. I have no idea how I missed that.

Even if we plan an u/c or just a h/b, what if something happens? A c-sec is like $30k here I believe. !!!!!
 
#12 ·
I would not withhold any information when trying to get insurance. I just read an article the other day about insurance companies retroactively canceling people's policies because they neglected to mention minor health conditions. I know it's a slightly different situation, but still.

Hopefully you'll be able to the health insurance and not need to use the trust fund, BUT be glad you have it to fall back on if the insurance doesn't work out. A lot people don't have that extra safety net.
 
#13 ·
wow, lots of response! I'm going to this insurance office to see if they can find me a plan that has a shorter waiting period for coverage on pre-existing conditions (pregnancy), so that hopefully my birth will be covered, and I'll just pay for the prenatal care. For all I know, this might be impossible, but I'll check it out.

Yeah, I'm super thankful about having the safety net. I need to just chill out. I think I was just having an emotional episode feeling like the world was going to end ......darn these hormones.
 
#14 ·
Quote:

Originally Posted by GuavaGirl View Post
wow, lots of response! I'm going to this insurance office to see if they can find me a plan that has a shorter waiting period for coverage on pre-existing conditions (pregnancy), so that hopefully my birth will be covered, and I'll just pay for the prenatal care. For all I know, this might be impossible, but I'll check it out.

Yeah, I'm super thankful about having the safety net. I need to just chill out. I think I was just having an emotional episode feeling like the world was going to end ......darn these hormones.

GuavaGirl, Call the Providence Maternal Care Clinic

http://www.providence.org/oregon/Hea...ternalCare.htm

it is staffed by CNM and one would deliver at Providence (which has private rooms, and seems like a pretty progressive hospital)... anyway, they have payment plans and financial counseling for people paying out of pocket.

I have had good vibes from all the CNMs I;ve met there so far, and feel really comfortable about the clinic model and being there.

Looking over the costs, especially if the birth is natural, they're really low.
 
#15 ·
If a trust fund is not a savings/checking account, and they don't ask about it, then I don't think you should be required to mention it. Why don't you get a copy of the application and look it over?

Oregon health program - determine eligibility
 
#16 ·
Quote:

Originally Posted by Serenyd View Post
If a trust fund is not a savings/checking account, and they don't ask about it, then I don't think you should be required to mention it. Why don't you get a copy of the application and look it over?

Oregon health program - determine eligibility
Yeah, I would just call and ask- just don't leave your name or anything. I know that some government divisions will "flag" names with awkward questions for further review later.. this happened to a friend of mine who was asking about credits to renew her teaching application, but other offices can do it as well. Call and ask questions, but don't let them connect the conversation to the paper work unless it will assist you.
 
#17 ·
carmel23: I don't live in Portland, so I don't think that hospital would work for me. I do plan on using a CNM in my town though. I've heard my hospital is good at working out payment plans, etc.

Serenyd: I have an application and they ask about things "like stocks and bonds" and I'm thinking that it falls into the same category.

Pinoikoi: Yeah, I think I might call and ask just in case, but I'm pretty sure it's not gonna work. Technically this account earns dividends, that I can access, through a trust officer, for only medical expenses, but I just don't have full unrestricted access for 5 more years. (it's how my dad wrote it in the will) I mean, if I'm telling the truth, it seems like there's no way I'd be approved.....so I think I'm on to my next plan.
 
#18 ·
Quote:

Originally Posted by shakenbake View Post
did you try medicaid? most people can get it for free and it covers everything!
my husband isnr doesnt cover maternity at all and i got it
this is what I was thinking. I went on Medicaid for this pregnancy. Sure, we probably could have tried to pay it all on our own but we would have had medical bills for a while if we went that route. We have regular insurance but it doesn't cover maternity and I qualified for Medicaid since it's only for 9 mos and then I'll go off it.
 
#19 ·
I re-read the OP so I'm not sure that what I've posted really helps, but, its good info to have.

FWIW....here in KS insurance companies CAN NOT count pregnancy as a pre-existing condition. I know this first hand!!!! Found out I was pregnant w/DS 2 weeks before the insurance kicked in. BCBS covered everything.


Okay....its against HIPAA regulations for them to treat pregnancy as a pre-existing condition. I do believe its one thing for them to not offer maternity coverage but another issue entirely to treat it as pre-existing condition. The following comes from the US Dept of Labor website. Also, keep in mind that there are HIPAA loopholes that allow insurance companies to worm their way out of pregnancy costs.

http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html

"Are there illnesses or injuries that cannot be subject to a preexisting condition exclusion?
Yes, as follows:

Pregnancy, even if the woman had no prior coverage before enrolling in her current employer's plan.

Conditions present in a newborn or a child under 18 who is adopted or placed for adoption (even if the adoption is not yet final), as long as the child is enrolled in health coverage within 30 days of birth, adoption, or placement for adoption. In addition, the child must not have a subsequent, significant break in coverage (defined as 63 days). For instance, a significant break might occur if a parent lost his job and health coverage for himself and his family shortly after a child's birth. This break will be discussed in the Creditable Coverage section.

