Open enrollment decisions--what would you do?
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Anonymous
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It's almost open enrollment and I have to decide between my insurance and DH's and I am struggling to decide which option is best. We've been TTC for 8 months with no success and I will turn 34 next year. If this continues we may end up pursuing infertility treatment, which is a whole new world to me. If you were in my situation, what would you do given these choices?
Insurance 1: UHC. Has some coverage for infertility (covers 90% of treatment of underlying condition and artificial insemination after a $200 deductible). It also offers access to ParentSteps, which is a program that offers the ability to purchase multiple treatment cycles and infertility medications at group discount prices. The only participating clinic in this area is Shady Grove. There is not much info about it on their website beyond an example saying that one cycle of IVF costs $12,000 on average and with the program the cost would be $7,900 at Shady Grove However, coverage for pregnancy and L&D is not as good--I've been told by a UHC rep the out of pocket costs can be around 4 grand as a ballpark. Insurance 2: BCBS. There is NO coverage for infertility at all, including diagnostic studies done for assessing infertility or any procedures done o enhance fertility. However, they told me that they do cover treatment of any underlying medical conditions, ie endometriosis, PCOS. Coverage for pregnancy and L&D is amazing--it's 100% of most things.... Given these options, which would you go with? |
Anonymous
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Are those your only two options?
If so, I'd go with the one that covers infertility. Besides, it might take you more than 3 months to get pregnant. and when you're pregnant you can switch this time next year to a better plan with maternity benefits. FWIW we have Kaiser and they do 50% infertility and great coverage for preg and L&D. |
Anonymous
| I assume this is not Federal BCBS, because the IF coverage is much better than that. |
Anonymous
| Do the fertility coverage. When is the last day for enrollment? You'd have to conceive before March to give birth in 2016. Infertility is much much more expensive since most people need multiple treatments. Do that plan and sock away the 4k for delivery. |
Anonymous
| Thanks, that is what I want to do too but DH keeps thinking we will get pregnant and that I should stay on BCBS. These are our only two options and the BCBS is not the federal plan...it is so hard to really know what they will pay in the end but my gut says go with UHC since it's likely testing and treatment are in my future (though I would love it if we got pregnant on our own). |
Anonymous
| I have UHC, and I was very happy with their coverage while undergoing two years of infertility treatments (diagnosis, multiple IUIs, IVF, FET). I am 22w pregnant now off of my last FET, and the prenatal coverage so far has been great. No complaints. I guess there may be further costs incurred at delivery, but, based off of my coworkers' experiences, I don't expect to hit an out of pocket cost of $4000. |
Anonymous
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In your situation, I'd pick UHC for the infertility coverage.
But for what it's worth, I have BCBS federal and the maternity coverage is fabulous. I haven't paid a dime and that includes 2 ultrasounds plus all my bloodwork/testing. |
Anonymous
| Do you live in Maryland? If so I'd wait and buy a plan through the exchange. The platinum plans cover IUI and IVF. |
Anonymous
| This is OP. Not a MD resident so that's not an option.... |
Anonymous
| Is this Fed BCBS? I think it's different than what you described. I had Carefirst (not Fed) with my first. Got pregnant right before my first IUI but they would have covered 6 IUIs. My maternity coverage was great. I only paid $20 total and that was the copay for a CVS when I had complications. I have UHC now and am a little worried about the infertility coverage and maternity. I wish we could go back to Carefirst but DH switched jobs. |
Anonymous
Really? we are about to go to Infertility specialist and everyone on this forum has told me it isn't covered? |
Anonymous
PP who posted this back to answer. I have Fed BCBS basic and paid the following: RE initial visit: $35 copay (same as any specialist) HSG: $150 copay hysterscopy: $150 copay SA: $25 copay Diagnostic blood work: $0 copay (covered at 100%) genetic testing (required by my RE): $99 (not covered by insurance) Monitoring for IUI: $40 per visit copy Clomid: $10 copay Ovidrel: $99 (not covered by insurance) IUI procedure, including male and female parts: $400 (not covered by insurance) IVF would have been $40 per monitoring visit + $9k for IVF + meds (so likely $12-15k out of pocket) |
Anonymous
I think sometimes DHs have a hard time accepting there is a problem or that they can't get you pregnant. I would go with the infertility coverage. Even if you get pregnant on your own it will probably take another three months. If you get pregnant naturally next month you can be thankful you didn't have to put yourself through infertility treatments. I would gladly pay 4k in labor and delivery to not have to go through what I'm going through. |
Anonymous
I had federal bcbs and it wasn't covered. This was confirmed by the shady grove financial specialist. the only thing the plan covers is testing to see if you have any problems. It doesn't cover IUI or ivf. It may cover to treat pcos or endo but that's most likely by meds that aren't expensive to begin with. |
Anonymous
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HEY EVERYBODY: just because you have a plan with the same insurance company, doesn't mean you and OP will have the same coverage. It is totally up to what your company negotiates with the insurance company. It could be wildly different. I'm amazed by the number of people who don't know this, but it's true.
Witness: My best friend has BCBS Fed and I have a private BCBS plan and my infertility coverage is 100% and I paid nothing out of pocket for my entire pregnancy and delivery. Her coverage was abysmal compared to mine. |