2015 Federal BCBS vs Aetna for Maternity Benefits?

[Anonymous]

OP here. Thanks everyone for all this info. And it's a good reminder that I can switch to Aetna after the baby's born, if we want to go through IF treatment a second time before January 2016.

Now to figure out dental.....

[Anonymous]

Anonymous wrote:So has anyone run into any pitfalls with Fed BCBS Basic maternity coverage, like the anesthesiologist or hospital pediatrician not being in-network? Specifically interested in hearing about GWU hospital, but curious in general.

EVERYTHING at GW is covered.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I have BCBS Federal Basic and I have yet to pay anything out of pocket. I haven't delivered yet, but my understanding is that barring complications, I will only owe $175 for the hospital stay (haven't looked to see if prices have changed for 2015). I have had to see both MFM and cardiac specialists multiple times throughout the pregnancy and all the exams, ultrasounds, and lab work have been completely covered (including Mat21 and amnio). I have no basis for comparison with Aetna, but nothing bad to say about BCBS.

This reflects my experiences exactly. We are due in January and going to stay with BCBS basic - although I have been trying to figure out if the pump options for 2015 are going to change. I would really like it if they covered the Pump in Style.

This was the only change to maternity benefits that I could find - "Benefits are no longer provided for tocolytic therapy and home monitoring services performed on an outpatient basis." I am not sure what that means though and I haven't had an issues yet.

The pump options for 2015 are the same - a manual Ameda or the Ameda Purely Yours. Honestly, a PIS is like $200. If you want it so badly, just buy it with all the money you will be saving by only paying $175 for the entirety of your prenatal and hospital care.

[Anonymous]

I've heard BCBS basic is good. I would pick that over Aetna. I have GEHA (United Healthcare) and I haven't delivered yet, but so far I have paid nothing out of pocket for prenatal. I also called them to ask about L&D costs and they said as long as all providers are in network it is covered 100% - no copay or deductible.

The only complaint I've found so far with GEHA is brand name prescriptions are only covered at 50%, so can be pricey if it's a new drug. Also, breast pumps are only covered once every 2 years, and you have to order it after you're 7 months pregnant. A friend of mine who has BCBS federal said it covered a new pump each calendar year, so she was able to get two before the baby came.

[Anonymous]

Another vote for GEHA. There is ZERO cost for maternity care. The biweekly premiums are way lower than BCBS basic and they use the United Healthcare PPO network in this area which is HUGE.

Sick child visits are only $10.

[Anonymous]

Anonymous wrote:I just called VHC and Aetna Open Access today to get a ballpark figure of out-of-pocket costs to deliver my baby in February. According to the Aetna rep, they only cover 90% of the total hospital stay. So, the price can vary greatly b/c VHC charges roughly $8500 for a 2 night vaginal delivery, $13k+ for a c-section, $1,000-2,400 for unexplained "newborn care" (not the pediatrician check-up), $850/day for room & board and then additional costs for an epidural, neonatal services, NICU, etc. So, when I calculated what we'll potentially owe, on the low end, it was around $1,260 for a vaginal birth and 2-night hospital stay. I found it very concerning that the price could rise substantially depending on what drugs/care I or my my baby may need. On the other hand, a friend of mine who is due in December and is planning to deliver at VHC but has BCBS fed basic, was told by her insurance that her out of pocket costs would be $250, total...regardless of whether its a vaginal or a c-section delivery, including the epidural, etc. So, I plan to switch to BCBS during this open season. I used to be with them but switched to Aetna last year when I realized I needed IVF and as was mentioned earlier, Aetna offers the most reimbursement for IVF. But, since having a baby is a qualifying life event, I plan to switch back to Aetna after the baby is born to utilize Aetna's IVF coverage. Hope this info helps! This whole process has been a learning experience for me!!

I just looked at the Aetna Open Access brochure, and it looks like this has changed. They have a copay for 2015 instead of a coinsurance.

[Anonymous]

Any idea if BCBS or Aetna covers the rental of a hospital grade pump? I've heard those are so much better to have for a few months than the other normal-grade pumps.

[Anonymous]

OP here. Thanks for all the tips, guys. Now I'm looking seriously at the GEHA plan, which looks really great. The only main downside of it seems to be the $700 deductible for me and my husband total in the family plan, whereas BCBS has no deductible. But premiums, copay and coverage all seem a little better. Tough decision.

[Anonymous]

Has anyone had experience using the FEP BCBS for an out of hospital birth?

[Anonymous]

Anonymous wrote:OP here. Thanks for all the tips, guys. Now I'm looking seriously at the GEHA plan, which looks really great. The only main downside of it seems to be the $700 deductible for me and my husband total in the family plan, whereas BCBS has no deductible. But premiums, copay and coverage all seem a little better. Tough decision.

There is the $700 family deductible but if you factor in the lower premiums compared to bsbs you'll see that GEHA is comparable. And don't forget the $175 that bcbs will charge you for maternity.

[Anonymous]

I switched to BCBS Standard before my first child was born, and was so glad that I did. I ended up needing an emergency C-section, and she was in the NICU for 5 weeks. Maternity care was covered in full, and her services were also generously covered. She needed a lot of medical visits in her first year, and BCBS covered almost everything. I haven't compared with BCBS Basic, so I'm not totally sure of the differences, but overall I can give BCBS a thumbs up.

[Anonymous]

Anonymous wrote:Any idea if BCBS or Aetna covers the rental of a hospital grade pump? I've heard those are so much better to have for a few months than the other normal-grade pumps.

BCBS will only cover if it is medically necessary. Most likely, no.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I have BCBS Federal Basic and I have yet to pay anything out of pocket. I haven't delivered yet, but my understanding is that barring complications, I will only owe $175 for the hospital stay (haven't looked to see if prices have changed for 2015). I have had to see both MFM and cardiac specialists multiple times throughout the pregnancy and all the exams, ultrasounds, and lab work have been completely covered (including Mat21 and amnio). I have no basis for comparison with Aetna, but nothing bad to say about BCBS.

This reflects my experiences exactly. We are due in January and going to stay with BCBS basic - although I have been trying to figure out if the pump options for 2015 are going to change. I would really like it if they covered the Pump in Style.

This was the only change to maternity benefits that I could find - "Benefits are no longer provided for tocolytic therapy and home monitoring services performed on an outpatient basis." I am not sure what that means though and I haven't had an issues yet.

The pump options for 2015 are the same - a manual Ameda or the Ameda Purely Yours. Honestly, a PIS is like $200. If you want it so badly, just buy it with all the money you will be saving by only paying $175 for the entirety of your prenatal and hospital care.

I got the BCBS-covered Ameda Purely Yours for my work pumping. Honestly, I liked it as much as my Medela PIS.

[Anonymous]

I got the Ameda Purely Yours from BCBS. Not what I wanted, but it was either that or a manual pump. That said, the ordering process was so easy!

[Anonymous]

I'm not a fed, but my private employer Aetna was not great on maternity care. Be sure to check newborn costs in hospital too. We paid close to $1,000 for stuff not covered for a basic delivery and 36-hour stay at Shady Grove.