yes, of course. Either parent can certainly choose to add the newborn to their plan. But if both parents add the newborn for dual coverage, then the birthday rule comes into play, with the parent with the earlier birthday being Primary. The parent’s plan with the later birthday is Secondary. That is buried in the fine print of the plan that the parents (or their employers) choose.
Yes, dual coverage was much WORSE for my PT than just having single coverage for her and single coverage for her H and her paying whatever the copay and deductibles were than having to fight endlessly to try to get insurer to cover what they were obligated to do but never did, even with fighting and reporting them to insurance commissioner (who did nothing).
My young and healthy BiL and his wife did this, for all the same reasons. 2 years later, he had a massive heart attack, coded twice, hospital ICU and then a pacemaker. Even with a mercy rule for uninsured that wrote off part of the expenses, they are part of a program to which they pay every month and there is a lien on their home. They got an ACA plan but now they can’t afford that; his wife is on Medicare now but he is not. He’s a school teacher. They will never get out from under this debt.
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@greenbutton that is so sad. I’m sorry that happened. I would say more about how that would not happen in other countries but I don’t want my post deleted.
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100% . Just assume I have many deletable thoughts as well
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We haven’t had group insurance since I was in my late 20’s. I went on Medicare last year and while I’m saving some on premium costs the real difference is my out of pocket expenses have dropped significantly. With my old high deductible plan I rarely reached a point where they covered much.
Two of my kids work in jobs that don’t offer insurance. They are covered by their spouses insurance. In one case the premiums are based on salary. The more you make the higher your share is. They have multiple options of insurance plans that vary widely in monthly premium. The cost to add spouse and child is minimal. The other kid doesn’t have as many choices and the premiums are higher and adding spouse and kids is more expensive than my other kids choices.
My third kid has a spouse whose company offers health insurance but it’s very expensive and didn’t pay much. Once they married his wife went on his plan and dropped her previous coverage.
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Yes. That is the fact. If the mother has a family plan for the whole family (including the father), it doesn’t matter when the father’s birthday is.
We had this issue and just decided to go with my insurance for the family. It was the better plan. The only thing we kept was double dental.
So yes @twoinanddone . The family should do their research before the baby is born and choose the insurance plan that is best for the whole family. Not double coverage (which frankly doesn’t do anything anymore anyway).
ETA…DH reminded me that for a few years with one of his employers HE had double coverage…because his employer plan was free. BUT the family plan that included everyone was through my employer. Kids and I did not have double coverage…except for a few years until we figured out it was not worth doing. But not when they were newborns.
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My experience was that I didn’t add my first child until she was born, so can’t add them in advance. I believe for the family on the news story it was their first, and it appears they ‘decided’ to add to mother’s policy because that’s the insurance company that was billed (and they paid). Then the hospital or insurance company decided that the father’s birthday was first in the year so they backed off the mother’s insurance and billed the father’s.
fwiw: something is missing in the news story. If both parents had hospital coverage, then Dad’s would be Primary and Mom’s woudl be Secondary.
The way Coordination works is that Primary carrier (Dad’s) processes the hospital bills in its normal way. After Dad;s carrier pays, Mom’s carrier then processes the bills as if they were Primary, and they use whatever they woudl have paid if primary to pay the balances that Dad’s carrier did not pay (deductibles and copays). The Birthday Rule has been around since the 70’s, and is well known by hospitals and insurance folks.
If Dad’s carrier was rejecting the bills, they may have had other issues. For example, divorce settlement where one parent agreed to cover the kids. Or, Dad dropped his coverage. Or, Dad has a non-ACA plan that has catastrophic coverage only, and/or does not coordinate. Or…
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I looked up Anthem’s plans for 2027. The cheapest plan they offer for me went up from $1,158/month last year to $1,422/month, a 22.8% increase. This year, they’ve added a catastrophic plan for my age - a first. It’s “only” $1,176/month, a 2% increase from the cheapest plan last year, but it’s even crappier.
