Friday, February 6, 2015

Four Tips to Select the Best Healthcare Plan for your Family

My pregnancy wasn't an easy one. It was something I didn't discuss much, as I really didn't want to sound like a complaining, whining, woe-is-me pregnant lady.

I'm not ready to go into all the details and publish all the posts I wrote last summer. It was a sad, scary, dark and depressing place, and I am not yet ready to put that out there for the world to read.



But, I figure it's time to come out with a general breakdown with just how things were... 12 Emergency room visits in 6 weeks, Hyperemesis Gravidarium, fainting, subchorionic hemorrhage, an extremely unfortunate incident that caused my subchorionic hemorrhage to expand to the size of an index card putting me at risk for miscarriage and bleeding out, strict bedrest causing me not to be able to work, PICC line, Home Health Nursing for IV Fluids, PICC line clotting and new one/reinsertion, 24/7 Zofran pump for Hyperemesis Gravidarium, and then modified bed rest but still unable to work, blood transfusions followed by iron infusions. An overnight stay about a week prior to delivery. Delivery of twins at 31.5 weeks gestation. Hospitalized for 4 days following delivery. According to my insurance site, claims processed for the period I was pregnant were upwards of $750,000

For the twins? Born premature and spend 9.5 weeks in the NICU. And ALL that entails. Let's just say for shiggles, that these babies have already racked upwards of 2.5 million dollars in medical expenses- EACH. $2,500,000. We're still getting bills trickling in, still seeing specialists and having therapy appointments that will be ongoing for quite some time.



Today I want to discuss the importance of health insurance, open enrollment, and selecting the proper health insurance program for your family. Some people think that the Affordable Health Care act is exactly what the country needed, and some people think the country has gone too far. You need health insurance, especially with the costs of healthcare rising. I am not going to get into a discussion on whether this is right or wrong, I'm not going to share my opinion either way on the subject. What I am going to do is explain the concepts above and why health care reform matters .

Based on my explanation and details of my above, imagine how horrible my financial situation would have been had we not had a quality medical insurance policy. The beauty of having federally mandated policies is that most preventative care is now covered, restricts lifetime limits, and removes the preexisting condition requirement for children under nineteen years of age.

The Affordable Care Act made Medicaid limits increase in some states in order to help more people qualify for policies. You have until February 15th for open enrollment through the Healthcare exchange website. Open enrollment is the period of time that you are able to freely select the health benefits that you use for the following calendar year. However, if you have a qualifying event (loss of job, new job, new baby, marriage, death, etc), then you're able to apply to make changes to your policies.

The Healthcare Exchange Websites are basically search engines that help you select the best health programs for you and your family. This lets you shop for the best policy for your family. Yes! SHOP! Some sites are state-run, and some are federal run. These are designed to help people find good policies for them, as well as requiring these insurance companies to meet federally mandated guidelines. I love the exchange site, as it allows you to compare current health plans available to you, basically stacking up what you have to those others that are in the open marketplace.

Truthfully, looking at all of the options, it can be a little daunting. First, you'll need to compare your needs for the upcoming year. Do you have a baby on the way? Do you have children aging out of the system? They're annual, so you can make changes as your and your family's needs change.

