2015 Federal BCBS vs Aetna for Maternity Benefits?

[Anonymous]

Hello,

With open season enrollment coming up, I'm going through the federal health plans and trying to decide what me and my husband should do for next year (I'm due in April). I'm trying to decide between BCBS (probably the Basic federal plan) and the Aetna Federal OpenAccess HMO. Does anyone have experience with either of those, and would you recommend those plans for maternity and childbirth? It seems like Aetna charges a nightly fee for the hospital stay during delivery, which has me a little worried.

Thank you!

[Anonymous]

I've had two deliveries with BCBS FEP Basic and it's very low cost for maternity services and seems to have all the major local groups as in-network so I feel like it's a great plan - you have access to pretty much any provider who takes insurance and you have very predictable, and few, co-pays. I never had an issue with a hospital consultant billing as out of network after the fact at either VHC or GW.

For my first, there was a second co-pay for my daughter's succtioning (counted as a separate "surgery") due to meconium but I have yet to get billed separately for that again with my second, who also required suctioning. There's still time for them to bill it as a second surgery if they want, but who knows. But so far, I had two $150 copays for my first delivery & postpartum recovery, and I've had one $175 copay for my second delivery & postpartum care.

[Anonymous]

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.

[Anonymous]

I had my DC in April and the previous open season switched from Aetna open access to BCBS basic (no deductible). Aetna was going to require 10% of the hospital stay for birth be out of pocket, BCBS picked up everything but the hosipital admission fee and one co-pay for an ultrasound. So it was a good move for me. Make sure you know what your doctor accepts.

[Anonymous]

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.

[Anonymous]

Thanks so much, guys. OP here. My main reason for considering Aetna was because we've had infertility issues in the past, and will probably try for a second. Aetna's coverage for IF is much better than BCBS. However, given that we're set to deliver our first one in April, I think we'd probably wait till January 2016 at the earliest in any case for our second, so it probably doesn't matter.

Aetna seems not as good as BCBS for maternity care -- $200/night for hospital stay, at a cap of $1000. If I were to have no complications and stay only one night after delivery that would be ok, but if there's a NICU situation, it could end up being a lot more money. And the Aetna customer service was really terrible -- I called them and they couldn't answer any of my questions. So I think I'll switch to BCBS for the following year, and can then re-evaluate for 2016 after the baby comes.

[Anonymous]

ANother thing to consider is the ped visits, etc., for the kid once it's born- not just maternity and childbirth. I had BCBS with my existing kids and it was great,but this was several years ago.

[Anonymous]

Have you considered GEHA? Maternity is covered in full. The language in the brochure says 'complete maternity care' is covered in full instead of other plans that say 'routine maternity care'

I have it and it's been great. Only $10 company's for sick kid visits.

[Anonymous]

New fed here -- we compared the plans and all seemed pretty comparable for maternity care. We ended up picking GEHA.

[Anonymous]

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!!

[Anonymous]

NP here - can someone tell me what the monthly family rate is for GEHA. We aren't Feds yet but DH is anticipating receiving his full package this week or next and we are trying to plan expenses for next year. Thanks.

[Anonymous]

Anonymous wrote:NP here - can someone tell me what the monthly family rate is for GEHA. We aren't Feds yet but DH is anticipating receiving his full package this week or next and we are trying to plan expenses for next year. Thanks.

www.opm.gov should have all the rates and plan brochures for 2015.

[Anonymous]

Anonymous wrote:

Anonymous wrote:NP here - can someone tell me what the monthly family rate is for GEHA. We aren't Feds yet but DH is anticipating receiving his full package this week or next and we are trying to plan expenses for next year. Thanks.

www.opm.gov should have all the rates and plan brochures for 2015.

Thank you. I didn't know that.

[Anonymous]

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.

[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.

Delivered at GW in June with BCBS basic, used their peds service and anesthesia, and still only paid my $175. I've been really pleased with BCBS so far; this is I think our third year with it (and I have an older child, so the benefits work well when you're thinking about ped care, etc)