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Real Money: How to navigate Healthcare.gov when you're expecting

Few surprises are more exciting than learning your family is pregnant. There are endless calls to make, photos to share, and parties to plan. Once the thrill of the news settles down, the reality of your growing family may shift your attention to the expense.

As one of my colleagues covered last week, having a baby isn't always easy, especially without an employer to help cover the bill. So, let's revisit the topic for new parents. Thankfully, there are steps you can take now to soften the financial sting later.

Maternity care is covered

If you're expecting and don't have health insurance there's good news. Because of the Affordable Care Act, you're covered even with a pre-existing condition. This means insurers can't turn you away for being pregnant. Open enrollment is officially underway, so now is the perfect time to sign up through Healthcare.gov or your state's exchange.

Other new parent needs

Plantar Fasciitis Bundle

$109.99

Elvie Double Electric Breast Pump

$499.99


How a lower deductible plan pays off

All Marketplace plans cover pregnancy and having a baby. The problem is, each plan's coverage is different. The only way to find out specifics is by digging into the plan's Summary of Benefits and Coverage (SBC).

A couple of bronze plans with similar monthly premiums could have different out-of-pocket expenses. In my case, both plans have a $7,900 limit on how much you will pay out-of-pocket. But there are major differences before you get there.

One plan covers 100% of services after hitting their $7,900 deductible. The other's deductible is a little lower at $7,000, but you're still on the hook for 50% of services after that. As you can imagine, you may owe more if any part of your pregnancy doesn't go as planned. Or you pick out-of-network providers.

To cut back on costly surprises, consider paying higher monthly premiums for a lower deductible. Because maternity care is so unpredictable, you may reach the deductible quickly. If you're feeling overwhelmed, take a few minutes to read through our ultimate guide to open enrollment.

Stick with providers in your network

One of the perks of shopping for health insurance on Healthcare.gov, is you can filter plans by specific doctors and hospitals. Knowing who you want to see and where you want to go now may save you from heartache later. When making appointments, always confirm specialists are covered — even when they work at an in-network hospital.

You can change your plan after the baby is born

Once the baby's here, you have the choice to stick with your current plan or pick a new one. That's because giving birth kicks you into a Special Enrollment Period. If you prefer a plan with lower premiums and a higher deductible, this is your opportunity to make a change. When you give birth, the clock starts ticking, and you have 60 days to decide.

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Whether you budget week-to-week, or plan to use your FSA for bigger things, our weekly Real Money column will help you maximize your flex spending dollars. Look for it every Tuesday, exclusively on the FSAstore.com Learning Center. And for the latest info about your health and financial wellness, be sure to follow us on Facebook, Instagram and Twitter.

FSA Friday - 1/11/19 - Healthcare spending is still all about price

What a headline, right? I mean, it makes sense -- one of the reasons healthcare spending continues to rise is because the costs are rising just as quickly. Despite countless healthcare policy reforms and system restructuring, the U.S. still pays more for healthcare than any other country in the world.

What's worse (and this might not be a surprise, either) we're not getting more for our money. Let's take a look at this week's article to shed a little more light.

Prices Still Responsible for High U.S. Healthcare Spending - Jacqueline LaPointe, REVCycle Intelligence

In 2003, authors Gerard F. Anderson, Peter Hussey, and Varduhi Petrosyan published what's now considered a landmark study of U.S. healthcare spending, "It's the Prices, Stupid." At the time, the U.S. was already leading the world in health spending, but at nearly half the cost we see today.

Because of this inexplicable growth, all three authors reunited for a follow-up study to see what's driving it, even after all the constant reforms and policy adjustments.

Well, it turns out some things never change. Using updated data from the Organization for Economic Cooperation and Development (OECD), Anderson, Hussey and Petrosyan show that all the changes have delivered nearly identical results -- just with exponentially rising price tags in tow.

Some key takeaways:

  • U.S. healthcare spending per capita was $9,892 in 2016, up from just $4,559 in 2000, which was the time period in the 2003 article.
  • More recent U.S. spending level was 25% higher than that of Switzerland, 108% greater than Canada, and 145% higher than the OECD median.

To put it in a relative context, our nation spent 17.2% of its gross domestic product (GDP) on healthcare in 2016, nearly double the OECD median of 8.9%.

So, what are we getting for our hard-earned money? As it turns out, you don't always get what you pay for. Because the U.S. still devotes fewer healthcare resources, like physicians per capita, acute care beds per capita, and hospital admissions per capita.

To boot, we also saw 26% fewer hospital beds, 20% fewer practicing nurses, and 19% fewer practicing physicians per capita versus the median.

Some of the cost differential was attributed to private vs. public sector financing, which accounts for some of the wider gaps in costs -- sometimes up to 50% more for specific services.

The article does a good job breaking down the spending problems by diving into more acute detail about hospital mergers, Medicare funding and more. It's a dense read, but it's also a necessary one, considering that we're staring down the barrel of more reform. And, like most of you reading this, we're hopeful that 2019 will be the year things shift back toward the healthcare consumer.

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FSA Friday is a weekly roundup of the latest topics, tips and headlines to keep you updated on all things flex spending. It appears every Friday, exclusively on the FSAstore.com Learning Center. And for the latest info about your health and financial wellness, be sure to follow us on Facebook, Instagram, YouTube and Twitter.

Living Well

FSA Friday - 12/21/18 - Why are people skipping necessary healthcare treatments?

Healthcare costs are rising -- this we already know (and have for a long time). But it seems like this exponentially growing burden isn't just a financial problem anymore -- it's affecting the everyday well-being of patients in need.

Let's dive into this week's headline to learn a little more...

17% of Families Make at Least One Large Healthcare Payment a Year - Jacqueline LaPointe, Revcycle Intelligence

According to this alarming piece from Revcycle Intelligence, families are choosing to delay necessary medical care until they can afford large payments, not only affecting their wellness, but also the bottom lines of healthcare providers.

The JPMorgan Chase Institute determined that one in six families make at least one "extraordinary" healthcare payment each year (which is defined as "at least $400 and up to 1% of annual income." And the average payment amount exceeded $2,000.

It seems like people are either choosing to save their money before seeking medical help, potentially putting off necessary treatments solely for the sake of finances. That's why it's no surprise that healthcare visits and spending get a boost every March and April, when most US citizens receive their tax refunds.

In fact, about 70% of tax filers receive a refund, which represented the largest cash intake of the year for approximately 40% of individuals in the Out-of-Pocket Spending Panel. Within a week after receiving their tax refunds, surveyed individuals increased healthcare visits and spending by 60%.

Of course, much of this excess spending could be avoided if patients sought care at the time of need, and not just when their finances allow. The article suggests that more patient-friendly billing and collection strategies could encourage people to stay on top of their health without so much worry about the bills that follow.

The author goes on to say that less-complex billing strategies would encourage those who are on the fence to seek treatment as needed, leading to better patient outcomes, and more consistent revenue for healthcare workers and facilities.

We can't help but wonder if combining these billing strategies with flexible spending accounts could ease these burdens even further, promoting healthier lifestyles regardless of income or tax bracket.

FSA Friday is a weekly roundup of the latest topics, tips and headlines to keep you updated on all things flex spending. It appears every Friday, exclusively on the FSAstore.com Learning Center. And for the latest info about your health and financial wellness, be sure to follow us on Facebook, Instagram, YouTube and Twitter.