Here's my Tips Guide on how to Select the Right Policy for Your Family
  • Expenses. Add up all expenses from last year. Doctor visits, physical/occupational/speech therapy visits, counseling therapy, medical prescriptions, and any medical procedures you may have had. 
  • Costs. Look at all the various deductibles, co-payments for regular office check ups and/or specialists, co-insurancespremiums (that you pay monthly, or comes out of your paycheck), and your maximum out of pocket/catastrophic cap. If you have access to all of your Explanation of Benefits (EOBs) from last year, it might make it easier to pull this information together. If you have premature children with medical issues (like mine) and expect a lot of doctor and hospital visits, you want to have a low co-payment, as well as a low deductible plan. The flip side of this is that it might be difficult to find a policy that has these two pieces to it, especially with a reasonably priced monthly premium. Sometimes, you need to sit down and put pen to paper to figure it all out. 
  • Coverage. Look into the meat of the policy and see what is covered and what isn't covered. For example, I like to receive regular chiropractic adjustments, in order to help maintain spinal alignment. I feel this helps manage my neck pain and improve my overall health. I always make sure that this is something that is covered under my plan, and that there are ENOUGH visits covered annually. Also, when we knew my children were premature, we knew that it would be extremely likely that our preemies would need to have Speech/Occupational/Physical therapies. Turns out this was a good idea to keep in mind, as Little Sir, he needs feeding therapy due to the fact he has a feeding tube and we are working on weaning him from it, but it's definitely something taking more time than I expected. Also, if you're a student, you want to look into special Student Health Insurance rates just for you. 
  • Compare. Two of the most popular types of policies are HMO or a PPO plan. An HMO is a "Health Maintenance Organization." HMO plans offer a wide range of healthcare services through a network of providers who agree to supply services to members. With an HMO you'll likely have coverage for a broader range of preventive healthcare services than you would through another type of plan. As a member of an HMO, you'll be required to choose a primary care physician (PCP). Your PCP will take care of most of your healthcare needs. Before you can see a specialist, you'll need to obtain a referral from your PCP. PPO plans, or "Preferred Provider Organization" plans, are one of the most popular types of plans in the Individual and Family market. PPO plans allow you to visit whatever in-network physician or healthcare provider you wish without first requiring a referral from a primary care physician. As a member of a PPO plan, you'll be encouraged to use the insurance company's network of preferred doctors and you usually won't need to choose a primary care physician. No matter which healthcare provider you choose, in-network healthcare services will be covered at a higher benefit level than out-of-network services. It's important to check if you provider accepts your health plan so you receive the highest level of benefit coverage. You will probably have an annual deductible to pay before the insurance company starts covering your medical bills. You may also have a co-payment for services or co-insurance which helps to contribute to the total charge of your bill.
  • There are many other types of programs, you'll want to look into each and research what is available and best for you. You'll hear about  EPO Health Plans, Point of Service (POS) plan, Indemnity Health Plan, Network Health Plan, High Risk Insurance Pools and even Catastrophic Health Plans.


Make sure you swing by United Health Care for more information on health care programs and to get in your 2015 policy prior to the February 15th open enrollment deadline. 
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Disclosure: This post was sponsored by United Healthcare and compensation was received for this post,  the sponsor and any compensation received for this post in no way affected the opinion or any statements presented. Ramblings of Mama will only make recommendations that we feel are beneficial to our readers. The information provided in this post is the expressed opinion of the author, is for informational purposes only, and is in no way reflective of the beliefs of any current or previous employers. This disclosure is done in accordance with the Federal Trade Commission 10 CFR, Part 255 Guides Concerning the use of Endorsements and Testimonials in Advertising. Links enclosed may contain affiliate links. If you have any questions or would like your product or company featured on Ramblings of Mama, please Contact Michelle


Health Accounts and Health Reform

History of Health Insurance

Health Care Reform Update

Health Insurance Myths and Facts

Changing Health Plans

Health Insurance Glossary

Save on Health Insurance


Chhabra, A., & Et al. (2014, April 6). Subchorionic Hemorrhage. Retrieved February 6, 2015, from http://emedicine.medscape.com/article/404971-overview

Cunningham. (2014, April 18). About Hyperemesis Gravidarum. Retrieved February 5, 2015, from http://www.helpher.org/mothers/about-hyperemesis/index.php

Danielsson, K. (2014, December 10). Subchorionic Hematoma. Retrieved February 6, 2015, from http://miscarriage.about.com/od/amimiscarrying/p/subchorionic.htm

Pillar, R. (2007, January 1). Retrieved February 6, 2015, from http://www.justmommies.com/articles/subchorionic-hematoma.shtml

7 comments:

  1. Girl, I feel you on the importance of insurance. I have no idea what we would have done without it. My boys didn't stay in NICU, but like you I had a tremendously difficult pregnancy with lots of hospital visits, and we then had to tackle Children's and surgery and umpteen specialists visits. I will never understand the folks that spend so much time talking negatively about something that I consider to be a basic need! Healthcare reform matters!

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  2. Thanks so much for writing this important post. My daughter was a NICU baby, and while she wasn't there nearly as long as your little ones, her bill would have ruined us if we hadn't have had insurance. (And decent insurance, at that.) It's awesome that you're getting the message out!

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  3. When my labor/delivery started going wrong, it was some small relief that we wouldn't have to worry about the bills due to comprehensive insurance coverage.

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  4. my best friend's half-sister makes $64 an hour on the laptop . She has been laid off for 8 months but last month her payment was $20881 just working on the laptop for a few hours. i was reading this ..

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  5. Thank you for this post and I'm sorry you had such a horrible time. My wife needs insurance but when we look at all the plans it can be confusing and most are so expensive. The cheaper ones require a very high deductible that we would never be able to afford. Trying to find health insurance can be so difficult .

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  6. My heart goes out to you for all you went through during your pregnancy to have those sweet little blessings.But yes insurance is really important to have-- by not having some kind --will wipe a person financially out. And it is very confusing to what really is the best for each person

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  7. It is so important to have good health care for our family. I really appreciate all this information you provided us with Thank you so uch

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Thanks a bunch for your comment love!