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How To Get The Best Health Insurance For A Newborn Baby – Kids Plans

Health insurance coverage for a newborn is easily available and is quite affordable, since children's rates are based on the age of the applicant. Many of the largest companies offer 2017 policies that can be applied for in minutes, and quickly approved. We help you find quality medical benefits for your baby at the lowest possible price. A federal subsidy can reduce your Marketplace plan rate below $20 per month.
 

Having a baby qualifies as a "qualifying life event," which is considered a major change in life circumstances. Thus, once you give birth, a period of up to 60 days is available to obtain qualified health insurance benefits, regardless of any existing medical conditions. If you have current coverage, you may add your boy or girl to the existing policy. Needed treatment can be covered immediately. Additional specific details are discussed later in this article.
 

It's also important to know and understand many of the rights and privileges you have. For example, typically, you can expect either an approved two, three, or four-day stay in the hospital, depending on the type of delivery. Also, with most policies, by notifying the insurer within 30 days of birth, benefits will become retroactive to the actual date of birth. NOTE: The expectant mother also is entitled to specific benefits under most plans such as breast-feeding supplies, lactate consulting and related rental of equipment. Postpartum depression is also a covered condition that will not be excluded. Therapy and prescription drugs are included in benefits.
 

Adding A Child To Your Existing Plan
 

The easiest way to cover your new addition is to add them to an existing policy...preferably, your own. Most policies either cover your newborn immediately, or when the baby has been released from doctor's care. However, if you are presently covered on a non-compliant policy (limited benefit or temporary contract), you likely will not be able to add additional family members without submitting a new application. Since it will be medically-underwritten, benefits will not start immediately, and any immediate medical issues will be excluded from the new policy. Most consumers are not familiar with the carriers that issue and underwrite "Non-compliant" plans.
 

If you have recently enrolled in a Marketplace (Obamacare) policy (covered in additional detail below) from a state or federal Exchange, the birth of a child qualifies for a "Special Enrollment Period (SEP). Thus, regardless if the Open Enrollment period is current, or has already ended, you can purchase coverage without answering medical questions, qualify for a subsidy (if applicable), and have all pre-existing conditions covered. This includes medications, pending surgeries, diagnostic tests and well-check visits. Life-threatening juvenile illnesses are also covered, such as diabetes, cerebral palsy, sickle cell anemia, cystic fibrosis, cancer, AIDS, and epilepsy.
 

This option will, of course, increase your premium, but not substantially. In many Midwestern states, the monthly increase may be as little as $35-$65 per month. In other areas, the premium could be higher. If you already have dependents covered under your own plan, there's a possibility that there will be little or no change in your monthly cost, since certain policies charge the same amount once you exceed two dependents. And adding a dependent could could possibly result in a larger subsidy. NOTE: It is also possible that adding a son or daughter to your policy might make you Medicaid-eligible, and therefore risking loss of a federal subsidy.
 

Purchasing A Marketplace Policy
 

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You can also purchase an individual private policy through a state or federal Marketplace. Because premiums are based on age (among other factors), you won't have to pay a high rate. Although Open Enrollment periods (under The Affordable Care Act) begin in November, special circumstances will allow you to apply for coverage if specific events occur.
 

The birth of a child is one of those events (mentioned earlier). If you move to a different service area, get divorced, or lose qualified benefits from your employer, you can also obtain Marketplace coverage. For 2017, Open Enrollment began on November 1st (terminating on January 31st 2017). Many states feature new carriers, including some companies, who have increased the number of states where they offer policies. However, several major companies have begun to reduce their areas of coverage. Aetna only offers on-Exchange contracts in four states, while UnitedHeathcare has drastically reduced their coverage area. Humana and Cigna have also reduced the number of states where they offer plans.
 

Each year, new plans offer richer and more comprehensive benefits (prenatal and adolescent) while premiums occasionally reduce, instead of becoming more costly. Although many states often have substantial rate increases, children and toddler premiums generally do not increase as fast. With the passage of the Affordable Care Act (Obamacare) legislation a few years ago, baby benefits cover all pre-existing conditions and all needed preventive pediatric expenses. As the newborns become children, and eventually adults, benefits change to continue to provide comprehensive coverage. Young adult health insurance coverage is offered in every state, and prices continue to remain fairly low.
 

