The rising cost and decreasing convenience of health benefits has been a staple of the political pulpit schpiel for years. Until recently, I hadn't paid much mind to the growing outrage. I'm a healthy guy that hasn't been to see a doctor in probably over a decade. I even went a couple years without medical coverage on purpose because it seemed like a waste of money. Sure it seems that every year the cost goes up, and Heidi and I are irritated that my employer couldn't secure more reasonable rates, but after a while, we always get used to the living conditions, and forget about it.
I've recently had the pleasure of joining the outraged party.
I switched employers and the new company doesn't offer a group plan. Instead, they just let you do your thing, and give you a set monthly amount to offset costs. My previous employer had a group plan and as such, I was offered COBRA extension of benefits. In the past, this never seemed like a
good plan, just one that was available to prevent a break in coverage.
Insert fetus into the equation
It's been a painful learning process, but in the end, I was basically forced to extend COBRA through the pregnancy. Here's my story of discovery regarding why the medical insurance situation in the US sucks:
Not having a group plan available to me, I needed to research individual plans for myself and Heidi, so I poked around on
Anthem BCBS's website and was thoroughly confused. So I called. Here's where things started to go south.
It turns out both Heidi and I would be denied coverage should we have applied for individual coverage. Because she was pregnant. In fact, if I applied for an individual policy and didn't even include her on my policy,
I would be declined. Reason being, once the baby was born, coverage rules mandate that either of us could add the child to the plan regardless of how healthy or unhealthy they were. Since nothing is known about this new client, naturally BCBS assumes they will be born with every medical malady in the book—and probably some that hadn't made it into the book yet. It would therefore be a risk for them to extend coverage to the baby. They're not in the risk business. They're in the
insurance business.
Another option available to us was to "transfer" the former employer's group policy to an individual policy. But why would someone do this when they could just apply for an individual policy for likely less than the group policy fees? Simple. Because their application would be declined. Why? Most likely because they were injured, or had every medical malady in the book. So out of the kindness of their hearts, and possibly a law or two, BCBS offers this transfer system to the people who have no other means to secure medical coverage...for the low low price of $1200-$1500 a month. Oh, and did I mention that the resulting policy coverage is crap?
And the gem I learned yesterday, after spending way too much time talking to too many people? BCBS individual plans don't include maternity coverage, anyway! BCBS only offers maternity coverage through group plans.
So I could either create a company and offer a group plan to myself as a self employer or stick with COBRA. Lucky for me COBRA is available for 18 months, and it's pretty likely my child won't gestate for quite that long.
Once the baby is born, and proves to be healthy, we could apply for an individual plan that includes the baby, which should be less expensive. However, should we decide to get pregnant again, that plan wouldn't cover the maternity. Nice.
I'll be paying a little more attention to the political ramblings regarding the medical insurance industry from now on.