Genetic information. For example, if a woman is found to have a gene indicating she is at a higher risk for breast cancer, she cannot be denied coverage if there is no diagnosis of the disease."
 
#20 ·
I just wanted to add that if you don't qualify for state insurance, a hospital bill can be paid off sending as little as $25 a month. Also, I know of a family who had a $5000 hospital bill from the birth of their youngest. They called the hospital, said they couldn't afford the bill, and the hospital wrote it of for them.
As several of the pp's have mentioned, you do have other options and while they might not be ideal they are still options.
 
#26 ·
They called the hospital, said they couldn't afford the bill, and the hospital wrote it of for them.
QUOTE]

Sometimes, there is help if you know to ask for it. I happen to work in a hospital so I know this firsthand, but they try to keep it on the down-low.
 
#21 ·
Quote:

Originally Posted by soxthecatrules View Post
Okay....its against HIPAA regulations for them to treat pregnancy as a pre-existing condition. I do believe its one thing for them to not offer maternity coverage but another issue entirely to treat it as pre-existing condition. The following comes from the US Dept of Labor website. Also, keep in mind that there are HIPAA loopholes that allow insurance companies to worm their way out of pregnancy costs.
Soxthecat, I cannot speak to the law in KS, but the federal rule is that pregnancy cannot be treated as a pre-existing condition for *group* health insurance (i.e., through an employer). It can be treated as pre-existing for independently purchased individual insurance.
 
#22 ·
Quote:

Originally Posted by soxthecatrules View Post
I re-read the OP so I'm not sure that what I've posted really helps, but, its good info to have.

FWIW....here in KS insurance companies CAN NOT count pregnancy as a pre-existing condition. I know this first hand!!!! Found out I was pregnant w/DS 2 weeks before the insurance kicked in. BCBS covered everything.


Okay....its against HIPAA regulations for them to treat pregnancy as a pre-existing condition. I do believe its one thing for them to not offer maternity coverage but another issue entirely to treat it as pre-existing condition. The following comes from the US Dept of Labor website. Also, keep in mind that there are HIPAA loopholes that allow insurance companies to worm their way out of pregnancy costs.

http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html

"Are there illnesses or injuries that cannot be subject to a preexisting condition exclusion?
Yes, as follows:

Pregnancy, even if the woman had no prior coverage before enrolling in her current employer's plan.

Conditions present in a newborn or a child under 18 who is adopted or placed for adoption (even if the adoption is not yet final), as long as the child is enrolled in health coverage within 30 days of birth, adoption, or placement for adoption. In addition, the child must not have a subsequent, significant break in coverage (defined as 63 days). For instance, a significant break might occur if a parent lost his job and health coverage for himself and his family shortly after a child's birth. This break will be discussed in the Creditable Coverage section.

Genetic information. For example, if a woman is found to have a gene indicating she is at a higher risk for breast cancer, she cannot be denied coverage if there is no diagnosis of the disease."
They aren't denying because of pregnancy. They are denying because they missed open enrollment. At least thats my understanding with the OP.
 
#23 ·
katwrangler: right. I can't get on my husband's insurance because we missed open enrollment. ...but, I mentioned applying for individual insurance. I believe pregnancy will most likely be considered a pre-existing condition. Some companies have a waiting period (like 6 mo to a year) where they don't cover expenses from pre-existing conditions, but after that time period, they do.
 
#24 ·
Quote:

Originally Posted by Talula Fairie View Post
Have you thought about hiring a midwife and birthing at a birthing center or at home? That's about 1/3 the price of your average hospital birth.
:

We have insurance and made sure it covered maternity before I tried to get pregnant. Well, I got pregnant and out insurance decided to up the maternity deductible to $6,500 (it only costs $6,300 for an OBGYN + hospital birth in my state. The insurance just didn't want to pay for maternity anymore). So I'm pregnant and can either have a hospital birth and pay $6,300 out of my own hard earned monies, or I can hire a midwife and have a homebirth and pay $2,000. It was an easy choice for me since I wanted a homebirth anyway and my midwife supports my beliefs. (although I am furious that I still have to pay for insurance every month).

But I would only suggest a Midwife and Homebirth if you and your baby are healthy. If you are high-risk it is more tricky.

Good luck and congrats on your pregnancy!!
 
#25 ·
bananachild: Thanks, but I am just not comfortable with a homebirth. It's actually not even an option for me. The only midwife in my area is a CNM who does hospital births. My main concern is protecting myself financially in the case that anything out of the ordinary (& most likely costly) were to happen, during my birth.
 
#27 ·
In my state, the income limits are different if disabled or pregnant, but pregnant would require a spend-down. Disabled no, and there is a medicaid to medicare COB program. If you don't want to spend down your money, you can invest it for your birth expenses in a medical savings account or a regular brokerage or investment account. You might want to find out how much a pre-paid hospital birth costs. Some hospitals in Arizona have $2500 package that includes a few pre-natal visits, birth, and one post-natal visit. Besides, you don't need insurance to be pregnant or have a baby. Babies don't verify your policy.
 
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