r/HealthInsurance • u/milwaukee4 • Dec 20 '24

Plan Choice Suggestions Girlfriend is pregnant with $3500 deductible and 20% copay

My girlfriend has Aetna insurance through her job with a $3500 deductible and $7000 OOP max. Her OBGYN gave us a paper today to sign stating that we will have to pay them $3803 for the delivery because of the $3500 deductible plus $303 for a 20% copay. It also said that this does NOT include the hospital stay fees, which I guess could be another couple thousand or maybe even another $3500 and eat up her entire $7000 OOP max.
She makes $65k a year so she won't qualify for most programs and we could pay it if we have to but I am wondering if anyone has any advice/ideas for us to help lower this massive amount? Some sort of supplemental insurance or a government program that anyone knows of? My insurance deductible is only $500 but we are not married so I don't think that my insurance can be used in any way. Even if we had a shotgun wedding could my insurance somehow be used to help?

edit: she is only 11 weeks pregnant

Thanks In Advance

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61

u/Big-Sheepherder-6134 Dec 20 '24

These are normal costs. What is you max OOP on your plan. $500 deductible is great but what about the OOP?

8

u/milwaukee4 Dec 20 '24

my OOP is $3150. Not sure if they would change my ded and oop if i added someone or or just my rate

31

u/SphinxBear Dec 20 '24

It likely would because the deductible and out of pocket max is usually higher for a family plan than individual. Do you have your plan summary? Should be on there.

13

u/Moonbase0 Dec 20 '24

I just want to add that the plan could include an embedded deductible where any individual could be subject to the individual deductible and OOMP.

1

u/Meffa63 Dec 20 '24

Plans w/individual deductibles and OOP maxs is mostly what I have seen in health plans.

7

u/scontoFumare Dec 20 '24

You would then have separate individual and family deductibles and OOP max. Each beneficiary has their own individual and there's the overall family one.

Keep in mind when your child is born, they are then added to the plan and there is separate billing for services rendered directly to your child - so another deductible and oopm.

1

u/No_Calligrapher9234 Dec 20 '24

Yes you would reach family deductible this year too so no deductible for you if on the same plan

2

u/No_Calligrapher9234 Dec 20 '24

She’s also paying several hundred dollars a month less than on your plan. Adding her and baby if married reduce the deductible and oop possibly but will Also raise monthly premiums all year significantly too but if there complications the plans will max out at the upper limits

2

u/a_mulher Dec 20 '24

It would likely increase ded and oop. Also check how much the premiums would be. My employer pays my premiums in full but for a dependent I do have to pay. Once you have the full info (like is the same doctor and hospital covered by your plan) then see if marriage and moving her to your insurance is worth it. Also remember ded and oop restart (generally) January 1st. So any services now wouldn’t count towards 2025 and you’d start at zero again.

1

u/CatchMeIfYouCan09 Dec 20 '24

I had Aflac hospital indemnity.....48hrs after discharge i had a deposit for almost 15k.

Had shitty insurance but never had copays with my OB; no bills from the hospital before or after baby was born.... no extra bills for other Dr's or surgery.