This includes include well-child visits, immunizations and approved vaccines (Hepatitis A and B, Influenza, Meningococcal, Varicella and many others). Overall, as your baby gets older, more than 25 specific treatments for children must be covered. The US National Library of Medicine is also a valuable resource for providing information regarding health topics, drugs, and supplements, and educational videos. Listed below are several of the services you may not be aware of, but typically can be used in the earlier years:
 

Screening for autism between the ages of 1 1/2 and 2
 

Developmental and depression screening
 

BMI (Height and Weight) and blood pressure screening at most ages
 

Hearing and vision screening
 

Sickle cell and Hemoglobinopathies screening
 

Hypothyroidism testing
 

Iron supplements
 

PKU and obesity screening
 

Oral risk assessment
 

Gonorrhea medication for newborns
 

Alcohol and drug addiction assessments for older children.
 

Federal Subsidies Through The Exchanges
 

A federal subsidy can easily pay the bulk of your premium, depending on your Adjusted Gross Income (AGI). If your income is too high, you may be ineligible to receive a subsidy, which is applied to your rate as an immediate tax-credit. If your income is too low, also may be ineligible for financial aid, although CHIP or Medicaid will likely be offered. Any sudden changes in income or employment may trigger changes. You can contact us to review what ramifications (if any) these changes will have on your medical benefits.
 

Using Milwaukee as an example, If your household income for yourself, your husband (both age 30) and your child is approximately $63,000, you will qualify for a $233 per month subsidy to assist paying your premium. However, if your income is only $40,000, the subsidy amount jumps to $366 and your child probably will be eligible for CHIP. Utilizing this example, if the household consisted of four persons ( two adults and two children) with an income of $75,000, the subsidy would be $298 per month. NOTE: To qualify for financial aid, you must enroll in a Marketplace (Exchange) plan. "Off-Marketplace" policies, such as temporary and limited-benefit contracts are not eligible for any subsidy funds. Catastrophic-tier policies are also not eligible.
 

Therefore, whether the birth occurs in January, June or December, coverage for the baby can be purchased. Medical issues (if there are any) no longer have any impact on the price you pay for a policy. One of the main concerns is finding a large reputable insurer that offers a contract with all of your network providers included. Typically, Aetna, Blue Cross, Humana, Cigna, and UnitedHealthcare offer the most competitively-priced products with large countrywide provider networks.
 

We help you find the proper fit since each state has a different set of participating insurers. Although Obamacare has lowered premiums for many Americans, it has also reduced the number of companies that offer a policy. While some states offer many carrier choices (Wisconsin-16 and Ohio and Texas-14), smaller states often only have a few carriers to choose from. For example, Wyoming only offers one choice (BCBS), while the following states only offer two choices -- Alaska, Delaware, Hawaii, Oklahoma, South Dakota, and West Virginia.
 

CHIP And Medicaid
 

You may also be eligible for Medicaid, or your newborn may be eligible for special government assistance. More than 50% of kids in low-income households qualify, so it is a viable option to consider. If the total family income is under $45,000, there's a very good chance that Medicaid or CHIP (Children's Health Insurance Program) will be available. Benefits are very comprehensive, including 100% coverage on most preventative expenses.
 

Many states have either expanded Medicaid eligibility, or are considering legislation to expand. If approved, depending on the size of the state, hundreds of thousands of persons can become eligible, as the Federal Poverty Level guidelines "expand" from 100% to 138% of FPL household income. When Ohio expanded their program, more than 300,000 persons became eligible to qualify for these benefits. Thus, instead of being forced to purchase a plan that would cost as much as $500-$1,000 per month for the entire family, the "premium" dropped below $50. That's a pretty good deal!
 

