5 ms·

ACA plans absolutely cover childbirth (https://www.healthcare.gov/what-if-im-pregnant-or-plan-to-get-pregnant/ https://www.healthcare.gov/what-if-im-pregnant-or

ACA plans absolutely cover childbirth (https://www.healthcare.gov/what-if-im-pregnant-or-plan-to-get-pregnant/ https://www.healthcare.gov/what-if-im-pregnant-or-plan-to-ge...). But it might not matter because you aren't on a marketplace plan according to the screenshots in your post. You are on this plan: https://www.trinetaetna.com/pdfs/Aetna_PPO_7150.pdf https://www.trinetaetna.com/pdfs/Aetna_PPO_7150.pdf Which does cover childbirth according to page 3. And has a 7150 deductible per person - the $14300 is the family out of pocket max, so the childbirth should top out at the 7150. Other expenses might put you at the same 40K cost for the year, but not the childbirth alone.

Aaronontheweb 10mo ago
> the $14300 is the family out of pocket max You know they charge you, separately, for both the mother's care AND the infant's during a delivery right? Those count as two people. I am, with 100% certainty, going to hit the out of pocket max - I have every time. Like I've paid for three kids all on the same plan, including one born in January so my deductible got spread over two different billing years. I have to ask - why are you defending this?
- codingdave 10mo ago
  I'm not defending it. I'm correcting your misinformation. You are claiming that ACA plans do not cover childbirth. They do. You are claiming that this event alone costs 40K, which is not accurate. It hits your out of pocket max, exactly as designed. It sounds like you have never looked at an ACA silver plan, which is the lower deductible/out of pocket max option. I also have a family of 5, and have a $1800 per year out of pocket max from an ACA plan. You would still have the same level of premiums as you do now for silver plans, but you would save 13K a year. You are picking bad plans, dude. Our system has problems, but when you make enough to not be subsidized, yet still pick a crappy 40K per year plan, that is beyond the systemic problems. It is a bad choice. There are insurance consultants who work with people, especially high income people, to find good plans for their family. You should be calling them.
  - Aaronontheweb 10mo ago
    Dude, you don't even have your own facts straight and you are embarrassing yourself. It's clear you have no experience, don't understand your own sources you provided, or any clue how child birth actually works from a medical billing standpoint. Edit: what do I have to gain from spreading "misinformation?" I just want better / more options?
    - tptacek 10mo ago
      I don't know what you have to gain from it, but you're wrong. 42 U.S. Code § 18022, (b)(1)(D). ACA plans are required to cover childbirth.
      - Aaronontheweb 10mo ago
        That's not what the link the OP included said and not what I said either, but I concede your point - that's my fault for checking individual health care marketplaces (like eHealthInsurance and Aetna direct) or not looking closely enough on healthcare.gov. Looking through some plans now, but TBH these are genuinely not much of an improvement in the cost department and a massive downgrade in the provider selection department. Hence my whole section on trade-offs.
        tptacek 10mo ago
        The logic you're using about out-of-pocket costs versus your deductible appear also not to be valid, and are causing you to misstate your out-of-pocket liability by a factor of roughly 4x.
        Aaronontheweb 10mo ago
        I can assure you they are, if anything, understated - as I am not including the expenses my health insurance will not cover. So no, you are fully in the wrong there. What do I have to do to prove it? Show you itemized receipts? Moreover, what are you even trying to accomplish by asking for this? Please provide me with a forthright defense of the modern U.S. health insurance markets and why it makes sense for me to have to pay this much to keep our population above replacement level.
Aaronontheweb 10mo ago
> ACA plans absolutely cover childbirth (https://www.healthcare.gov/what-if-im-pregnant-or-plan-to-ge https://www.healthcare.gov/what-if-im-pregnant-or-plan-to-ge...) that link doesn't even say what you says it does - it said you can apply for coverage, not that there are plans that cover child birth. Have you never done this before?

Aaronontheweb 10mo ago

> the $14300 is the family out of pocket max You know they charge you, separately, for both the mother's care AND the infant's during a delivery right? Those count as two people. I am, with 100% certainty, going to hit the out of pocket max - I have every time. Like I've paid for three kids all on the same plan, including one born in January so my deductible got spread over two different billing years. I have to ask - why are you defending this?

codingdave 10mo ago
I'm not defending it. I'm correcting your misinformation. You are claiming that ACA plans do not cover childbirth. They do. You are claiming that this event alone costs 40K, which is not accurate. It hits your out of pocket max, exactly as designed. It sounds like you have never looked at an ACA silver plan, which is the lower deductible/out of pocket max option. I also have a family of 5, and have a $1800 per year out of pocket max from an ACA plan. You would still have the same level of premiums as you do now for silver plans, but you would save 13K a year. You are picking bad plans, dude. Our system has problems, but when you make enough to not be subsidized, yet still pick a crappy 40K per year plan, that is beyond the systemic problems. It is a bad choice. There are insurance consultants who work with people, especially high income people, to find good plans for their family. You should be calling them.
- Aaronontheweb 10mo ago
  Dude, you don't even have your own facts straight and you are embarrassing yourself. It's clear you have no experience, don't understand your own sources you provided, or any clue how child birth actually works from a medical billing standpoint. Edit: what do I have to gain from spreading "misinformation?" I just want better / more options?
  - tptacek 10mo ago
    I don't know what you have to gain from it, but you're wrong. 42 U.S. Code § 18022, (b)(1)(D). ACA plans are required to cover childbirth.
    - Aaronontheweb 10mo ago
      That's not what the link the OP included said and not what I said either, but I concede your point - that's my fault for checking individual health care marketplaces (like eHealthInsurance and Aetna direct) or not looking closely enough on healthcare.gov. Looking through some plans now, but TBH these are genuinely not much of an improvement in the cost department and a massive downgrade in the provider selection department. Hence my whole section on trade-offs.
      - tptacek 10mo ago
        The logic you're using about out-of-pocket costs versus your deductible appear also not to be valid, and are causing you to misstate your out-of-pocket liability by a factor of roughly 4x.
        Aaronontheweb 10mo ago
        I can assure you they are, if anything, understated - as I am not including the expenses my health insurance will not cover. So no, you are fully in the wrong there. What do I have to do to prove it? Show you itemized receipts? Moreover, what are you even trying to accomplish by asking for this? Please provide me with a forthright defense of the modern U.S. health insurance markets and why it makes sense for me to have to pay this much to keep our population above replacement level.

Aaronontheweb 10mo ago

> ACA plans absolutely cover childbirth (https://www.healthcare.gov/what-if-im-pregnant-or-plan-to-ge https://www.healthcare.gov/what-if-im-pregnant-or-plan-to-ge...) that link doesn't even say what you says it does - it said you can apply for coverage, not that there are plans that cover child birth. Have you never done this before?