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Perhaps not the company contribution, but you can contribute the max to an HSA when retired, assuming you have a qualifying HDHP (which now includes all bronze ACA plans). That’s more than $10K for a couple over 55 and a significant tax benefit for upper income folks. HSA is triple tax advantaged.
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Prompted by your post, I checked what Anthem had available for 2027. Catastrophic plan is around $927. I currently have a "gold"plan with a deductible of $1050 and pay $1210 a month. Next year I it looks like i can get a terrible bronze plan for just a bit more. To complicate matters even more, our local hospital (Sentara) where all my providers are is locked in a contract dispute with Anthem and “may” be out of network on January 1, 2027. The only other insurer that offers plans in my area is…wait for it…Sentara Health Plans. I’m going to go ahead and price my medications without insurance and will probably end up rolling the dice next year.
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I looked, I could not find any pricing for 2027 in my area. Said I would be able to see what was offered on November 1.
Since I only will have 3 months in 2027, I’m hoping my current plan won’t have a huge increase and that I can stay where I am. This past year it went up $200 per month. I’d be ok with a similar amount
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Same. I can only see proposed increases for 2027 (they are all double digit increases), my state hasn’t approved any yet.
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We start open enrollment soon. The price book is on the way - but they renamed the lower deductible plan from the 1700 to 1800 plan. I’m on the 4400 which two years ago was the 4000.
It’s still the 4400 next year - but don’t know how pricing will be impacted.
But for those buying the lower deductible, it’s going up $100 - for them 2 years in a row (was the 1600 two years ago.
Haven’t seen other terms - like does the max out of pocket remain at $7K.
I am definitely not looking up anything on our ACA site. I did a year or two ago, and I’m still getting bombarded by phone calls and texts trying to sell me plans!
We got our new rates by my employer yesterday. Ours are going up by 10% for the employee. I’m not sure what my employer is absorbing. I’ll find that out on Jan. 31st paycheck. I’m sure it’s at least 10% if not more. Not thrilled, but not really complaining too much.
I save over $10K a year in premiums + employer’s HSA contribution by doing the $5K per person deductible vs the $2000 deductible “traditional” plan.
A family plan costs 11x the single price. An employee + spouse costs 9.7x the single price. An employee + child only costs 4.5x the single price. Spouses are expensive!
I’m quite certain nobody has heard of our insurance company. We switched to them 12ish years ago when we were priced out of Anthem. It’s very tiny and local. It participates in a network of a bunch of other tiny companies to make it regional. Trying to figure out if someone is in network can be a nightmare. And if the medical office bills the wrong insurance company, it’ll get kicked out until they get the right one. All of my EOBs list which company is actually paying for it. The upside to this is when you have a problem, it is easier to get a live body on the phone who will help deal with the problem. And this live body you may even run into at Walmart.
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I’m sure everything is subject to change but I don’t see the costs becoming any less. I think the other frustration is that there are only two options for insurance companies, both of them not great. Anthem allows me to “shop” and compare my current coverage with other plan options. My current plan premium will increase by $160/month which isn’t terrible when you see what you can get for not much less - unless care is all out of network due to a contract dispute. I can’t go without coverage.
Just put this in the Medicare thread, but for those on Medicare Part D plans, be sure to go into the Medicare web site and check your drugs. One of my fancy combo brand name drugs is not covered for 2027. I can go back to the component drugs, whew. If I didn’t pay attention and left everything as is, I would be facing prescription costs of over $5000 next year.
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Is AI contributing to higher costs?
Did anyone receive a $500 check as a one time refund of their ACA plan?
I was told in the letter that accompanied it that I was overcharged to fund the operation of healthcare dot gov
Does this mean that on November 1 I will find that my premiums for 2027 will go down since it seems that I’ve been paying too much for this insurance.
This is not political in my mind to report about a check and a letter that accompanied it.
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