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A Federal Subsidy May Reduce Your Rate


 

Infants that have mothers already enrolled in Medicaid should be immediately eligible for CHIP. And if a child has not had his/her 6th birthday, and the family income is under $30,000, once again, CHIP may be offered.  The coverage is very comprehensive and is known as "EPSDT," which is the shortened version of  early periodic screening, diagnosis and treatment. Federal funding is expected to continue for CHIP for many more years (and hopefully beyond). If the ACA Legislation was ever altered or repealed, it should not impact EPSDT. NOTE: State that operate their own Marketplaces also offer CHIP.
 

You also are protected by "The Newborn's Act." Under this legislation, if you have medical coverage, you are entitled to at least 48 hours of hospital benefits if the delivery is vaginal. If cesarean,  the minimum amount of covered benefit is four days. Pre-authorization is not necessary when there is a two or four-day stay in the hospital. However, you are required to stay the full time-period if it is required by the treating physician. Any attempt to leave aerly may jeopardize benefits.
 

No Coverage?
 

The final option is not costly, but it is risky. By self-insuring (going without coverage) and paying for all services in cash, although there are no coverage premiums to pay, an expensive hospital stay will be difficult to immediately pay for. Therefore it is likely, you will inherit a monthly payment obligation that will last for many years. Assuming an outstanding bill of about $10,000, even if it is negotiated down to $6,000, it is likely you will need to pay at least $150 per month until the obligation is payed off.
 

If you remain uninsured, you are also breaking the law. Beginning in 2014, the federal government began imposing a special tax of 1% of your household income if you remained without coverage. The tax has increased to 2.5% of household income for 2017 (or $695 per adult and $347.50 per child, whichever is greater). Thus, a $60,000 income household could pay about $1,500 in penalties. NOTE: Although Christian Healthcare plans have grown in popularity, not all of these policies meet the ACA guidelines enabling you to avoid the special tax. However, several more-recognized programs are acceptable, including Christian Healthcare Ministries, Medi-Share, and Samaritan Ministries. Each of these alternatives have alcohol-consumption guidelines that can impact your eligibility.
 

Your newborn needs the proper medical attention to start life on the right foot. We help you find affordable health insurance coverage from either a reputable company, the government, or a combination of both. Children's medical plans can provide quality benefits at a very low cost for most consumers. There also is no cap on the amount of benefits paid for the calendar year or during your lifetime. Thus, if a chronic conditions requires hundreds of thousands of dollars of treatment, the cost will be paid.
 

Additional Information
 

According to the CDC (Centers For Disease Control And Prevention), the US preterm birth rate fell to its lowest point in almost 20 years. Based on a 37 weeks gestation period, the number of early deliveries is at 11.4%, with a short-term goal of less than 10% within the next five years. But there still is plenty of room for additional improvement since our country ranks in the bottom half of all countries, according to the World Health Association.
 

The passage of the Affordable Care Act (ACA) should continue to help improve the numbers, since women have much better access to free preventive care and maternity benefits. Many Southern states, including Mississippi and Louisiana have bigger challenges since their current preterm birth rates are close to 15%. Increased education and community outreach should help lower the rates.

 

Guess which states are ranked the best (and worst!) to deliver your baby? According to W-Hub, a popular financial consumer resource, the 10 top-rated states are Alaska, Iowa, Wyoming, Maine, Kentucky, Minnesota, Hawaii, Oregon, North Dakota, and Vermont. The 10 worst-rated states are Mississippi, Pennsylvania, West Virginia, South Carolina, Nevada, New York, Louisiana, Georgia, Alabama, and Arkansas.

 

Typically, the average cost of delivering a baby is about $11,000 ($15,000 for a C-section). These survey results considered many factors, including hospital and facility charges and costs, quality of medical services received, and availability of local services. Additional variables considered in the research were wages of doctors, nurses, and specialists, number of clinics and pediatricians in the area, and infant mortality rates.

3 comments

  1. Carol

    We are trying to determine if my newborn grandson can have his own obamacare/coveredca policy if his dad has coverage through his employer. The cost to add a baby through is employer is astronomical and we are hoping to find out if the baby can have his own individual health insurance policy. If so, would it be applied for through coveredca or through an insurance company like Blue Shield? This question has been difficult to research. Thank you for any help.

  2. Cindy J. Coffey

    Love reading this guide! All people need to read this post!

  3. Mandy Lewis

    Who do I contact for coverage

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